Freischmidt Holger, Armbruster Jonas, Rothhaas Catharina, Titze Nadine, Guehring Thorsten, Nurjadi Dennis, Kretzer Jan Philippe, Schmidmaier Gerhard, Grützner Paul Alfred, Helbig Lars
Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany.
Trauma Centre, Hospital Paulinenhilfe Stuttgart at Tübingen University Hospital, Rosenbergstr. 38, 70176 Stuttgart, Germany.
Biomedicines. 2022 Oct 8;10(10):2513. doi: 10.3390/biomedicines10102513.
The treatment of non-unions is often complicated by segmental bone defects and bacterial colonization. Because of the limited availability of autologous bone grafts, tissue engineering focuses on antibiotic-loaded bone graft substitutes. HACaS+G is a resorbable calcium sulphate-hydroxyapatite loaded with gentamicin. The osteoinductive, osteoconductive, and anti-infective effect of HACaS+G has already been demonstrated in clinical studies on patients with chronic osteomyelitis. However, especially for the treatment of infected non-unions with segmental bone defects by HACaS+G, reliable clinical testing is difficult and sufficient experimental data are lacking. We used an already established sequential animal model in infected and non-infected rat femora to investigate the osteoinductive, osteoconductive, and anti-infective efficacy of HACaS+G for the treatment of infected non-unions. In biomechanical testing, bone consolidation could not be observed under infected and non-infected conditions. Only a prophylactic effect against infections, but no eradication, could be verified in the microbiological analysis. Using µ-CT scans and histology, osteoinduction was detected in both the infected and non-infected bone, whereas osteoconduction occurred only in the non-infected setting. Our data showed that HACaS+G is osteoinductive, but does not have added benefits in infected non-unions in terms of osteoconduction and mechanical bone stability, especially in those with segmental bone defects.
骨不连的治疗常常因节段性骨缺损和细菌定植而变得复杂。由于自体骨移植的可用性有限,组织工程学专注于载抗生素的骨移植替代物。HACaS+G是一种负载庆大霉素的可吸收硫酸钙-羟基磷灰石。HACaS+G的骨诱导、骨传导和抗感染作用已在慢性骨髓炎患者的临床研究中得到证实。然而,特别是对于用HACaS+G治疗伴有节段性骨缺损的感染性骨不连,可靠的临床测试很困难且缺乏足够的实验数据。我们使用已建立的感染和未感染大鼠股骨的序贯动物模型,来研究HACaS+G治疗感染性骨不连的骨诱导、骨传导和抗感染疗效。在生物力学测试中,在感染和未感染条件下均未观察到骨愈合。在微生物学分析中,仅证实了对感染的预防作用,但未证实根除感染。使用μ-CT扫描和组织学方法,在感染和未感染的骨中均检测到骨诱导,而骨传导仅发生在未感染的情况下。我们的数据表明,HACaS+G具有骨诱导作用,但在感染性骨不连的骨传导和机械性骨稳定性方面没有额外益处,尤其是在伴有节段性骨缺损的情况下。
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