CAJ | 학술논문

目的探讨自体微小颗粒骨复合万古霉素缓释微球治疗感染性骨缺损的效果.方法通过复乳-固化法制备万古霉素缓释微球.取48只家兔,按沈霖造模法制作双侧桡骨中上段慢性骨髓炎模型,随机分为3组,每组16只.1个月后局部彻底清创造成骨缺损,A组植入自体微小颗粒骨,B组植入自体微小颗粒骨混合万古霉素,C组植入自体微小颗粒骨复合万古霉素缓释微球.分别于术前、术后1d、3d、7d、2周、4周测定各组动物血清C-反应蛋白(CRP)及红细胞沉降率(ESR),于术后2、4、8及12周每组处死4只兔,行植骨区大体形态、X线片及组织学观察.结果术后3d、7dB组CRP水平显著低于A组,但大于C组;术后1d、3d、2周、4周B、C组ESR显著低于A组,术后7d、2周C组ESR显著低于B组,差异均有统计学意义(P＜0.05).术后2、4、8周B、C组X线片评分均优于A组,差异有统计学意义(P＜0.05);术后12周A、B、C3组之间X线片评分比较差异无统计学意义(P＞0.05).术后2、4、8、12周,B、C组组织学评分均优于A组,差异有统计学意义(P＜0.05).结论对于家兔感染性骨缺损,局部应用自体微小颗粒骨复合万古霉素缓释微球的疗效与自体微小颗粒骨混合万古霉素相当,均好于自体微小颗粒骨.
목적 탐토자체미소과립골복합만고매소완석미구치료감염성골결손적효과.방법 통과복유-고화법제비만고매소완석미구.취48지가토,안침림조모법제작쌍측뇨골중상단만성골수염모형,수궤분위3조,매조16지.1개월후국부철저청창조성골결손,A조식입자체미소과립골,B조식입자체미소과립골혼합만고매소,C조식입자체미소과립골복합만고매소완석미구.분별우술전、술후1d、3d、7d、2주、4주측정각조동물혈청C-반응단백(CRP)급홍세포침강솔(ESR),우술후2、4、8급12주매조처사4지토,행식골구대체형태、X선편급조직학관찰.결과 술후3d、7dB조CRP수평현저저우A조,단대우C조;술후1d、3d、2주、4주B、C조ESR현저저우A조,술후7d、2주C조ESR현저저우B조,차이균유통계학의의(P＜0.05).술후2、4、8주B、C조X선편평분균우우A조,차이유통계학의의(P＜0.05);술후12주A、B、C3조지간X선편평분비교차이무통계학의의(P＞0.05).술후2、4、8、12주,B、C조조직학평분균우우A조,차이유통계학의의(P＜0.05).결론 대우가토감염성골결손,국부응용자체미소과립골복합만고매소완석미구적료효여자체미소과립골혼합만고매소상당,균호우자체미소과립골.
Objective To evaluate the effect of compounds of autologous micromorselized bone and [poly(D,L-lactide-co-glycolide),PLGA] microspheres loaded with hydrochloric vancomycin on repairing infected bone defects.Methods PLGA microspheres loaded with vancomycin were manufactured.Animal models of chronic osteomyelitis were created at the middle and upper segments of bilateral radii in 48 white rabbits.The rabbit models were randomized into 3 equal groups (16 in each).Bone defects were made one month later by topical debridement.In group A,tiny autogenous granular bone was implanted into the defects; in group B,autogenous bone microspheres loaded with vancomycin were implanted; in group C,compounds of autogenous tiny granular bone and vancomycin-loaded PLGA microspheres were implanted.The serum c-reaction protein (CRP) and erythrocyte sedimentation rate (ESR) were detected in each group at preoperation,1,3,7 days,2 and 4 weeks postoperation.Four rabbits were sacrificed each time at 2,4,8 and 12 weeks postoperation for gross observation,X-ray and histopathological examinations of the implant areas.Results At 3,7 days postoperation,the CRP level in group B was significantly lower than that in group A,but significantly higher than that in group C (P ＜ 0.05).At 1,3 days,2,4 weeks postoperation,the ESR in groups B and C was significantly lower than that in group A; at 7 days and 2 weeks postoperation,the ESR in group C was significantly lower than that in group B (P ＜ 0.05).At 2,4,8 weeks postoperation,groups B and C scored significantly better than group A in X-ray assessment (P ＜ 0.05).At 12 weeks postoperation,there was no significant difference in X-ray assessment between groups A,B and C (P ＞ 0.05).At 2,4,8,12 weeks postoperation,the histological scores for groups B and C were significantly higher than those for group A(P ＜ 0.05).Conclusion In treatment of infected bone defects in rabbits,compounds of autologous micromorselized bone and PLGA microspheres loaded with hydrochloric vancomycin are similar to autogenous bone microspheres loaded with vancomycin in therapeutic effect but better than tiny autogenous granular bone.