Elution and mechanical properties of antifungal bone cement

The effect of the incorporation of amphotericin B into bone cement was examined; as literature suggests, this may be a feasible method for the treatment of periprosthetic fungal infections. Addition of antifungal increased the compressive strength of the bone cement--a statistically significant amount from 107 +/- 2.3 to 121 +/- 1.5 MPa. Elution of tobramycin and amphotericin B was quantified using ultraviolet-visible spectroscopy. Spectroscopy showed that 18% of the antibiotic was released during the first week, with most released in the first 24 hours. The elution of antifungal, however, was unable to be detected after 1 week, with less than 0.03% released. Amphotericin B does not weaken bone cement. Its inability to be delivered at a clinically significant dose gives no clear indication for its incorporation into cement.     

Antibiotic Susceptibility in Gram-Positive Chronic Joint Arthroplasty Infections: Increased Aminoglycoside Resistance Rate in Patients With Prior Aminoglycoside-Impregnated Cement Spacer Use

Two-stage revision using aminoglycoside-cement spacers (A-CSs) is widely used to manage chronic periprosthetic joint infection (PJI). However, aminoglycoside-resistance in gram-positive cocci (GPC) seems to be increasing. Moreover, the contribution of these A-CSs to select resistant mutants is a matter of concern. We study the antibiotic susceptibility profile of GPC after 113 chronic hip and knee PJIs. Aminoglycoside susceptibility-profiles were compared between cases where A-CSs had previously been used (n: 52), and cases of primary infection (n: 61). 32% of isolates were resistant to gentamicin and 40.6% to tobramycin. Gentamicin resistance after previous A-CS use was significantly higher (49.2% [30/61] vs. 19.3% [16/83]; P: 0.0001) as well as with tobramycin (52.7% [29/55] vs. 30.9% [21/66]; P: 0.014). A high rate of gentamicin-tobramycin resistance exists among the most common bacteria involved in chronic-PJI. The risk of selection for aminoglycoside-resistant mutants in cases of infection relapse is a concern following A-CS use.     

High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex cement spacers in two-stage revision of infected hip implants: a study of 46 patients at an average follow-up of 107 days.

This study investigated the release of antibiotics in vivo, from an articulating polymethylmethacrylate (PMMA) spacer used in two-stage revision arthroplasty of infected hip implants. Forty-six patients who underwent two-stage revision hip arthroplasty for infections were managed with an interim PMMA spacer loaded with a high dose of vancomycin and aztreonam. Serum and aliquots of drainage collected after the first-stage surgery, and joint fluid obtained at the time of the second-stage surgery were analyzed for antibiotic concentrations by high performance liquid chromatography and bioactivity by tube dilution bioassay. Following implantation, the highest levels of antibiotics were measured in aliquots of drainage on the first day (vancomycin: 1538.0 +/- 243.6 microg/mL; aztreonam: 1003.5 +/- 323.5 microg/mL), decreasing to 571.9 +/- 169.4 microg/mL for vancomycin and 313.6 +/- 88.3 microg/mL for aztreonam after 7 days. Antibiotic concentrations in serum were very low (vancomycin: 0.58 +/- 0.2 microg/mL, range: 0.1-1.6 microg/mL; aztreonam: 0.46 +/- 0.3 microg/mL, range: 0.1-0.9 microg/mL at 24 h) and there was no systemic adverse effect. At a mean 107 days after the first-stage surgery, the concentrations of antibiotics in joint fluid were well above the minimal inhibitory concentration of most common microorganisms. The released antibiotics were bioactive against the test organisms. Based on the observed results, we confirmed the safety and effectiveness of in vivo drug delivery from antibiotic-impregnated PMMA hip spacers.     

