抗生素骨水泥治疗骨关节感染的优势与问题

编辑：中国组织工程研究时间：2022-11-24 点击：

1First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou 730000, Gansu Province, China; 2Department of Orthopedic Trauma, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China

Received:2022-01-17 Accepted:2022-03-02 Online:2023-01-28 Published:2022-06-01
Contact: Gao Qiuming, Chief physician, Professor, Master’s supervisor, Department of Orthopedic Trauma, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
About author:Han Tao, Master candidate, First Clinical Medical College of Gansu University of Traditional Chinese Medicine, Lanzhou 730000, Gansu Province, China
Supported by:
The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army Intra-Hospital Research Program - Basic and Clinical Incubation Program, No. 2021yxky037 (to GQM)

摘要：

文题释义：
抗生素骨水泥：最早由Buchholz、Engelbrecht等于1970年提出，抗生素骨水泥是通过在聚甲基丙烯酸甲酯(polymethyl methacrylate，PMMA)骨水泥中加入抗生素后混合而成的一种稳定的抗生素缓释系统，在其固化之前可以根据临床需求将其制备成各种形状的占位器。将其植入体内后可以为局部感染提供较高浓度的抗生素，从而达到预防和治疗局部感染的目的。
骨关节感染：是指由各种病原微生物引起的骨骼肌肉系统感染，其通常由开放性骨折、手术时的直接接种、邻近部位感染的蔓延或继发于其他感染源的血行播撒所致。常见的骨关节感染包括骨髓炎、感染性关节炎以及骨科植入物相关的感染，这些感染常常迁延难愈且复发风险高，给患者生活带来了极大的困扰。

背景：聚甲基丙烯酸甲酯(PMMA)骨水泥具有良好的稳定性、可塑性和空间占位能力，是目前临床上最常用的抗生素载体之一。局部应用抗生素骨水泥可以预防、延缓甚至根除骨骼肌肉系统的感染，是目前解决骨关节感染难题的常用手段。但是，抗生素的加入会显著影响聚甲基丙烯酸甲酯骨水泥的机械性能，并且有引发不良反应的可能。另外，有学者发现抗生素骨水泥的抗生素释放率很低，局部应用抗生素骨水泥并不能有效消灭细菌，且有引起细菌耐药的可能。因此，他们对抗生素骨水泥在控制感染方面的有效性提出了质疑，并引起了广泛热议。
目的：综述抗生素骨水泥的优势与问题，并总结其在临床使用中的注意事项。
方法：通过计算机在PubMed、万方、中国知网数据库中以“抗生素骨水泥、聚甲基丙烯酸甲酯、PMMA；Bone Cements、Anti-Bacterial Agents、Bone and Bones、joints、elution、release、Mechanical”为中、英文检索词，检索2017-01-01/2021-12-31发表的相关文献。排除与文章内容无关的、创新性差、重复的文献后，最终纳入68篇文献进行综述。
结果与结论：目前，抗生素骨水泥仍是治疗骨关节感染的最佳选择之一。随着对抗生素骨水泥研究的不断深入，许多能改善其抗生素释放方式、抗菌能力和力学性能的新方法不断涌现出来，同时其在临床上的使用也得到了拓展。但仍然有许多问题尚未得到解决，还需进一步的研究，如抗生素的选择、剂量以及最佳的混合方法等。另外，通过对可加入聚甲基丙烯酸甲酯骨水泥的改性材料和抗生素替代物的开发与局部应用有望解决细菌耐药问题。相信随着医学、药学和生物材料科学的发展，抗生素骨水泥会在临床上得到更加广泛的应用。

https://orcid.org/0000-0001-8487-4845(韩涛)

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料；口腔生物材料；纳米材料；缓释材料；材料相容性；组织工程

关键词: 聚甲基丙烯酸甲酯, 抗生素骨水泥, 骨关节感染, 洗脱, 力学强度, 改性, 耐药, 不良反应, 综述

Abstract: BACKGROUND: Polymethyl methacrylate bone cement has good stability, plasticity and space-occupying ability, and is currently the most commonly used antibiotic carrier in clinical practice. Topical application of antibiotic-loaded bone cements can prevent, delay or even eradicate infections in the skeletal muscular system, and is currently a common means of addressing the challenge of bone and joint infections. However, the addition of antibiotics can significantly affect the mechanical properties of polymethyl methacrylate bone cement and has the potential to cause adverse reactions. In addition, some scholars found that the antibiotic release rate of antibiotic-loaded bone cements is very low, and topical application of antibiotic-loaded bone cements does not effectively destroy bacteria and has the potential to cause bacterial resistance. Therefore, they questioned the effectiveness of antibiotic-loaded bone cements in controlling infections, and it has been widely debated.
OBJECTIVE: To review the advantages and problems of antibiotic-loaded bone cements and to summarize the precautions for its clinical use.
METHODS: The computerized searches were conducted on PubMed, Wanfang and CNKI databases using “antibiotic-loaded bone cements, polymethyl methacrylate, PMMA; bone cements, anti-bacterial agents, bone and bones, joints, elution, release, and mechanical” as the search terms in Chinese and English to search the relevant literature from January 1, 2017 to December 31, 2021. After excluding the literature that was not related to the article content, poorly innovative and duplicated, 68 papers were finally included for review.
RESULTS AND CONCLUSION: Currently, antibiotic-loaded bone cements are one of the best options for the treatment of bone and joint infections. As research on antibiotic-loaded bone cements continues, many new methods have emerged to improve their antibiotic release, antimicrobial capacity and mechanical properties, and their use in clinical practice has also expanded. However, there are still many issues that have not been solved and further research is needed, such as the selection of antibiotics, dosage, and the optimal mixing method. In addition, the development and local application of modified materials and antibiotic substitutes that can be incorporated into polymethyl methacrylate bone cement are expected to solve the problem of bacterial resistance. It is believed that with the development of medicine, pharmacology and biomaterials science, polymethyl methacrylate bone cement will be more widely used in clinical practice.

Key words: polymethyl methacrylate, antibiotic-loaded bone cements, bone and joint infection, elution, mechanical strength, modification, drug resistance, adverse effect, review

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