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

发布时间：2018-06-15 00:25

本文选题：骨钉 + 羟基磷灰石　；参考：《中国组织工程研究》2017年14期

【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(P0.05);(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(P0.05);(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。
[Abstract]:Background: tibia is the most common site of open fracture in human body. Intramedullary fixation has become the first choice in treatment, but the risk of infection is higher and the treatment is more difficult, which limits the use of internal fixation. Objective: to investigate the therapeutic effect of vancomycin-hydroxyapatite-coated titanium intramedullary nail on bacterial wound infection of open fracture of femur in rabbits. Methods: three kinds of vancomycin-hydroxyapatite coated intramedullary nails with different antibiotic concentrations were prepared by bionic solution growth method. The bacterial contamination model of open fracture of femur was made in 40 healthy male new southwest white rabbits. According to the intramedullary nail implantation, the rabbits were divided into two groups: normal intramedullary nail group (n = 10), low and middle bone marrow nail group (n = 10). High concentration of vancomycin-hydroxyapatite coated intramedullary nail group. The appearance of the wound was observed dynamically, the body weight, anus temperature, the content of leukocyte C-reactive protein in venous blood, the pathological examination of soft tissue around the fracture and X-ray examination of the injured limb were carried out regularly. Results and conclusion the vancomycin-hydroxyapatite coated intramedullary nail prepared by the experiment had obvious bacteriostasis in vitro. The anus temperature of the common intramedullary nail group was significantly higher than that of the vancomycin hydroxyapatite group on the 3rd day after the model was made, and the anus temperature of the common intramedullary nail group was significantly higher than that of the vancomycin hydroxyapatite group. In high concentration vancomycin-hydroxyapatite group, the leukocyte C-reactive protein in venous blood was significantly lower than that in the common intramedullary nail group on the 28th day after modeling.) the histopathological changes of hematoxylin and eosin around the fracture were observed by hematoxylin and eosin staining. The degree of inflammation in the prime-hydroxyapatite coating group was significantly lower than that in the common intramedullary nail group at each time point. X ray showed that the callus of the common intramedullary nail group grew slowly and the dead bone formed. The callus growth of vancomycin-hydroxyapatite coated group was better than that of common intramedullary nail group (6). Vancomycin-hydroxyapatite-coated intramedullary nail can effectively reduce the incidence of postoperative infection in the treatment of animal model of bacterial contamination of open femoral fractures.
【作者单位】：西南医科大学附属医院骨与关节外科;
【基金】：泸州市科技局项目(2011-S-39(3/6))~~
【分类号】：R318.08;R683

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