Abstract

Bone infections can be challenging to treat and can lead to several surgeries and relapses. When a graft is needed, cavitary bone loss can be grafted with cancellous or cortical bone. Both can be used for grafting. However, the antibiotic releasing capacity of these grafts has not been compared. Which type of bone is best at releasing the most antibiotic has not been well established. The aim of this study was to determine which type of bone is best for antibiotic release when the bone is suffused with antibiotics by the surgeon. The hypothesis is that there would be a difference between the type of bone tested due to different release capacities of cortical and cancellous bone. This was an experimental study. Cortical spongy bone in chips, Spongy bone in chips and demineralized cortical bone powder were compared. For each type of bone, 5 samples were tested. Processed and decontaminated grafts were freeze-dried to be kept at room temperature. The primary endpoint was the amount of vancomycin released by the graft as it affects the concentration of antibiotic around the graft in clinical practice. The procedure for the study consisted of full graft immersion in a vancomycin solution. Then, the liquid was removed with aspiration. In order to measure the quantity of antibiotic released, the bone was put into distilled water in agitation in a heated rocker at 37 °C. After 30 min of soaking, 1 mL of the liquid was removed. The same extraction process was also carried out after 60 min soaking, 2 h, 3 h, 24 h, and 48 h. No differences were found between each type of bone relative to the concentration of vancomycin released at each time of the assessment. There was a significant difference in the weight of the bone with a higher weight for the cortical powder (1.793 g) versus cortical spongy bone and spongy bone (1.154 g and 1.013 g) with a p value < 0.0001. A significant difference was seen in the weight of the bone with vancomycin after the aspiration of the liquid with 3.026 g for cortical powder, 2.140 g and 2.049 g for the cortical spongy bone and the spongy bone with a p value < 0.0001. In daily clinical practice, one can use cancellous bone, cortico-cancellous bone or cortical powder in order to add vancomycin to a bone graft. Our results show the release kinetics of the soaked allografts. With a maximum of 14 mg/mL in the first minutes and a rapid decrease it shows a pattern comparable to antibiotic loaded bone cement. The method used appears favourable for prophylactic use, protecting the graft against contamination at implantation, but is not sufficient for treating chronic bone infection.

Level of evidence

V.

中文翻译：

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哪种类型的骨骼释放出的万古霉素最多？海绵骨，皮质粉末和皮质海绵骨的比较

摘要

骨感染的治疗可能具有挑战性，并可能导致多次手术和复发。当需要移植时，可以将空骨丢失与松质或皮质骨移植在一起。两者均可用于嫁接。然而，尚未比较这些移植物的抗生素释放能力。哪种类型的骨骼最能释放出最多的抗生素，目前尚无定论。这项研究的目的是确定外科医生给骨头注入抗生素时哪种骨头最适合释放抗生素。假设是，由于皮层和松质骨的释放能力不同，所测试的骨类型之​​间会有差异。这是一项实验性研究。比较了片状皮质海绵状骨，片状海绵状骨和脱矿质的皮质骨粉。对于每种类型的骨骼，测试了5个样品。将经过处理和去污的移植物冷冻干燥，以保持在室温下。主要终点是移植物释放的万古霉素的量，因为它影响临床实践中移植物周围抗生素的浓度。研究程序包括将移植物完全浸入万古霉素溶液中。然后，通过抽吸除去液体。为了测量释放的抗生素的量，将骨头放入37°C加热的摇床上搅拌下的蒸馏水中。浸泡30分钟后，除去1 mL液体。在浸泡60分钟，2小时，3小时，24小时和48小时后，也进行了相同的提取过程。相对于每次评估时释放的万古霉素浓度，每种骨之间均未发现差异。p值<0.0001。抽吸液体后，万古霉素的骨重量有显着差异，皮质粉末为3.026 g，皮质海绵状骨为2.140 g，海绵状骨为2.049 g，p值<0.0001。在日常临床实践中，可以使用松质骨，皮质-松质骨或皮质粉末来向骨移植物中添加万古霉素。我们的结果显示了浸泡的同种异体移植物的释放动力学。在开始的几分钟内最高含量为14 mg / mL，并迅速降低，显示出与载有抗生素的骨水泥相当的模式。所使用的方法似乎有利于预防性使用，可以保护移植物免受植入时的污染，但不足以治疗慢性骨感染。

证据水平

V.