自体微小颗粒骨复合万古霉素缓释微球治疗感染性骨缺损的实验研究  

Repairing infected bone defects with compounds of autologous micromorselized bone and poly（D,L-lactide-co-glycolide） microspheres loaded with hydrochloric vancomycin

作　　者：刘启明[1] 周岳[1] 王明波[2] 乔泽文[1] 杨海波[1] 胡宁敏[1] 

机构地区：[1]宁夏医科大学总医院创伤骨科,银川750004 [2]深圳清华大学研究院、深圳医用材料及植入器械重点实验室

出　　处：《中华创伤骨科杂志》2014年第11期983-989,共7页Chinese Journal of Orthopaedic Trauma

基　　金：宁夏回族自治区自然科学基金（NZl215）

摘　　要：目的 探讨自体微小颗粒骨复合万古霉素缓释微球治疗感染性骨缺损的效果.方法 通过复乳-固化法制备万古霉素缓释微球.取48只家兔,按沈霖造模法制作双侧桡骨中上段慢性骨髓炎模型,随机分为3组,每组16只.1个月后局部彻底清创造成骨缺损,A组植入自体微小颗粒骨,B组植入自体微小颗粒骨混合万古霉素,C组植入自体微小颗粒骨复合万古霉素缓释微球.分别于术前、术后1d、3d、7d、2周、4周测定各组动物血清C-反应蛋白（CRP）及红细胞沉降率（ESR）,于术后2、4、8及12周每组处死4只兔,行植骨区大体形态、X线片及组织学观察.结果 术后3d、7dB组CRP水平显著低于A组,但大于C组;术后1d、3d、2周、4周B、C组ESR显著低于A组,术后7d、2周C组ESR显著低于B组,差异均有统计学意义（P＜0.05）.术后2、4、8周B、C组X线片评分均优于A组,差异有统计学意义（P＜0.05）;术后12周A、B、C3组之间X线片评分比较差异无统计学意义（P＞0.05）.术后2、4、8、12周,B、C组组织学评分均优于A组,差异有统计学意义（P＜0.05）.结论 对于家兔感染性骨缺损,局部应用自体微小颗粒骨复合万古霉素缓释微球的疗效与自体微小颗粒骨混合万古霉素相当,均好于自体微小颗粒骨.Objective To evaluate the effect of compounds of autologous micromorselized bone and [poly（D,L-lactide-co-glycolide）,PLGA] microspheres loaded with hydrochloric vancomycin on repairing infected bone defects.Methods PLGA microspheres loaded with vancomycin were manufactured.Animal models of chronic osteomyelitis were created at the middle and upper segments of bilateral radii in 48 white rabbits.The rabbit models were randomized into 3 equal groups （16 in each）.Bone defects were made one month later by topical debridement.In group A,tiny autogenous granular bone was implanted into the defects; in group B,autogenous bone microspheres loaded with vancomycin were implanted; in group C,compounds of autogenous tiny granular bone and vancomycin-loaded PLGA microspheres were implanted.The serum c-reaction protein （CRP） and erythrocyte sedimentation rate （ESR） were detected in each group at preoperation,1,3,7 days,2 and 4 weeks postoperation.Four rabbits were sacrificed each time at 2,4,8 and 12 weeks postoperation for gross observation,X-ray and histopathological examinations of the implant areas.Results At 3,7 days postoperation,the CRP level in group B was significantly lower than that in group A,but significantly higher than that in group C （P 〈 0.05）.At 1,3 days,2,4 weeks postoperation,the ESR in groups B and C was significantly lower than that in group A; at 7 days and 2 weeks postoperation,the ESR in group C was significantly lower than that in group B （P 〈 0.05）.At 2,4,8 weeks postoperation,groups B and C scored significantly better than group A in X-ray assessment （P 〈 0.05）.At 12 weeks postoperation,there was no significant difference in X-ray assessment between groups A,B and C （P 〉 0.05）.At 2,4,8,12 weeks postoperation,the histological scores for groups B and C were significantly higher than those for group A（P 〈 0.05）.Conclusion In treatment of infected bone defects in rabbits,compounds of autologous micromorselized bone and PLGA microspheres loaded with hydrochlo

关 键 词：万古霉素 羟基乳酸聚合物910 骨移植 骨缺损 兔 

分 类 号：R681.2[医药卫生—骨科学]