局部抗生素递送系统治疗骨髓炎的优势与问题  

Advantages and problems of local antibiotic delivery system in the treatment of osteomyelitis

作　　者：刘飞 崔宇韬 刘贺[2] Liu Fei;Cui Yutao;Liu He(Yixing Shanjuan Orthopedic Hospital,Yixing 214233,Jiangsu Province,China;Department of Orthopedics,Second Hospital of Jilin University,Changchun 130041,Jilin Province,China)

机构地区：[1]宜兴市善卷骨科医院,江苏省宜兴市214233 [2]吉林大学第二医院骨科,吉林省长春市130041

出　　处：《中国组织工程研究》2021年第4期614-620,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:局部抗生素递送系统可提高局部药物浓度、减小药物毒性、提高药物生物利用度,提高抗菌疗效,为骨髓炎的长期治疗提供了新的方法。目的:总结介绍多种局部药物缓释系统在骨髓炎治疗中的应用进展,并分析目前的不足及研究方向。方法:作者以"osteomyelitis,drug delivery system,antibiotics,PMMA,Degradable material,骨髓炎,药物缓释系统,聚甲基丙烯酸甲酯,可降解材料"为关键词,检索2007至2020年期间PubMed、Web of Science、Medline、万方、CNKI数据库中的相关文献。初检文章221篇,筛选后对76篇文章进行分析。结果与结论:目前常用于局部药物释放系统的载体材料包括可降解材料(如胶原、生物活性玻璃等)及不可降解材料(如聚甲基丙烯酸甲酯骨水泥)等。不可生物降解的抗生素载体在临床上已有成功应用,但这些载体需要通过第二次手术移除,并且其早期的爆发性药物释放会对其疗效产生很大影响,因此对于不可降解材料的改进需要进一步研究,从而更好地提高其疗效。可生物降解材料的局部抗生素传递系统不仅可在感染部位持续地传递药物,而且还可在早期充当骨填充材料,而某些降解产物甚至可以为血管及新骨生成创造良好的骨传导环境,但是复合系统中药物释放的精确控制还需要进一步研究。BACKGROUND:Local antibiotic delivery system can increase local drug concentration,reduce drug toxicity,and increase drug bioavailability,thereby improving the antibacterial efficacy and providing a new method for the long-term treatment of osteomyelitis.OBJECTIVE:To summarize the application progress of various local drug sustained-release systems in the treatment of osteomyelitis,and analyze the current deficiencies and research directions.METHODS:The authors searched for related articles in PubMed,Web of Science,Medline,Wanfang and CNKI databases published from 2007 to 2020.The key words were“osteomyelitis,drug delivery system,antibiotics,PMMA,degradable material”in English;and“osteomyelitis,drug release system,PMMA,degradable materials”in Chinese.There were 221 preliminary inspection articles,and 76 articles were analyzed after screening.RESULTS AND CONCLUSION:Currently,carrier materials commonly used in local drug release systems include degradable materials such as collagen,bioactive glass,and non-degradable materials such as PMMA bone cement.Non-biodegradable antibiotic carriers have been successfully used clinically,but these carriers need to be removed by a second operation,and their early explosive drug release will have a great impact on their efficacy.Therefore,further research on the improvement of non-degradable materials is needed to better improve their efficacy.The local antibiotic delivery system of biodegradable materials can not only continuously deliver drugs at the infection site,but also act as bone filling materials in the early stage.Some degradation products can even create a good bone conduction environment for blood vessels and new bone formation.However,the precise control of drug release in complex systems requires further research.

关 键 词：材料 骨 骨髓炎 递送系统 抗生素 骨水泥 组织工程 综述 

分 类 号：R459.9[医药卫生—治疗学] R313[医药卫生—临床医学]