Antibacterial efficacy of a new gentamicin‐coating for cementless prostheses compared to gentamicin‐loaded bone cement

Cementless prostheses are increasingly popular but require alternative prophylactic measures than the use of antibiotic‐loaded bone cements. Here, we determine the 24‐h growth inhibition of gentamicin‐releasing coatings from grit‐blasted and porous‐coated titanium alloys, and compare their antibacterial efficacies and gentamicin release‐profiles to those of a commercially available gentamicin‐loaded bone cement. Antibacterial efficacy increased with increasing doses of gentamicin in the coating and loading with 1.0 and 0.1 mg gentamicin/cm² on both grit‐blasted and porous‐coated samples yielded comparable efficacy to gentamicin‐loaded bone cement. The coating had a higher burst release than bone cement, and also inhibited growth of gentamicin‐resistant strains. Antibacterial efficacy of the gentamicin coatings disappeared after 4 days, while gentamicin‐loaded bone cement exhibited efficacy over at least 7 days. Shut‐down after 4 days of gentamicin‐release from coatings is advantageous over the low‐dosage tail‐release from bone cements, as it minimizing risk of inducing antibiotic‐resistant strains. Both gentamicin‐loaded cement discs and gentamicin‐coated titanium coupons were able to kill gentamicin‐sensitive and ‐resistant bacteria in a simulated prothesis‐related interfacial gap. In conclusion, the gentamicin coating provided similar antibacterial properties to those seen by gentamicin‐loaded bone cement, implying protection of a prosthesis from being colonized by peri‐operatively introduced bacteria in cementless total joint arthroplasty. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1654–1661, 2011     

Comprehensive meta-analysis of antibiotic-impregnated bone cement versus plain bone cement in primary total knee arthroplasty for preventing periprosthetic joint infection

PurposeAntibiotic-loaded bone cement (ALBC) was usually used to prevent periprosthetic joint infection (PJI) in primary total knee arthroplasty (PTKA), but whether to use ALBC or plain bone cement in PTKA remains unclear. We aimed to compare the occurrence rate of PJI using two different cements, and to investigate the efficacy of different antibiotic types and doses administered in preventing surgical site infection (SSI) with ALBC.MethodsThe availability of ALBC for preventing PJI was evaluated by using a systematic review and meta-analysis referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Existing articles until December 2021 involving PTKA patients with both ALBC and plain bone cement cohorts were scanned by searching “total knee arthroplasty”, “antibiotic-loaded cement”, “antibiotic prophylaxis”, “antibiotic-impregnated cement” and “antibiotic-laden cement” in the database of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library. Subgroup analysis included the effectiveness of different antibiotic types and doses in preventing SSI with ALBC. The modified Jadad scale was employed to score the qualities of included articles.ResultsEleven quantitative studies were enrolled, including 34,159 knees undergoing PTKA. The meta-analysis results demonstrated that the use of prophylactic ALBC could significantly reduce the prevalence of deep incisional SSI after PTKA, whereas there was no significant reduction in the rate of superficial incisional SSI. Moreover, gentamicin-loaded cement was effective in preventing deep incisional SSI, and the use of high-dose ALBC significantly reduced the rate of deep incisional SSI after PTKA. Besides, no significant adverse reactions and complications were stated during the use of ALBC in PTKA.ConclusionThe preventive application of ALBC during PTKA could reduce the rates of deep PJI. Furthermore, bone cement containing gentamicin and high-dose ALBC could even better prevent deep infection after PTKA. However, the existing related articles are mostly single-center and retrospective studies, and further high-quality ones are needed for confirmation.     

抗生素骨水泥和连续灌注治疗关节置换后感染

目的　为人工关节置换术后感染探索新的治疗方法。方法　回顾 68例人工关节置换手术 ,发生术后感染 10例 ,其中全膝关节置换术后感染 4例 ,全髋关节置换术后感染 6例 ,全部采用抗生素骨水泥同时采用抗生素连续灌注。结果　病程在 2周内的 4例用此方法全部保留假体成功 ,其余 6例病程都在 4周以上 ,保留假体失败。结论　关节置换术后感染是严重并发症 ,本方法是一种保留假体的补救措施。     

How do porosity-inducing techniques affect antibiotic elution from bone cement? An in vitro comparison between hydrogen peroxide and a mechanical mixer

