Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Acibadem Atakent Hospital, Kucukcekmece/Istanbul, Turkey.
Department of Orthopedics and Traumatology, Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Injury. 2023 Feb;54(2):329-338. doi: 10.1016/j.injury.2022.10.027. Epub 2022 Oct 27.
Masquelet technique is a two-stage surgical procedure used in the treatment of critical-size bone defects (CSD). Adding antibiotics to polymethylmethacrylate (PMMA) is still questionable to create higher quality induced membrane (IM). The aim of the study was to evaluate the effects of three antibiotic-supplemented cement, fusidic acid, teicoplanin, and gentamicin, on osteogenesis and IM progression applied to rat femur CSD model by comparing histopathological, biochemical, and immunohistochemical findings.
Twenty-eight male rats were divided into four groups control, gentamicin (G), teicoplanin (T), and fusidic acid (FA). A 10 mm CSD was created in rat femurs. In the postoperative 4th week, intracardiac blood samples were collected for biochemical analysis of bone alkaline phosphatase (BALP), osteocalcin (OC), and tumor necrosis factor-alpha (TNF-α) levels. IMs obtained in secondary operation were fixed and prepared for histopathological scoring of membrane progression and immunohistochemical evaluation of rat-specific Transforming Growth Factor-Beta (TGF-β), Runt-related Transcription Factor 2 (Runx2), and Vascular Endothelial Growth Factor (VEGF) expressions.
Levels of BALP and OC in serum didn't change among groups significantly while serum TNF-α levels significantly decreased in all antibiotic groups compared to the control group (P = 0.017). Histological scores of groups FA and T were significantly higher than those of groups Control and G (P = 0.0007). IMs of groups T and FA showed good progression while those of groups Control and G were also moderately progressed. A significant increase in TGF-β expression was observed in group G and FA (P = 0.001) while a significant increase in the expression of VEGF was observed in groups G and T compared to the control group (P = 0.036).
The bone cement impregnated with thermostable and safe antibiotics, gentamicin, fusidic acid, and teicoplanin can increase osteogenesis and support IM progression by increasing the expressions of TGF-β and VEGF. Anabolic effects of induced membranes used in the treatment of critical-size bone defects can be enhanced by antibiotic-supplemented PMMAs applied by altering the original technique.
Masquelet 技术是一种两阶段手术，用于治疗临界尺寸骨缺损（CSD）。在聚甲基丙烯酸甲酯（PMMA）中添加抗生素仍存在争议，因为它是否能产生更高质量的诱导膜（IM）。本研究旨在通过比较组织病理学、生物化学和免疫组织化学结果，评估三种抗生素（万古霉素、替考拉宁和夫西地酸）增强的 PMMA 对大鼠股骨临界尺寸骨缺损模型成骨和 IM 进展的影响。
将 28 只雄性大鼠分为四组：对照组、庆大霉素（G）组、替考拉宁（T）组和夫西地酸（FA）组。在大鼠股骨中造成 10mm 的 CSD。术后第 4 周，经心内采血，用于检测骨碱性磷酸酶（BALP）、骨钙素（OC）和肿瘤坏死因子-α（TNF-α）水平。在二次手术中获得的 IM 进行固定，并进行膜进展的组织病理学评分和大鼠特异性转化生长因子-β（TGF-β）、成骨特异性转录因子 2（Runx2）和血管内皮生长因子（VEGF）表达的免疫组织化学评估。
血清中 BALP 和 OC 水平在各组之间无显著变化，而所有抗生素组的血清 TNF-α水平与对照组相比均显著降低（P=0.017）。FA 组和 T 组的组织学评分明显高于对照组和 G 组（P=0.0007）。T 组和 FA 组的 IM 进展良好，而对照组和 G 组的 IM 进展也较好。G 组和 FA 组 TGF-β表达显著增加（P=0.001），G 组和 T 组 VEGF 表达与对照组相比显著增加（P=0.036）。
用热稳定和安全的抗生素（庆大霉素、夫西地酸和替考拉宁）浸渍的骨水泥可以通过增加 TGF-β和 VEGF 的表达来增加成骨和支持 IM 进展。通过改变原始技术，应用抗生素增强的 PMMA 可增强诱导膜在治疗临界尺寸骨缺损中的合成代谢作用。
