Guimbard-Pérez J H, Nicolás-Ortiz P, Cristiani-Winer M, Orosco-Falcone D, Gutiérrez N, Pomba M
Departamento de Cirugía Espinal. Sanatorio Allende, Córdoba, Argentina.
Acta Ortop Mex. 2020 Sep-Oct;34(5):276-281.
In vitro studies suggest that vancomycin is highly cytotoxic for osteoblasts. However, several clinical studies in vivo have not provided evidence or determined that effect on osteogenesis. The aim of this work was to investigate the effect of topical vancomycin on a lumbar arthrodesis model on New Zealand white rabbits.
Double-blind randomized experimental study. Posterolateral spinal fusion was performed on 30 rabbits, divided into two groups, A: graft/placebo, B: graft/vancomycin. After sacrificing them, the bone callus was evaluated with axial tomography and classified into three groups: no fusion (0), partial/incomplete fusion (1) and fusion (2). The samples were also histologically analyzed. The associations between the presence of fusion (complete/incomplete) and the group tested were estimated using Poisson log-linear models with two covariates. Adherences to histologically obtained responses were studied using contingency tables and 2 tests. The significance level was set equal to 0.05.
Treatment with vancomycin has 30% (0.30. CI 95%: 0.12-0.94) less chance compared to the placebo group, of presenting complete fusion. In other words, the vancomycin group has 2.3 times (CI 95%: 1.02-4.91) more likelyhood, compared to placebo, to have incomplete fusion.
The application of vancomycin powder mixed with graft reduces fusion rates by 30%, but at doses 5 times higher than those routinely used in arthrodesis by the authors medical team.
体外研究表明，万古霉素对成骨细胞具有高度细胞毒性。然而，多项体内临床研究并未提供证据或确定其对骨生成的影响。本研究旨在探讨局部应用万古霉素对新西兰白兔腰椎融合模型的影响。
双盲随机实验研究。对30只兔子进行后外侧脊柱融合术，分为两组，A组：植入物/安慰剂，B组：植入物/万古霉素。处死兔子后，通过轴向断层扫描评估骨痂，并分为三组：未融合（0级）、部分/不完全融合（1级）和融合（2级）。对样本进行组织学分析。使用具有两个协变量的泊松对数线性模型估计融合（完全/不完全）的存在与测试组之间的关联。使用列联表和卡方检验研究组织学获得的反应的依从性。显著性水平设定为0.05。
与安慰剂组相比，万古霉素治疗组实现完全融合的几率降低30%（0.30，95%置信区间：0.12 - 0.94）。换句话说，与安慰剂组相比，万古霉素组出现不完全融合的可能性高2.3倍（95%置信区间：1.02 - 4.91）。
与植入物混合的万古霉素粉末的应用使融合率降低30%，但所用剂量比作者医疗团队在脊柱融合术中常规使用的剂量高5倍。
