Singh Vivek Ajit, Wei Chang Chee, Haseeb Amber, Shanmugam Rukmanikanthan, Ju Cindy Shuan
1 Department of Orthopaedic Surgery, National Orthopaedic Center of Excellence for Research & Learning, University of Malaya, Kuala Lumpur, Malaysia.
2 Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Malaysia.
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499018822247. doi: 10.1177/2309499018822247.
Bone cement is commonly used as a void filler for bone defects. Antibiotics can be added to bone cement to increase local drug delivery in eradicating infection. After antibiotic elution, nonbiodegradable material becomes an undesirable agent. The purpose of this study was to evaluate effects of addition of vancomycin on the compressive strength of injectable synthetic bone substitute, JectOS. JectOS, a partially biodegradable cement that over time dissolves and is replaced by bone, could be potentially used as a biodegradable antibiotic carrier.
Vancomycin at various concentrations was added to JectOS and polymethyl methacrylate (PMMA). Then, the cement was molded into standardized dimensions for in vitro testing. Cylindrical vancomycin-JectOS samples were subjected to compressive strength. The results obtained were compared to PMMA-vancomycin compressive strength data attained from historical controls. The zone of inhibition was carried out using vancomycin-JectOS and vancomycin-PMMA disk on methicillin-resistant strain culture agar.
With the addition of 2.5%, 5%, and 10% vancomycin, the average compressive strengths reduced to 8.01 ± 0.95 MPa (24.6%), 7.52 ± 0.71 MPa (29.2%), and 7.23 ± 1.34 MPa (31.9%). Addition of vancomycin significantly weakened biomechanical properties of JectOS, but there was no significant difference in the compressive strength at increasing concentrations. The average diameters of zone of inhibition for JectOS-vancomycin were 24.7 ± 1.44 (2.5%) mm, 25.9 ± 0.85 mm (5%), and 26.8 ± 1.81 mm (10%), which outperformed PMMA.
JectOS has poor mechanical performance but superior elution property. JectOS-vancomycin cement is suitable as a void filler delivering high local concentration of vancomycin. We recommended using it for contained bone defects that do not require mechanical strength.
骨水泥通常用作骨缺损的填充材料。可在骨水泥中添加抗生素，以增加局部药物递送，从而消除感染。抗生素洗脱后，不可生物降解的材料会成为不良物质。本研究的目的是评估添加万古霉素对可注射合成骨替代物JectOS抗压强度的影响。JectOS是一种部分可生物降解的骨水泥，随着时间的推移会溶解并被骨组织替代，有可能用作可生物降解的抗生素载体。
将不同浓度的万古霉素添加到JectOS和聚甲基丙烯酸甲酯（PMMA）中。然后，将骨水泥模制成标准化尺寸用于体外测试。对圆柱形万古霉素-JectOS样品进行抗压强度测试。将获得的结果与历史对照中得到的PMMA-万古霉素抗压强度数据进行比较。使用万古霉素-JectOS和万古霉素-PMMA圆盘在耐甲氧西林菌株培养琼脂上进行抑菌圈试验。
添加2.5%、5%和10%的万古霉素后，平均抗压强度分别降至8.01±0.95兆帕（降低24.6%）、7.52±0.71兆帕（降低29.2%）和7.23±1.34兆帕（降低31.9%）。添加万古霉素显著削弱了JectOS的生物力学性能，但在浓度增加时抗压强度没有显著差异。JectOS-万古霉素的抑菌圈平均直径分别为24.7±1.44（2.5%）毫米、25.9±0.85毫米（5%）和26.8±1.81毫米（10%），优于PMMA。
JectOS力学性能较差，但洗脱性能优越。JectOS-万古霉素骨水泥适合作为输送高局部浓度万古霉素的骨缺损填充材料。我们建议将其用于不需要机械强度的局限性骨缺损。