Background Increasing the porosity of an antibiotic-loaded cement spacer increases the antibiotic elution, but the correlation between porosity and antibiotic elution is not well documented. The purposes of this study was to attempt new porosity-increasing methods and to investigate the correlation between antibiotic elution and both total and surface porosity. Materials and methods Five types of antibiotic-loaded bone cement (ALBC) using 2 g cefazolin and 40 g cement were prepared. Other than manual mixing, hydrogen peroxide was used as a foaming agent and a mixing drill piece was used as a mechanical device to try to induce porosity when mixing the cement. Elution of antibiotic into phosphate-buffered saline was measured from 1 h to 1 week. Surface porosity was calculated from density values which were measured with a density kit and an electronic balance, while total porosity was quantified using micro-computed tomography. Results When a mixing drill piece was used to induce porosity, we observed a significant increasin antibiotic elution compared to a manually mixed ALBC. On the other hand, hydrogen peroxide reduced the elution significantly. Mild correlation between the total amount of cluted in 1 week antibiotic elution and total porosity was observed. Conclusions In terms of improving elution, the mixing drill piece seemed to be efficient. A relationship between surface porosity and elution efficacy was not observed.     

新型椎弓根钉骨水泥强化系统的生物力学与骨水泥剂量关系

目的建立骨质疏松模型,研究骨质疏松情况下新型经皮长U形空心椎弓根钉骨水泥强化系统(PMI-NPPS)的生物力学与骨水泥剂量之间的关系。方法取年龄在2.5~3.0岁绵羊腰椎,根据羊腰椎大小定做特定尺寸的羊PMI-NPPS。将40个椎体分成A、B组,B组脱钙4 h,分别进行骨密度测量,统计学分析确认骨质疏松模型建立。制备50个骨质疏松椎体随机分成5组,置入羊PMI-NPPS及骨水泥,按剂量分为0 ml组、0.5 ml组、1.0 ml组、1.5 ml组、2.0 ml组,进行生物力学测试,然后得出骨水泥剂量与Fmax(最大拔出力)的关系。结果 A组骨密度值为(0.875±0.003)g/cm~3、B组骨密度值为(0.631±0.003)g/cm~3,B组骨密度值低于A组,差异有统计学意义(P0.05)。脱钙后椎体骨密度较脱钙前降低27.9%。0 ml组、0.5 ml组、1.0 ml组、1.5 ml组、2.0 ml组的Fmax分别为(372.34±47.96)N、(613.85±30.37)N、(760.64±51.18)N、(896.59±47.97)N、(1 011.59±47.97)N。Pearson相关分析结果提示骨水泥剂量与Fmax呈直线相关,线性回归方程为y=312.5x+418.75(R~2=0.977),且1.5 ml为最理想的骨水泥剂量。结论当骨水泥剂量为0~2 ml时,随着骨水泥剂量的增加,羊PMI-NPPS的Fmax越高,且呈线性相关;当骨水泥剂量为1.5 ml时,羊PMI-NPPS的Fmax可达到正常骨密度时内固定的强度。     

椎体成形术中高黏度骨水泥渗漏分析

目的了解高黏度骨水泥在椎体成形术中的渗漏率、渗漏部位及其临床疗效等相关问题。方法回顾性分析本院自2013-06—2014-09行高黏度骨水泥经皮椎体成形术42例的影像资料及临床病例,分析研究手术前后腰背部疼痛VAS评分,骨水泥渗漏部位及相关并发症等。结果患者术后24 h疼痛均明显缓解,视觉疼痛模拟评分(VAS)明显改善(P0.05),10例13个椎体(22.81%)出现骨水泥渗漏,椎体周围渗漏发生率(46.15%)最高,均未出现明显临床症状及体征。结论高黏度骨水泥能确切改善患者疼痛症状,渗漏率相对较低,且多无明显临床症状,适合临床应用。     

Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

In view of the demographic changes and projected increase of arthroplasty procedures worldwide, the number of prosthetic joint infection cases will naturally grow. Therefore, in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance. In the absence of a "miracle weapon" priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks, the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen. Instead of a "one size fits all" philosophy, it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors. A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre. The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.     

