Polylactide-polyglycolide antibiotic implants
Polylactide-polyglycolide antibiotic implants
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DOI：
10.1097/01.blo.0000175720.99118.fe
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发表时间：
2005-08-01
影响因子：
4.2
通讯作者：
Feschuk, C
中科院分区：
文献类型：
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作者：
Garvin, K;Feschuk, C
外科医生一直在努力减少骨科感染，但目前没有一种治疗方法能以最大的有效性提供最小的副作用。混合在巴黎中的抗生素已经成功地治疗了慢性骨髓炎患者的大骨缺损，并且具有良好的耐受性和被身体吸收的优点。浸在聚甲基丙烯酸甲酯（PMMA）中的抗生素已经成功地提供了局部抗生素递送。然而，抗生素对骨水泥的影响、抗生素的不一致洗脱以及移除PMMA植入物的需要驱动了对更好的抗生素递送系统的需求。抗生素浸渍的聚乳酸、聚乙醇酸或聚对二氧环己酮的聚合物或共聚物可提供用于局部抗生素递送的可吸收系统。用于治疗小骨折的类似生物可降解系统已获得成功，副作用极小。体外研究表明，从生物可吸收微球和珠粒中洗脱抗生素的结果很有希望。动物体内试验表明，抗生素浸渍聚合物可以成功地治疗兔和狗的诱导骨髓炎。这些研究提供了一致的可重复的结果，现在是时候计划人体试验，以评估植入感染骨中的抗生素微球的疗效，并计划体内和体外动物试验，以研究抗菌聚合物涂层组件的可行性。
Surgeons continually struggle to reduce orthopaedic infections, but no current treatment offers minimum side effects with maximum effectiveness. Antibiotics mixed in plaster of paris have been successful in treating large bony defects in patients with chronic osteomyelitis, and have the advantage of being well tolerated and absorbed by the body. Antibiotics impregnated in polymethylmethacrylate (PMMA) have offered local antibiotic delivery with some success. However, the effect of the antibiotic on the bone cement, the inconsistent elution of the antibiotic, and the need to remove the PMMA implant drives the need for a better system of antibiotic delivery. Polymers or copolymers of antibiotic-impregnated polylactic acid, polyglycolic acid or polyparadioxanone may provide an absorbable system for localized antibiotic delivery. Similar biodegradable systems used to treat small bone fractures have been successful with minimal side effects. In vitro studies have shown promising results of antibiotic elution from bioabsorbable microspheres and beads. Animal in vivo tests have shown that antibiotic impregnated polymers can successfully treat induced osteomyelitis in rabbits and dogs. These studies have provided consistent reproducible results, and now it is time to plan human trials to assess the efficacy of antibiotic microspheres implanted in infected bone and to plan in vivo and in vitro animal testing to investigate the feasibility of antibiotic-polymer-coated components.