Department of Periodontics, Burdwan Dental College & Hospital, Powerhouse Para, West Bengal 713101, India.
Department of Orthopaedics, Calcutta National Medical College & Hospital, Kolkata, West Bengal 700014, India.
J Control Release. 2022 Jun;346:180-192. doi: 10.1016/j.jconrel.2022.04.018. Epub 2022 Apr 23.
Repair of methicillin-resistant Staphylococcal (MRSA) chronic osteomyelitis and resulting bone defect is one of the major challenges in orthopaedics. Previous study has shown the effectiveness of antibiotic loaded biodegradable composite bone cement with in vitro tests and in the treatment of experimental osteomyelitis. The cement is composed of poly(lactide-co-glycolide) encapsulated antibiotic-biphasic calcium phosphate granule complex and additive antibiotic powder in gypsum binder. In this study, the cement was studied further to evaluate its in vitro biological properties (cytocompatibility, platelet activation), anti-infective, and bone regenerative potential in comparison to poly(methyl methacrylate) (PMMA) cement and parenteral therapy in 43 patients (age 5-57 years) with chronic MRSA osteomyelitis by analyzing the results of histopathology, radiographs, magnetic resonance imaging, scanning electron microscopy, and serum drug concentrations for 1 year. The composite cement showed superior cytocompatibility and coagulant activity compared to PMMA cement. Moreover, the results of different postoperative clinical and radiological examinations also proved the supremacy of composite cement over the other treatment modalities in terms of success rate, faster sepsis control and bone regeneration. Low serum antibiotic concentrations and normal serum calcium levels indicate that the calcium-rich composite cement is safe for application in human. Therefore, we conclude that the composite bone cement is a promising candidate for the treatment of chronic osteomyelitis.
耐甲氧西林金黄色葡萄球菌（MRSA）慢性骨髓炎及由此导致的骨缺损的修复是骨科领域的一大挑战。既往研究已经证实，载抗生素可生物降解复合骨水泥在体外试验和治疗实验性骨髓炎中具有有效性。该水泥由聚（乳酸-共-乙醇酸）包裹抗生素-双相磷酸钙颗粒复合物和石膏基质中的添加剂抗生素粉末组成。在本研究中，我们进一步研究了该水泥，通过分析 43 例（年龄 5-57 岁）慢性 MRSA 骨髓炎患者的组织病理学、影像学、磁共振成像、扫描电子显微镜和血清药物浓度结果，对其体外生物学特性（细胞相容性、血小板激活）、抗感染和骨再生潜能进行评估，以与聚甲基丙烯酸甲酯（PMMA）水泥和全身治疗进行比较。与 PMMA 水泥相比，复合水泥显示出更好的细胞相容性和凝固活性。此外，不同术后临床和影像学检查的结果也证明了复合水泥在成功率、更快的脓毒症控制和骨再生方面优于其他治疗方式。低血清抗生素浓度和正常血清钙水平表明富含钙的复合水泥在人体应用中是安全的。因此，我们得出结论，该复合骨水泥是治疗慢性骨髓炎的一种有前途的候选药物。