The compressive properties of bone cements containing large doses of antibiotics

The addition of large amounts of antibiotics to bone cement provides a convenient local delivery, but may influence the compressive properties of the cement. Flucloxacillin and vancomycin were added to Simplex P (Stryker, Limerick, Ireland) and VersaBond (Smith & Nephew) cements. Tripling the antibiotic dose from 2 to 6 g had little effect on the static compressive properties 24 hours after curing. After 4 weeks in phosphate-buffered saline, there was marked decrease in properties with the addition of antibiotics. Compressive strength of cements with 6 g of antibiotic was reduced to near or below the ASTM and ISO minimum of 70 MPa after 4 weeks in phosphate-buffered saline. Microcomputer tomography revealed increased porosity and clumping of the radiopacifier with the addition of antibiotics.     

Antibiotic-free antimicrobial poly (methyl methacrylate) bone cements: A state-of-the-art review

Prosthetic joint infection (PJI) is the most serious complication following total joint arthroplasty, this being because it is associated with, among other things, high morbidity and low quality of life, is difficult to prevent, and is very challenging to treat/manage. The many shortcomings of antibiotic-loaded poly (methyl methacrylate) (PMMA) bone cement (ALBC) as an agent for preventing and treating/ managing PJI are well-known. One is that microorganisms responsible for most PJI cases, such as methicillin-resistant S. aureus, have developed or are developing resistance to gentamicin sulfate, which is the antibiotic in the vast majority of approved ALBC brands. This has led to many research efforts to develop cements that do not contain gentamicin (or, for that matter, any antibiotic) but demonstrate excellent antimicrobial efficacy. There is a sizeable body of literature on these so-called “antibiotic-free antimicrobial” PMMA bone cements (AFAMBCs). The present work is a comprehensive and critical review of this body. In addition to summaries of key trends in results of characterization studies of AFAMBCs, the attractive features and shortcomings of the literature are highlighted. Shortcomings provide motivation for future work, with some ideas being formulation of a new generation of AFAMBCs by, example, adding a nanostructured material and/or an extract from a natural product to the powder and/or liquid of the basis cement, respectively.     

椎体成形术中骨水泥弥散分布等级的量效关系

目的 提出椎体成形术骨水泥弥散等级分级理论,对不同等级下的止痛效果、腰椎功能进行评价.方法 收集椎体成形术患者57例,根据正侧位X线片简便判断出骨水泥分布等级并进行分组,对术前、术后1周、术后3个月各组间止痛效果、腰椎功能障碍指数进行比较.结果 57例获得平均7个月的随访.57例中14例出现椎体周围骨水泥外渗的情况,未出现神经症状或原有症状加重,每个椎体内注入骨水泥量1.5～5.0(2.6±1.1)ml,57例根据骨水泥弥散等级分为3组,VAS、ODI评分各组内术后与术前比较差异有统计学意义(P＜0.001);术后1周、3个月的组间VAS评分差异无统计学意义(P＞0.05),但在术后1周1级组与3级组ODI评分差异有统计学意义(P ＜0.05);而3个月后各组间ODI评分差异无统计学意义(P＞0.05).结论 经皮椎体成形术(PVP)各级骨水泥弥散等级均可有效缓解椎体压缩骨折引起的疼痛,疼痛缓解程度与骨水泥弥散程度不成比例关系;但在椎体成形术后早期骨水泥弥散等级对脊柱功能障碍指数影响存在统计学意义,认为该分级方法对PVP术后早期脊柱功能评价存在临床指导意义.     

Vancomycin-Gentamicin Prefabricated Spacers in 2-Stage Revision Arthroplasty for Chronic Hip and Knee Periprosthetic Joint Infection: Insights Into Reimplantation Microbiology and Outcomes

