骨移植物负载万古霉素治疗慢性骨髓炎的对比研究

A contrast study on bone graft substitutes loaded with vancomycin in the treatment for chronic osteomylitis

目的观察负载抗生素的骨移植物特性,比较不同骨移植物抗菌能力和成骨效果。方法双侧胫骨近端慢性骨髓炎造模成功后,48只兔随机均分为4组接受治疗:A组:胫骨病灶清创并万古霉素皮下注射;B组:胫骨病灶清创并以预制的硫酸钙万古霉素颗粒填充清创后遗留的空腔;C组:胫骨病灶清创并以预制的磷酸钙万古霉素颗粒填充清创后遗留的空腔;D组:胫骨病灶清创并以预制的同种异体脱钙骨万古霉素颗粒填充清创后遗留的空腔。在胫骨病灶清创术后1、2、3个月末,每组各处死动物4只,解剖尸体并取胫骨纵剖两半行细菌学检查及病检。结果 B与C组及A与D组间细菌阳性率无统计学差异,而B、C组细菌阳性率低于A、D组。成骨能力:A组成骨比例低于其余各组,B、C、D组间成骨比例无统计学差异;2、3个月末成骨比例,A组<B组、D组<C组。结论负载万古霉素的硫酸钙、磷酸钙治疗慢性骨髓炎效果满意;而吸附万古霉素的同种异体骨治疗慢性骨髓炎感染率较高,可能因万古霉素释放过快,感染灶内难以维持较长时间的抗生素有效浓度所致。磷酸钙万古霉素组能够在控制感染的同时促进新骨生成而修复缺损区。

Objective To study the features of bone graft substitutes （BGS） loaded with antibiotics and to compare the antibacterial property of different BGS and the effects of osteogenesis. Methods After the establishment of the model of chronic osteomyelitis in bilateral proximal tibia,the 48 rabbits were randomly divided into 4 groups ： group A, group B, group C and group D. The debridement of the lesions was made to all the rabbits in the 4 groups, while subcutanous injection of vaneomycln was added to rabbits in group A, cavity-filling with vancomycin-CS granules to rabbits in group B, cavity-filling with vaneomycin-CPC granules to rabbits in group C and cavity-filling with vancomycin-PDCP to rabbits in group D. At the end of the first month,the second month, the third month and the fourth month,4 rabbits in each group were killed each time,respectively and their tibia were seperated out and cut longitudinally into 2 parts, and bacteriological and pathological studies were applied. Results There existed no statistical difference of the positive rates of bacterial culture between the group B and group C and between the group A and group D at the end of the third month, but the positive rates of bacterial culture in group B and group C were lower than those in group A and group D. The osteogenesis proportion in group A was lower than that in the other 3 groups, and the proportions in group B, group C and group D were of no statistical differece. At the end of the second month and the third month, the osteogenesis proportion in each group ranged as follows ： group A 〈 group B and group D 〈 group C. Conclusions CS and CPC, when loaded with vancomycin, are effective on chronic osteomyelitis. While there exists a higher rate of infection in the treatment of chronic osteomyelitis by PDCB loaded with vancomycin, which may be induced by the fast release of vancomycin and short maintance of effective concentration of the drug in the infected lesions. CPC loaded with vancomycin can control the infection and promote the bone formation in the defected site as well.