Hamilton Amber A, Wongcharoenwatana Jidapa, Hoellwarth Jason S, Fragomen Austin T, Rozbruch S Robert, Reif Taylor J
Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY 10021, USA.
Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10021, USA.
J Bone Jt Infect. 2024 Nov 7;9(6):261-270. doi: 10.5194/jbji-9-261-2024. eCollection 2024.
: Antibiotic-laden polymethyl methacrylate (PMMA)-coated intramedullary nails (IMNs) are an effective treatment for osteomyelitis, but they pose multiple disadvantages. Antibiotic-loaded resorbable calcium sulfate (ARCS) paste is an alternative option to deliver a local antibiotic depot around IMNs, but such use has been minimally investigated. This study aimed to define the immediate covering and filling characteristics of ARCS around IMNs by using anatomic bone models. : Five tibia models (foam with cortical shell) were prepared by reaming a uniform 13 mm cylindrical path. Three 40 cc kits of ARCS (STIMULAN, Biocomposites Ltd, Keele, UK) were mixed with 3 g vancomycin and 1.2 g tobramycin powder and injected into the intramedullary canal while wet, completely filling the canal. A 10 mm 345 mm tibial IMN was immediately inserted without interlocking screws and allowed to completely cure for 2 h. The models were then longitudinally cut without disrupting the dry ARCS covering on the nail. The ARCS was removed from the nail at five equidistant locations along the nail. The thickness of the ARCS was measured with a caliper. A repeated-measures ANOVA test was used to compare the mean width of each segment for each model. : In all five trials, the tibial canal volume surrounding the nail remained completely filled. The ARCS paste was confluent along the length of the IMN. There were no gaps or air pockets between the paste and reamed model bone. There was no statistically significant difference among the five samples at each location ( ) or among the five locations along the bone ( ). : In a model setting, ARCS fully fills the intramedullary canal of a tibia and covers an IMN uniformly. Study of the in vivo material properties of ARCS may further elucidate the bone penetration as well as the clinical utility of this antibiotic depot technique.
载抗生素的聚甲基丙烯酸甲酯（PMMA）涂层髓内钉（IMN）是治疗骨髓炎的有效方法，但存在多种缺点。载抗生素的可吸收硫酸钙（ARCS）糊剂是在IMN周围提供局部抗生素储存库的另一种选择，但对此类应用的研究极少。本研究旨在通过使用解剖学骨模型来确定ARCS在IMN周围的即时覆盖和填充特性。：通过钻出一条均匀的13毫米圆柱形通道制备了五个胫骨模型（带有皮质壳的泡沫）。将三个40立方厘米的ARCS套件（STIMULAN，Biocomposites Ltd，英国基尔）与3克万古霉素和1.2克妥布霉素粉末混合，并在湿润时注入髓腔，完全填满髓腔。立即插入一根10毫米×345毫米的胫骨IMN，不使用锁定螺钉，并让其完全固化2小时。然后在不破坏钉子上干燥的ARCS覆盖物的情况下纵向切割模型。沿着钉子在五个等距位置从钉子上取下ARCS。用卡尺测量ARCS的厚度。使用重复测量方差分析测试来比较每个模型每个节段的平均宽度。：在所有五次试验中，钉子周围的胫骨髓腔体积保持完全填充。ARCS糊剂沿IMN的长度融合。糊剂与扩孔后的模型骨之间没有间隙或气穴。在每个位置的五个样本之间（）或沿骨的五个位置之间（）没有统计学上的显著差异。：在模型设置中，ARCS完全填充胫骨的髓腔并均匀覆盖IMN。对ARCS体内材料特性的研究可能会进一步阐明这种抗生素储存库技术的骨渗透情况以及临床实用性。