BackgroundSecond-stage positive cultures in 2-stage revision arthroplasty are a matter of concern, as their influence in outcomes is not clearly defined. We sought to study reimplantation microbiology when using vancomycin-gentamicin prefabricated cement spacers in hip and knee periprosthetic joint infection. The associations of second-stage positive cultures with treatment failures and patient-associated factors were analyzed.MethodsWe conducted a retrospective cohort study, examining patients managed with 2-stage revision arthroplasty due to knee or hip chronic periprosthetic joint infection between 2010 and 2017. Prefabricated vancomycin-gentamicin cement spacers were used during the spacer stage. Intraoperative microbiological culture results after the first and second stages were evaluated. The primary end point was infection eradication or relapse.ResultsA total of 108 cases were included (61 hips and 47 knees). And 22.2% of patients had ≥1 second-stage positive culture, while 9.3% had ≥2 positive samples. Overall success, at an average follow-up of 46.4 months, was 77.8%. Treatment failure was higher among cases with positive cultures (15.5% vs 45.8%, P < .01) regardless of the number of positive samples. Diabetes was identified as a risk factor for second-stage positive cultures (P = .03); use of cement loaded with extra antibiotics for spacer fixation showed a protective effect (P < .01).ConclusionSecond-stage positive cultures were related to a higher failure rate when using vancomycin-gentamicin cement spacers. Diabetes increased the likelihood of second-stage positive cultures. The use of extra-antibiotic-loaded cement for spacer fixation during the first stage showed a protective effect.     

Fracture of the calcium phosphate bone cement which used to enchondroma of the hand: a case report

Enchondroma of a hand is a common benign tumor. Enchondroma commonly presents as a pathological fracture associated with pain, deformity, and swelling. Dysfunction of the fingers occurs as a result of the fracture. Curettage is the mainstay of surgical treatment for enchondroma.     

基于Mimics软件计算椎体强化术后椎体内骨水泥体积及骨水泥/椎体体积比的新方法

目的:建立基于Mimics软件计算椎体强化术后椎体内骨水泥量与骨水泥/椎体体积比的新方法,并验证其准确性与可靠性.方法:2012年1月～3月共有12例骨质疏松性椎体压缩骨折患者在我院接受椎体强化术(14个椎体),均使用标准化定量推注管道注入骨水泥,由2名脊柱外科医师准确记录骨水泥量,将他们记录的平均值定义为椎体内实际骨水泥量.术后对患者手术节段进行CT薄层扫描,再将CT数据输入Mimics软件,利用Mimics软件计算测量注入椎体的骨水泥量及椎体体积,并计算出椎体内骨水泥/椎体的体积比,将2名检测者计算出的骨水泥量平均值定义为椎体内骨水泥估计量,将计算出的椎体内骨水泥估计量与椎体内实际骨水泥量进行对比分析,判断这一新方法的准确性.并对2名不同检测者按照同样操作流程测量出的骨水泥体积及椎体体积进行比较,以判断这一新方法的可靠性.结果:12例患者(14个椎体)手术均顺利完成,术中未见明显骨水泥渗漏,2名医师记录的椎体内实际骨水泥量为4.99±0.60ml,检测者A测量出的骨水泥体积和椎体体积分别为5.01±0.61ml、26.66±2.93ml,检测者B测量出的骨水泥体积和椎体体积分别为5.02±0.59ml、26.64±2.92ml,检测者A及B测量出骨水泥体积的平均值(椎体内骨水泥估计量)为5.02±0.60ml,椎体内骨水泥/椎体体积比为0.19±0.03(0.13～0.23).椎体内骨水泥估计量与椎体内实际骨水泥量相比无显著性差异(P＞0.05),骨水泥估计量及椎体体积计算量在2名不同检测者之间也无显著性差异(P＞0.05).结论:Mimics软件可精确计算椎体内骨水泥量,并测量出骨水泥/椎体体积比,这一方法具有较好的准确性及可靠性,有利于进一步开展椎体强化术骨水泥量的相关研究.     

