全髋关节置换术后假体周围感染治疗及抗生素缓释系统研究进展

Advances on treatment of periprosthetic infection and antibiotic delivery system after total hip arthroplasty

髋关节置换术后假体周围感染是临床上的灾难性疾病,往往导致假体失效,需要全身抗生素联合手术才能根治感染,给医生、患者带来巨大的负担。保留假体清创、Ⅰ期翻修具有严格的适应证,满足条件的病例少。Ⅱ期翻修仍然是假体周围感染治疗的金标准,适用所有感染状况,治疗成功率高。在Ⅱ期翻修中,抗生素缓释系统起着关键作用,抗生素缓释系统载体是目前研究的重点,包括经典的骨水泥及可吸收生物材料,骨水泥具有很强的力学强度、但是抗生素释放呈现出急剧下降的趋势;可吸收生物材料可以持续高浓度释放抗生素,但机械强度差,不能单独使用。将骨水泥与可吸收生物材料联合应用,将是一种理想的抗生素载体,骨水泥是最常用的抗生素载体,但是抗生素释放浓度24 h后急剧下降,若低于最低抑菌浓度,将难以控制感染,并增加细菌耐药的风险;可降解材料可完全释放抗生素,释放时间长、浓度高,但是机械强度低。抗生素间隔器(spacer)在控制感染中发挥着重要作用,未来的研究将如何进一步延长抗生素缓释系统抗生素释放时间、增加抗生素释放量的同时,维持材料的机械强度。

Periprosthetic infection after hip replacement is a clinical catastrophic disease,which often leads to the failure of the prosthesis.It needs the combination of systemic antibiotics to cure the infection,which brings huge burden to doctors and patients.There are strict indications for debridement and one-stage revision of the prosthesis,and few cases meet the requirements.The second revision is still the gold standard for the treatment of periprosthetic infection.It is suitable for all infection conditions and has a high success rate.On the second phase of renovation,the antibiotic sustained-release system plays a key role,and the carrier of antibiotic sustained-release system is the focus of current research,including classic bone cement and absorbable biomaterials.Bone cement has strong mechanical strength,but the antibiotic release shows a sharp decline trend;the absorbable biomaterials can continuously release antibiotics with high concentration,but the mechanical strength is poor,so it could not use alone.The combination of bone cement and absorbable biomaterials will be an ideal antibiotic carrier.PMMA is the most commonly used antibiotic carrier,but the antibiotic release concentration is decreased sharply after 24 hours.It will be difficult to control the infection and increase the risk of bacterial resistance if it is lower than the minimum inhibitory concentration.The biodegradable materials can release antibiotics completely,with long release time and high concentration,but low mechanical strength.Antibiotic spacer plays an important role in the control of infection.In the future,how to further extend the antibiotic release time of antibiotic sustained-release system,increase the amount of antibiotic release and maintain the mechanical strength of the material will be studied.