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。     

Combined Autograft and Bone Cement for Painful Chondroblastoma: A Case Report

Chondroblastomas of the talus can lead to joint collapse and are often treated using curettage and bone grafting. In the present report, we describe the case of a 19-year-old female with a large chondroblastoma of the talus associated with a secondary aneurysmal cyst. We treated the large cartilage lesion, which involved most of the talus, with an iliac bone graft combined with bone cement to fill the large bone defect and preserve the subchondral bone of the articular surface of the dome of the talus.     

Nephrotoxicity After the Treatment of Periprosthetic Joint Infection With Antibiotic-Loaded Cement Spacers

Background

Treatment of periprosthetic joint infections commonly involves insertion of an antibiotic-loaded cement spacer (ACS). The risk for acute kidney injury (AKI) related to use of antibiotic spacers has not been well defined. We aimed to identify the incidence of and risk factors for AKI after placement of an ACS.

Cement Loaded With High-Dose Gentamicin and Clindamycin Reduces the Risk of Subsequent Infection After One-Stage Hip or Knee Arthroplasty Exchange for Periprosthetic Infection: A Preliminary Study

BackgroundThe use of antibiotic-loaded acrylic cement for treating periprosthetic joint infections remains controversial. We hypothesized that the raw rate of surgical site infection (SSI) is lower after using cement loaded with high-dose gentamicin and clindamycin than after using cement loaded with standard-dose gentamicin for implant fixation during 1-stage hip and knee revision arthroplasty for infection.MethodsOne hundred seventy-one continuous patients operated by 2 experienced surgeons during a 2-year period were included in the study. All patients were followed for 24 months. The primary endpoint was the raw rate of SSI after 2 years of follow-up time.ResultsThe raw rate of SSI after 2 years of follow-up time was significantly lower in the study group (13%) than in the control group (26%) (P = .03) with an odds ratio of 0.42 (P = .03). These SSIs were new infections rather than a recurrence/persistence of the initial infection.ConclusionThe cement used in the study group significantly reduced the risk of SSI relative to the cement used in the control group. Routine use of this high-dose dual antibiotic-loaded cement can be considered during 1-stage knee or hip revision arthroplasty for infection.     

Routine Use of Antibiotic Laden Bone Cement for Primary Total Knee Arthroplasty: Impact on Infecting Microbial Patterns and Resistance Profiles

Antibiotic-laden bone cement (ALBC) is used in primary arthroplasties throughout Europe. In North America, ALBC is only FDA approved for revision arthroplasty after periprosthetic joint infection (PJI). No article has evaluated whether infecting microbial profile and resistance has changed with the introduction of ALBC. We hypothesized that prophylactic use of ALBC in primary total knee arthroplasty (TKA) has not had a significant impact on infecting pathogens, and antibiotic resistance profiles. A retrospective cohort analysis was conducted of all PJI patients undergoing primary TKA and total hip arthroplasty (THA) between January 2000 and January 2009. No significant change in the patterns of infecting PJI pathogens, and no notable increase in percentage resistance was found among organisms grown from patients with PJI that had received prophylactic antibiotic-loaded cement in their primary joint arthroplasty. Early findings suggest that routine prophylactic use of ALBC has not led to changes in infecting pathogen profile, nor has led to the emergence of antimicrobial resistance at our institution.     

Moore Hemi-Arthroplasty with and Without Bone Cement in Femoral Neck Fractures: A Clinical Controlled Trial

In a clinical, controlled trial 112 patients with fresh femoral neck fractures were allocated to two groups of treatment: 55 patients had a Moore hemi-arthroplasty cemented with methyl methacrylate and 57 patients a non-cemented prosthesis. 75 patients attended the follow-up study. At 6 weeks, 3 months, 6 months and 12 months after the operation the function of the hip was assessed according to Merle d'Aubigné. At 6 weeks, 3 months and 6 months after the operation the clinical results were significantly better among patients with cemented prosthesis, especially in relation to pain relief and gait function. It is concluded that fixation of the prosthesis with cement improves the clinical results, at least during the first 6 months following the operation.     