高粘度骨水泥与低粘度骨水泥椎体成形术治疗骨质疏松性椎体压缩性骨折的疗效比较

目的 比较在椎体成形术中，高粘度骨水泥和低粘度骨水泥治疗骨质疏松性椎体压缩性骨折的临床疗效差异。方法 回顾性分析83例骨质疏松性椎体压缩性骨折患者，接受椎体成形术后的病例资料。其中采用低粘度骨水泥椎体成形术患者43例；采用高粘度骨水泥椎体成形术患者40例。记录单个椎体手术时间、骨水泥渗漏发生率，术后并发症发生率。利用视觉模拟评分及功能障碍指数评分对两组进行术前及术后一天、术后三个月疼痛及功能评价。通过X线片对术前、术后椎体各部进行测量，统计椎体高度变化。结果 83例患者均得到随访，通过对两组的各项指标比较，在术前视觉模拟评分和术前骨折压缩率上无明显统计学差异。在手术时间上高粘度组较低粘度骨水泥组明显缩短（t=22.32，P=0.000）。高粘度骨水泥组和低粘度骨水泥组的术后一日、术后三个月视觉模拟评分、功能障碍指数评分较术前明显降低，组内差异有高度显著性（P=0.000），组间无明显差异。高粘度组骨水泥渗漏率较低粘度骨水泥组明显降低，差异有统计学意义（P=0.0494）。椎体成形术后高粘度骨水泥组椎体高度恢复优于低粘度骨水泥组，差异有显著统计学意义（P=0.000）。结论 椎体成形术中使用不同类型的骨水泥都能有效的缓解病人疼痛，改善生活质量。与低粘度骨水泥相比，高粘度骨水泥有着较低的骨水泥渗漏率，同时缩短了手术时间和减少放射性的暴露。高粘度骨水泥在治疗骨质疏松性椎体压缩性骨折方面有一定的优势。     

Femoral nerve compression after migration of bone cement to the groin after hip arthroplasty

Although often a benign complication of total hip arthroplasty, cement extrusion can cause nerve, vessel, and organ compression. We report the case of a 70-year-old male patient in whom an extruded cement mass migrated anteriorly and compressed the femoral nerve and impinged on the femoral artery producing acute, severe groin pain with neuralgia 9 years postoperatively. Paresthesia of the anterior and medial thigh was found on examination. Radiographic, ultrasound, and computed tomographic studies confirmed a 6 × 1.5-cm mass of bone cement in the right groin compressing the femoral nerve that was removed successfully at surgery. Six months postoperatively, the patient's pain had resolved, but hyperesthesia of the medial thigh remained.     

No efficacy of silver bone cement in the prevention of methicillin‐sensitive Staphylococcal infections in a rabbit contaminated implant bed model

Data from literature showed that a new type of metallic silver PMMA cement had good results in infection prophylaxis. This study investigated the in vivo efficacy of silver cement in the prevention of methicillin‐sensitive Staphylococcal infections, compared to plain and tobramycin‐containing cement. In 48 rabbits, 0.6% silver, 1% silver, plain, or tobramycin PMMA cement was injected into the femoral medullary canal after contamination with 10⁵, 10⁶, or 10⁷ colony forming units (CFU) Staphylococcus aureus. After 14 days, bone was collected for bacteriology and histopathology. All plain and silver cement rabbits were infected, whereas only two tobra rabbits were infected (p < 0.001). The number of bacteria cultured (¹⁰logCFU) from bone adjacent to the cement, was 6.4 ± 0.3 and 6.1 ± 0.3 for the 0.6% and 1% silver rabbits. For the rabbits with plain and tobra cement, this was 6.2 ± 0.2 (p > 0.95) and 0.0 ± 0.0 (p < 0.001), respectively. Two tobra rabbits had a positive culture of a distal bone sample. Histological sections of plain, 0.6%, and 1% silver rabbits all showed signs of infection; these signs were absent in the tobra rabbits. Silver and plain cement were not effective in preventing infection, whereas tobra cement was effective. As silver cement predominantly exhibits an antimicrobial effect at the direct cement surface, this cement seems less useful in situations where there are bacteria present in surrounding tissues, like revision surgery. Whether silver cement has relevance in the prevention of bacterial colonization of cement remains to be determined. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 1002–1007, 2009     

髋关节抗生素骨水泥占位器的研究进展

感染可能是外科植入体如人工假体、髓内针、钢板的严重并发症。尽管围手术期给予适当的抗生素,但仍有相当数量患者术后发生假体周围感染(PJI)。感染的结果导致过度使用抗生素、假体移除、再手术和可能的截肢。当前,PJI通常很难预测、诊断和治疗,二期翻修术是治疗PJI的合理选择。本文仅对髋关节临时占位器(spacer)的有关研究进展作一综述。