新型纳米氮化钛银涂层髓内钉治疗家兔股骨骨折感染的研究  

A novel titanium-nitride silver nanoparticle coating intramedullary nail for treatment of fracture infection: a rabbit model study

作　　者：白博[1] 桑宏勋[2] 郇科 苏菲[1] 刘斌[1] 杨超[1] 姜培齐 

机构地区：[1]第四军医大学西京医院骨科,西安710032 [2]南方医科大学深圳医院骨科,深圳518000 [3]北京华钽生物科技开发有限公司,北京100088

出　　处：《中国矫形外科杂志》2017年第6期544-548,共5页Orthopedic Journal of China

基　　金：西京医院学科助推计划(编号:XJZT14D01)

摘　　要：[目的]观察研究纳米氮化钛银涂层髓内钉对家兔股骨骨折合并感染一期内固定的治疗效果。[方法]健康青年级家兔16只,随机分为纳米氮化钛组(Ti N)和纳米氮化钛银组(Ti N-Ag),建立家兔开放骨折合并金黄色葡萄球菌感染模型,一期应用Ti N髓内钉和Ti N-Ag髓内钉固定,对比观察两组家兔术后感染、日常活动、体重、体温等一般情况,定期拍摄X线片,术后8周取材进行微生物学和组织病理学检查,评价新型纳米氮化钛银涂层内固定材料的抗菌效果。[结果]术后8周,细菌培养结果提示Ti N组感染率为87.5%,Ti N-Ag组为25%(P=0.041);Ti N组动物体重平均增加(112.00±23.00)g,Ti N-Ag组增加(233.88±37.83)g,差异有统计学意义(P<0.001);Ti NAg组体温明显低于Ti N组(P<0.05)且波动较小;影像学检查结果:Ti N组骨折断端骨膜反应明显,有死骨形成,内固定松动移位,Ti N-Ag组骨折断段骨痂形成改建良好,内固定位置良好,未见明显死骨形成;组织病理学观察显示:Ti N组大量炎性细胞聚集浸润,Ti N-Ag组未见明显死骨及炎性细胞浸润。[结论]纳米氮化钛银涂层髓内钉对骨折合并感染有良好的预防和治疗效果,可有效降低术后感染风险。[Objective] To investigate the outcome of titanium-nitride silver nanoparticle coating intramedullary nail for treatment of femoral fracture infection in a rabbit model. [Methods] Sixteen mature rabbits, weighing 3.4 to 5.1 kg, were ran- domly divided into titanium-nitride intramedullary nail without nano-silver coating group （n=S, TiN group） and silver-coated nail group （n=8, TiN-Ag group）. An open femoral fracture with staphylococcus aureus infection[3 × 106 colony-forming units （CFU） /mL] model was created, then the two types intramedullary nail （4.0cm length and 0.35 cm diameter） were put into the medullary cavity. The weight, temperature, daily activities, radiologic films, microbiologic and histological parameters were observed and compared at the 8^th weeks after the operation, and the effect of the titanium-nitride silver nanoparticle coating internal fixation was evaluated. [Results] At 8^th weeks postoperatively, the infection rate of TiN group was 87.5% and that of TiN- Ag group was 25% （/9 = 0.041）, animals of the TiN group revealed a mean weight gain of 112±23.00 g and animals of the TiN- Ag group revealed 233.88±37.83 g, the results were statistically significant （P〈0.001） . The TiN-Ag group showed significantly （P〈0.05） lower temperature in comparison with the TiN group. The imaging showed obvious periosteal reaction, sequestrum, migration of implants in the broken ends of fractured bone in the TiN group at the 8＇h week postoperatively. On the contrary, the fracture ends had apparent porosis and with no sequestration, as well as the position of the internal fixation. Histopathological observation indicated a large number of inflammatory cells infiltration in TiN group. There was no inflammatory reaction in TiN-Ag group or growth of bacteria. [Conclusion] The new titanium-nitride silver nanoparticle coating intra- medullary nail is effective to treat and prevent the fracture, infection, and relative postoperative infection risk.

关 键 词：骨折 内固定 纳米银 抗菌治疗 生物膜 

分 类 号：R687.33[医药卫生—骨科学]