异体骨和异体骨骨水泥在骨骼重建方面的临床观察

目的研究异体骨和异体骨骨水泥重建骨缺损的疗效。方法本组42例，行异体骨植入的20例，异体骨骨水泥(异体骨粒与骨水泥体积比为1：1混合)重建的22例。结果42例患者随访3个月～2．5年，平均1．3a。其中20例用异体骨全部愈合，愈合时间3．5～7个月，平均5．2个月。22例异体骨水泥中有2例骨不连，其余均愈合，愈合率为90．9％，愈合时间为9～12个月，平均10．5个月。结论异体骨和异体骨骨水泥在骨缺损的重建上疗效优良，异体骨应用范围更广，治愈率更高，异体骨骨水泥在治疗良、恶交界性和恶性肿瘤上性能优越，尤其适应于生存时间长的骨肿瘤的保肢术是一种切实可行的方法。     

Bone Scintigraphy in Moore Hemiarthroplasty with and Without Cement Following Femoral Neck Fractures: A Controlled Study

In a controlled clinical trial patients with acute femoral neck fractures were allocated into two groups of treatment. One group (14 patients) had a Moore hemiarthroplasty cemented with methyl methacrylate, and the other (15 patients) a non-cemented prosthesis. Bone scanning with 99m-Tc-MDP was performed 6 weeks, 3 months, 6 months and 12 months after the operation. Increased activity without time-trend was found at the operated side during the entire observation period in both groups. the activity was equally increased in the two groups. No correlation was found between the scintigraphic activity and the functional hip assessment according to Merle Aubigne.

Bone scintigraphy is of no diagnostic value in the evaluation of a hemiarthroplasty, cemented or without cementation, during the first year postoperatively, as an increased activity might be expected through the entire period.     

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.     

Bioactivity of Ceftazidime and Fluconazole Included in Polymethyl Methacrylate Bone Cement for Use in Arthroplasty

Background

The microorganisms that most frequently cause prosthetic joint infection are methicillin-resistant Staphylococcus aureus and gram-negative aerobic bacillus. Studies have documented the efficacy of mixing antibiotics with polymethyl methacrylate, but that of antifungal drugs has not received much attention. The objective of this in vitro study was to characterize the elution profile and bioactivity of ceftazidime and fluconazole when incorporated into bone cement in proportions intended for prophylaxis and treatment of bone infections.

Viability and Osteogenicity of Bone Graft Coated with Methylmethacrylate Cement

The idea of utilizing bone grafts during hip arthroplasty has been discussed in the literature and clinical successes have been indicated. These communications, however, did not relate to long-term results. Thus, to date, we still lack sufficient understanding as to the fate of bone grafts when they are coated with methyl-methacrylate. In order to elucidate the above issue further an experimental study has recently been initiated in an attempt to provide answers to the following questions: a) do bone grafts remain viable when they are held in place with methyl-methacrylate bone cement? and b) do such grafts retain their osteogenic potential? In the present study osteotomies were made in the femora of dogs and cortico-cancellous strips of autogenous bone were placed around the osteotomy site. The grafts were then surrounded by polymethylmethacrylate bone cement. Mechanical examinations and morphological studies, performed 3, 6 and 10 months following surgery, revealed the elaboration of fibro-osseous union. Our present findings tend to indicate that bone grafts, even if they are covered with methylmethacrylate bone cement, still retain their viability as well as their osteogenic potential.     

Is the Commercial Antibiotic-Loaded Bone Cement Useful in Prophylaxis and Cost Saving After Knee and Hip Joint Arthroplasty? The Transatlantic Paradox

Background

The use of antibiotic-loaded bone cement (ALBC) has proven to be effective in preventing periprosthetic infection (PPI) after total hip (THA) and knee arthroplasty (TKA). However, the economic benefit of using ALBC routinely remains controversial.

The in Vitro Elution of Gentamicin Sulphate from Methylmethacrylate Bone Cement: A Comparative Study

The in vitro elution of gentamicin from three brands of bone cement has been studied. One was found to have a much longer lasting activity than the other two. This activity and the possible deleterious side effects from the use of gentamicin in bone cement as a routine procedure are discussed.     

复合阿伦磷酸钠骨水泥洗提特性的实验研究

目的研究复合阿伦磷酸钠骨水泥的洗提特性及不同阿伦磷酸钠加入量对骨水泥洗提特性的影响。方法制备5组不同阿伦磷酸钠加入量的骨水泥浸提标本,用高效液相色谱仪串联质谱仪测定浸提液中20个不同时间点的药物释放速率和释放总量百分比。结果各组阿伦磷酸钠释放速率先快后慢,随着加入量增加而增大;释放总量百分比在快速释放期（约1周）相似,约11%,而在缓慢释放期差别更大,但在24周时均小于25%。结论骨水泥是一种良好的阿伦磷酸钠的载体和缓释体,阿伦磷酸钠在骨水泥聚合时未被破坏且可从骨水泥中缓慢释放,释放浓度随加入量增加而增加。     

Vancomycin-Impregnated polymethylmethacrylate beads for methicillin-resistant Staphylococcus aureus (MRSA) infection: Report of two cases

