Letsch R, Rosenthal E, Joka T
Abteilung für Unfallchirurgie, Universitätsklinikum Essen.
Aktuelle Traumatol. 1993 Nov;23(7):324-9.
Two antibiotic carriers (collagen sponge/PMMA-beads--loaded with gentamicin) for the treatment of osteomyelitis of long bones are compared in a randomised prospective study of 20 patients in respect of efficacy, safety and biocompatibility. In addition, the concentration of gentamicin in serum, urine and wound exudate was measured. This revealed marked differences. Gentamicin was released rapidly from the collagen sponge, leading to high levels in wound exudate and urine within the first 48 hours, with measurable but non-toxic concentrations in the serum. The liberation of gentamicin from the PMMA beads was much slower. This resulted in low steady levels in wound exudate and urine, and no detectable concentrations in the serum. The clinical outcome showed no differences between both methods of application. In 80% of the collagen sponge group and in 90% of the PMMA-beads group the osteomyelitis was completely allayed with disappearance of all infectious parameters. The number of re-operations was significantly higher in the PMMA group. It is recommended to use collagen sponges for the local treatment of osteomyelitis in cases that can probably be eradicated in a single surgical procedure, whereas PMMA beads should be applied in larger defects requiring a space-occupying function for further reconstructive operations.
在一项针对20例患者的随机前瞻性研究中，对两种用于治疗长骨骨髓炎的抗生素载体（负载庆大霉素的胶原海绵/聚甲基丙烯酸甲酯珠）在疗效、安全性和生物相容性方面进行了比较。此外，还测量了血清、尿液和伤口渗出液中庆大霉素的浓度。结果显示出显著差异。庆大霉素从胶原海绵中快速释放，在最初48小时内导致伤口渗出液和尿液中浓度较高，血清中浓度可测但无毒。庆大霉素从聚甲基丙烯酸甲酯珠中的释放要慢得多。这导致伤口渗出液和尿液中的稳定水平较低，血清中未检测到浓度。临床结果显示两种应用方法之间没有差异。在胶原海绵组的80%和聚甲基丙烯酸甲酯珠组的90%中，骨髓炎完全缓解，所有感染指标消失。聚甲基丙烯酸甲酯组的再次手术次数明显更高。建议在可能通过单次手术根除的病例中使用胶原海绵进行骨髓炎的局部治疗，而聚甲基丙烯酸甲酯珠应应用于需要占位功能以进行进一步重建手术的较大缺损。
