文献类型：期刊文献

中文题名：抗生素骨水泥治疗骨关节感染的优势与问题

英文题名：Advantages and problems of antibiotic-loaded bone cements for bone and joint infections

作者：韩涛[1];郝建强[1];李文波[2];石杰[2];高秋明[2]

第一作者：韩涛

机构：[1]甘肃中医药大学第一临床医学院,甘肃省兰州市730000;[2]联勤保障部队第九四〇医院创伤骨科,甘肃省兰州市730050

第一机构：甘肃中医药大学临床医学院

年份：2023

卷号：27

期号：3

起止页码：470

中文期刊名：中国组织工程研究

外文期刊名：Chinese Journal of Tissue Engineering Research

收录：CSTPCD;;北大核心:【北大核心2020】；

基金：联勤保障部队第九四〇医院院内科研计划项目-基础和临床培育项目(2021yxky037),项目负责人:高秋明。

语种：中文

中文关键词：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

外文关键词：polymethyl methacrylate;antibiotic-loaded bone cements;bone and joint infection;elution;mechanical strength;modification;drug resistance;adverse effect;review

摘要：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。
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.