Two patients with methicillin-resistant Staphylococcus aureus (MRSA) infection were treated with vancomycin (VCM)-impregnated polymethylmethacrylate (PMMA) beads. One patient, who had a history of polycystic kidney and diabetes mellitus, who was receiving hemodialysis due because of non-functional kidney, underwent resection of an intermediate grade chondrosarcoma in the pelvis. MRSA infection developed and curettage of the lesion was performed, but MRSA infection recurred. During the second revision surgery, VCM-impregnated PMMA beads were implanted. MRSA infection has not recurred for 16 months since the implantation of the VCM beads. The second patient had a history of total hip arthroplasty (THA) performed because of coxarthrosis. After the initial surgery, MRSA infection developed, recurring after the second revision surgery for THA. After curettage following removal of the prosthesis, VCM beads were implanted with a spacer composed of VCM-PMMA and a Luque rod. Infection did not recur and THA revision was performed 3 months after the VCM beads implantation. Fifteen months after the last revision surgery, infection has not recurred. Received for publication on July 24, 1997; accepted on Jan. 13, 1998     

载药骨基质明胶缓释体的研制与实验

目的　研制载药骨基质明胶缓释体 ,为人工关节感染和松动的防治提供新方法。方法　将BMG溶于头孢唑林钠溶液 ,通过真空吸附、冻干等处理 ,制得载药BMG。测定其体内、体外释药浓度及持续时间以及载药BMG的诱导成骨能力。结果　载药BMG体外对金葡菌的抑制作用为 2 2d ,体内为 14d。载药BMG体内释药时 ,局部组织浓度高 ,血浆浓度低 ;局部组织早期浓度高 ,以后为稳定的低浓度释放。载药BMG中掺入抗生素后不影响BMG的诱导成骨能力。结论　载药BMG既能持续释放有效浓度的抗生素 ,又具有强的诱导成骨能力 ,可望成为防治人工关节感染和松动的一种新方法。     

Fracture Toughness of Acrylic PMMA Bone Cement: A Mini-Review

BackgroundAcrylic PMMA bone cement is an essential component in cemented implants and formed the cement-bone and cement-implant interfaces. The information on the fracture parameters of PMMA bone cement would be decisive for all doctors, researchers, and orthopaedic surgeons.PurposeThis review aims to indicate the parameters responsible for the variation in the fracture toughness of PMMA bone cement. This mini-review also points out some limitations of the earlier published research article, which can be added in the future analysis and can be helpful to get the more realistic data of the fracture parameters of PMMA bone cement.ConclusionDifferent mixing techniques, storage medium, temperature, loading conditions, frequency and environment, cement viscosity, type of specimen, and the ASTM standards (shape, size, and geometry), constituents, loading rate, and cement porosity were the critical parameters to affect the fracture toughness of PMMA bone cement. This study will also be helpful to increase the structural integrity of PMMA bone cement and the cemented implant.     

Systemic Absorption of Antibiotics From Antibiotic-Loaded Cement Spacers for the Treatment of Periprosthetic Joint Infection

Background

Two-stage treatment of periprosthetic joint infections involves placement of high-dose antibiotic-loaded cement spacers (ACSs). Reports of ACS-induced nephrotoxicity have raised concern regarding systemic absorption of antibiotics after ACS placement. We sought to characterize the serum concentrations of antibiotics that occur after ACS placement.

脱钙骨基质/磷酸钙复合骨水泥骨诱导活性观察

目的:观察磷酸钙骨水泥(CPC)中加入脱钙骨基质(DBM)后形成的复合骨水泥的成骨诱导活性。方法:将DBM/CPC复合骨水泥分别植入兔背肌肌袋内,于不同时间取材,通过组织学切片、ALP等手段观察异位诱导成骨情况。结果:术后2周,DBM/CPC复合骨水泥组可见间充质细胞增殖、聚集并包绕DBM骨粒。4周时,DBM已有部分吸收,并软骨样细胞和软骨样组织包裹。8周,DBM进一步吸收,软骨细胞和软骨组织逐渐成熟,新骨形成。12周,DBM吸收并被新骨组织部分或大部分代替且相互连接成片。ALP测定结果与组织学观察的新骨形成情况基本一致。结论:DBM/CPC复合骨水泥有较强的异位诱导成骨能力,诱导新骨的形成伴随着材料的降解,可以有效弥补单纯使用CPC时降解速度太慢和无骨诱导能力的不足。     

Depressive Effects of Acrylic Cement Components on Bone Metabolism: Isotope Release and Phosphatase Production Studied in Vitro

In vitro methyl methacrylate bone cement components were found to depress the release of radioactive calcium and proline as well as the activity of both alkaline and acid phosphatases. These effects were dose dependent and reached levels observed for dead bone. These observations may reflect part of the pathogenesis of loosening of joint replacements involving the use of bone cement.