Calcium Sulfates: What Is the Evidence?
Calcium Sulfates: What Is the Evidence?
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DOI：
10.1097/bot.0b013e3181cec48e
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发表时间：
2010-03-01
影响因子：
2.3
通讯作者：
Mckee, Michael D.
中科院分区：
文献类型：
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作者：
Beuerlein, Murray J. S.;Mckee, Michael D.
硫酸钙作为一种生物可吸收骨替代物已被广泛使用了90年。其优点包括其低成本，易于获得和无限制供应，缺乏供体部位发病率，用作其他化合物（特别是抗生素）的递送载体，固有的骨传导特性（基于与骨相似的结构），以及其经证实的安全记录。我们试图确定支持使用硫酸钙作为生物可吸收骨替代物的循证医学研究（前瞻性和/或随机临床试验）。目前，大多数报告是基础科学调查、动物研究和质量不同程度的回顾性临床综述。多项回顾性综述显示，硫酸钙是一种有效的空隙填充剂，可用于包含性骨缺损，例如：压缩骨折复位后的干骺端空隙（跟骨、胫骨平台）、单纯性骨囊肿或创伤后缺损。三个病例系列研究了硫酸钙在骨不连治疗中的应用，发现了显著的失败率，表明单独使用这种材料在这种情况下并不是促进愈合的最佳选择。据报道，并发症发生率较低但一致，特别是硫酸钙吸收时伤口浆液性引流。当材料用于更大体积（大于20 mL）或皮下骨（胫骨、尺骨）时，该并发症更高。有一些I级至II级证据（一项随机试验、一项病例对照研究、一项前瞻性队列研究）表明，生物可吸收硫酸钙浸渍的骨水泥有可能减少与慢性骨髓炎和感染性骨不连手术治疗相关的手术次数和手术发病率，同时保持较高的感染根除率。硫酸钙仍然是一种廉价、安全、可靠的骨空隙填充剂，也可以作为抗生素或其他化合物的可吸收递送载体。需要进一步的高质量随机和前瞻性临床试验来确定硫酸钙在现代骨科中的作用。
Calcium sulphate has been used extensively as a bioabsorbable bone substitute for 90 years. Its advantages include its low cost, ready availability and unlimited supply, lack of donor site morbidity, use as a delivery vehicle for other compounds (especially antibiotics), inherent osteoconductive properties (based on a structure similar to bone), and its proven safety record. We sought to determine the evidence-based medical studies (prospective and/or randomized clinical trials) that support the use of calcium sulphate as a bioabsorbable bone substitute. At the present time, the majority of reports are basic science investigations, animal studies, and retrospective clinical reviews of varying degrees of quality. Multiple retrospective reviews reveal that calcium sulphate is an effective void-filler in contained bony defects such as metaphyseal voids after impacted fracture reduction (calcaneus, tibial plateau), simple bone cysts, or posttraumatic defects. Three case series examining the use of calcium sulphate in the treatment of bone nonunions revealed a significant failure rate, suggesting that this material, used in isolation, is not optimal to promote union in that setting. A low but consistent complication rate, specifically serous drainage from the wound as the calcium sulphate absorbs, has been reported. This complication is higher when the material is used in higher volumes (greater than 20 mL) or in subcutaneous bones (tibia, ulna). There is some Level I to II evidence (one randomized trial, one case-control study, one prospective cohort study) that antibiotic-impregnated bioabsorbable calcium sulphate has the potential to reduce the number of procedures and surgical morbidity associated with the surgical treatment of chronic osteomyelitis and infected nonunion while maintaining a high rate of infection eradication. Calcium sulphate remains an inexpensive, safe, reliable bone void filler that can also serve as a absorbable delivery vehicle for antibiotics or other compounds. Further high-quality randomized and prospective clinical trials are required to define the role of calcium sulphate in modern orthopaedics.