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首页> 外文期刊>The Journal of arthroplasty >Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system.
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Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system.

机译：骨水泥中抗生素的长期洗脱：使用载有抗生素的丙烯酸水泥（PROSTALAC）系统的假体进行的体内研究。

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摘要

A prospective study of 49 patients undergoing a modified 2-stage exchange arthroplasty for infected total hip and knee arthroplasties using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system with a variety of doses of tobramycin and vancomycin was performed. The intra-articular concentrations of tobramycin and vancomycin were measured at the time of removal of the PROSTALAC temporary spacer and reimplantation of a definitive joint arthroplasty prosthesis, at a mean 118 days following initial implantation. The 95% confidence interval of the intra-articular concentration of tobramycin (4.35-123.88 mg/L) was entirely above the breakpoint sensitivity limit for sensitive organisms when at least 3.6 g of tobramycin was used per package of bone-cement but was entirely below it when at most 2.4 g was used. Vancomycin elution was not as good; however, detectable levels were still present in most patients. There was a statistically significant increase in the elution of vancomycin when the dose of tobramycin was increased from at most 2.4 g to at least 3.6 g. The dose of vancomycin in the cement did not influence the elution of either tobramycin or vancomycin. On the basis of these results, the use of at least 3.6 g of tobramycin and 1 g of vancomycin per package of bone-cement is recommended when antibiotic-loaded cement spacers are used in 2-stage exchange arthroplasty for infected total hip and knee arthroplasties.
机译：进行了一项前瞻性研究，对49名患者进行了改良的2阶段置换置换术，该置换术采用了载有多种剂量的妥布霉素和万古霉素的载有抗生素的丙烯酸水泥（PROSTALAC）系统假体，进行了全髋关节和膝关节置换术的感染。在初次植入后平均118天，在移除PROSTALAC临时间隔物和确定的关节置换术假体再植入时，测量妥布霉素和万古霉素的关节内浓度。当每包骨水泥至少使用3.6 g妥布霉素时，妥布霉素的关节内浓度（4.35-123.88 mg / L）的95％置信区间完全高于敏感生物的断点敏感性极限。最多使用2.4克时。万古霉素洗脱效果不佳;但是，大多数患者中仍存在可检测的水平。当妥布霉素的剂量从最多2.4 g增加到至少3.6 g时，万古霉素的洗脱有统计学上的显着增加。水泥中万古霉素的剂量不影响妥布霉素或万古霉素的洗脱。根据这些结果，当在两阶段置换置换术中使用载有抗生素的水泥垫片治疗感染的全髋和膝关节置换术时，建议每包骨水泥至少使用3.6 g妥布霉素和1 g万古霉素。

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