背景:慢性骨髓炎的治疗策略中,局部抗生素缓释系统因可长期释放有效浓度的抗生素控制感染,同时能修复彻底清创后引起的骨缺损在临床中备受关注. 目的:总结可生物降解聚合物基材料制备抗生素缓释载体用于治疗骨髓炎的研究现状,并分析局限性及挑战. 方法:作者以"Polymer,Composite material,Osteomyelitis,Infectious bone defect,Drug delivery systems,Antibiotic sustained-release system,3D printing;聚合物,复合材料,骨髓炎,感染性骨缺损,药物递送系统,抗生素缓释系统,3D打印"为关键词,检索2015年1月至 2023年8月期间PubMed、Web of Science、中国知网、万方数据库中的相关文献.初检得到文章4 351篇,筛选后对87篇文章进行分析. 结果与结论:聚合物基材料因具有良好的生物相容性、生物降解性能、热稳定性及易加工性等多功能特点在抗生素缓释载体制备中得到广泛研究,但单一聚合物材料组成的抗生素缓释载体因生物力学性能不足等原因无法满足感染性骨缺损修复材料的标准.模拟天然骨组织结构形成的有机-无机复合材料型载体有望达到这个标准.3D打印技术可以精确控制载体的相互连接孔隙大小、几何形状和空间分布等,并能负载有效浓度的抗生素做到控制释放.高分子聚合物材料因具有良好的热稳定性、可塑性等优点最适合用于3D打印.因此在新型可生物降解有机-无机复合材料基础上,结合3D打印技术建立材料-结构-功能一体化的复合抗生素缓释载体因仿真模拟细胞外基质微环境有望成为慢性骨髓炎治疗中新颖的研究方向.
BACKGROUND:In the treatment strategy of chronic osteomyelitis,the local antibiotic slow-release system has attracted much attention in the clinic due to the long-term release of effective concentrations of antibiotics to control the infection,and at the same time,the ability to repair bone defects caused by debridement. OBJECTIVE:To summarize the research status of antibiotic sustained-release carriers prepared from biodegradable polymer-based materials for the treatment of osteomyelitis,and analyze the limitations and challenges. METHODS:Chinese and English key words were"polymer,composite material,osteomyelitis,infectious bone defect,drug delivery systems,antibiotic sustained-release system,3D printing".Relevant articles were searched in PubMed,Web of Science,CNKI,and WanFang databases from January 2015 to August 2023.4 351 articles were obtained in the initial examination,and 87 articles were analyzed after screening. RESULTS AND CONCLUSION:Polymer-based materials have been widely studied in the preparation of antibiotic sustained-release carriers due to their good biocompatibility,biodegradability,thermal stability,and easy processing.However,the antibiotic slow-release carrier composed of a single polymer material cannot meet the standard of infectious bone defect repair materials due to the lack of biomechanical properties.The organic-inorganic composite material carrier,which simulates the formation of natural bone tissue structure,is expected to meet this standard.3D printing technology can precisely control the size,geometry,and spatial distribution of the interconnecting pores of the carrier,and can load the effective concentration of antibiotics to achieve controlled release.The polymer material is the most suitable for 3D printing because of its good thermal stability and plasticity.Therefore,the author believes that on the basis of new biodegradable organic-inorganic composite materials and combined with 3D printing technology,the material-structure-function integrated composite antibiotic slow-release carrier to simulate the extracellular matrix microenvironment is expected to become a novel research direction in the treatment of chronic osteomyelitis.