载万古霉素-羟基磷灰石涂层髓内钉治疗长骨开放性骨折带菌性伤口感染模型研究  

Titanium intramedullary nail coated with vancomycin-hydroxyapatite in a model of open long bone fracture with wound infection

作　　者：王勇 万永鲜 张喜海 叶俊武 卓乃强 

机构地区：[1]西南医科大学附属医院骨与关节外科,四川省泸州市646000

出　　处：《中国组织工程研究》2017年第14期2163-2169,共7页Chinese Journal of Tissue Engineering Research

基　　金：泸州市科技局项目(2011-S-39(3/6))~~

摘　　要：背景:胫骨作为人体开放性骨折的好发部位,髓内固定已成为治疗的首选,但其术后感染的风险较高且处理较为棘手,从而限制了内固定的使用。目的:探讨载万古霉素-羟基磷灰石涂层钛髓内钉对兔股骨开放性骨折带菌伤口模型感染的治疗作用。方法:运用仿生溶液生长法,制备3种不同抗生素质量浓度的载万古霉素-羟基磷灰石涂层髓内钉,并在体外进行抑菌实验。取健康雄性新西南大白兔40只,制作股骨中段开放性骨折细菌污染模型,根据植入髓内钉不同分为普通髓内钉组(n=10)以及低、中、高3种不同浓度载万古霉素-羟基磷灰石涂层髓内钉组(n=10)。动态观察动物伤口外观,监测实验动物的体质量、肛温、静脉血中白细胞、C-反应蛋白含量,定期对骨折周围软组织行病理学检查及伤肢X射线片检查。结果与结论:(1)实验制备的载万古霉素-羟基磷灰石涂层髓内钉在体外具有明显的抑菌性能;(2)在造模后第3天普通髓内钉组肛温显著高于万古霉素-羟基磷灰石组(P<0.05);(3)低、中、高浓度万古霉素-羟基磷灰石组兔造模后第3,7,14,28天静脉血中白细胞、C-反应蛋白显著低于普通髓内钉组(P<0.05);(4)造模后骨折周围组织病理学苏木精-伊红染色显示载万古霉素-羟基磷灰石涂层组在各时间点其炎症反应程度明显低于普通髓内钉组;(5)伤肢X射线显示普通髓内钉组骨痂生长缓慢伴死骨形成,载万古霉素-羟基磷灰石涂层组骨痂生长明显好于同期普通髓内钉组;(6)结果表明,载万古霉素-羟基磷灰石涂层髓内钉在治疗动物开放性股骨骨折细菌污染模型时能有效降低术后感染的发生。BACKGROUND： Tibia open fracture is a common disease, and intramedullary fixation has become the first choice, but the high risk of postoperative infection limits its clinical application. OBJECTIVE： To investigate the early prevention effect of vancomycin-hydroxyapatite （VCM-HA） coated titanium intramedullary nail in a rabbit model of open femoral fracture combined with wound infection. METHODS： Titanium intramedullary nails coated with three different concentrations of VCM-HA were prepared using biomimetic deposition, and subsequently in vitro bacteriostasis experiment was performed. Forty healthy male New Zealand white rabbits were selected and the model of mid-femur open fracture with wound infection was prepared. The rabbit models were then divided into ordinary intramedullary nail, low-, middle- and high-concentration VCM-HA coated intramedullary nail groups （n=10 per group）. The wound appearance of the animals was dynamically observed. The body mass, anal temperature, white blood cells and C-reactive protein contents in the venous blood were monitored. The pathological examination of the soft tissue around the fracture and injured limb X-ray were conducted regularly. RESULTS AND CONCLUSION： The prepared VCM-HA coated titanium intramedullary nail exerted obvious antibacterial effects in vitro. The anal temperature in the ordinary nail group was significantly higher than that in the other three groups at 3 days after modeling （P 〈 0.05）. The white blood cells and C-reactive protein contents in the venous blood in the VCM-HA groups were significantly lower than those in the ordinary nail group at 3, 7, 14 and 28 days after modeling （P 〈 0.05）. The hematoxylin-eosin staining of the peripheral tissues displayed the inflammatory response in the VCM-HA groups was milder than that in the ordinary nail group at each time point after modeling. The injured limb X-ray displayed that the callus grew slowly accompanied with sequestration in the ordinary nail group, while the callus growth in t

关 键 词：骨钉 羟基磷灰石 万古霉素 感染 组织工程 生物材料 缓释材料 开放性骨折 抗生素涂层 抗生素载体 缓释系统 

分 类 号：R318[医药卫生—生物医学工程]