抗菌涂层改性预防骨科内植物感染生物膜形成的研究进展

Novel development of antimicrobial coating modification in prevention of biofilm formation of infections involving orthopaedic surgical implants

骨科内植物感染是各种骨科内植物术后常见的灾难性并发症,增加了社会经济负担,严重影响了患者生活质量。生物膜形成是骨科内植物感染的本质特征,在感染的发生、发展及诊疗中扮演重要角色。生物膜特有的生物学特征导致目前各种治疗内植物感染的方法疗效不佳。目前已经认识到生物膜一旦形成则很难完全控制和清除。与其它感染性疾病类似,控制骨科内植物感染的最佳手段是预防,其中对内植物表面进行抗菌涂层改性以实现细菌与内植物表面接触时直接被杀灭或抑制其与内植物表面的粘附是最直接也最关键的预防靶点。因此,本文对各种主动抗菌涂层改性方法如抗生素等、被动抗菌涂层改性方法如两性离子聚合物等,尤其近年来兴起的主动改性与被动改性相结合的新策略进行简要综述,这对临床防治骨科内植物感染生物膜形成以及延长内植物使用寿命、降低医疗费用、提高患者生活质量具有重要意义。

As the number of joint arthroplasty and internal fixation surgeries continues to rise,the infection involving orthopaedic surgical implants is a devastating complication.The prospect of the increasing burden of these infection and its tremendous impact on patients,health institutions,and society is a significant public health concern.Biofilm formation is the essential characteristic of these infections.The success rate of treatment on biofilm infections such as antibiotic and debridement is lower than what excepted.Due to the recognized difficulty in eradicating biofilms once they have formed,the prevention of infection following prosthetic or device implantation continues to be the focus of intense research in orthopedics specialties.Bacteria-killing and bacteria-resistive are the two key points in prevention of biofilm formation.Surface-tethered bacteria-killing materials and bacteria-resistive materials implant coatings show great potential for the prevention of bioflim formation.Implant coatings that resist biofilm-based infections fall into two catergories:(1)passive coatings,which impede bacterial adhesion,including polyethylene glycol,zwitterionic polymers,vitamin E;(2)active coatings,which release pre-incorporated antimicrobials to kill bacteria upon contact,including antibiotics,antimicrobial peptides,silver and chitosan.Significant interests have been focused on implant surfaces integrating traditional antimicrobial agents with newly synthesized bacteria-resistant or bacteria-release materials in recent years,such as applying active and passive approaches simultaneously,applying active and passive approach sequentially and repeatedly switching between active and passive approaches.