抗生素骨水泥在感染相关难愈性创面治疗中的研究进展

Research Progress of Antibiotic-Loaded Bone Cement in the Treatment of Infection-Associated Chronic Non-Healing Wounds

摘要: 抗生素骨水泥(antibiotic-loaded bone cement, ALBC)作为一种局部药物递送系统，近年来在感染性创面治疗领域日益受到关注。其可在创面局部持续释放高浓度抗生素，有效克服全身抗生素治疗中局部药物浓度不足及全身不良反应等局限，同时有助于控制感染、促进肉芽组织形成及血管生成，为复杂感染性创面的治疗提供了新的策略。随着材料学的发展，新型自发泡骨水泥、磷酸钙骨水泥等改良型骨水泥材料不断涌现，在提高抗生素释放效率的同时，进一步改善了生物相容性和组织安全性。现有研究表明，ALBC在糖尿病足溃疡、压力性损伤等难愈性复杂创面治疗中具有一定应用潜力，可显著降低感染复发率、减少截肢风险，并促进创面修复及功能恢复。近年来，不少学者开始探索ALBC及其联合治疗策略在软组织创面修复中的应用效果，如ALBC联合糖皮质激素治疗、ALBC联合胫骨横向骨搬移技术、ALBC联合螺旋桨皮瓣修复、ALBC联合负压封闭引流(negative pressure wound therapy, NPWT)，以及ALBC填充技术联合自体富血小板血浆(platelet-rich plasma, PRP)等，均在临床实践中取得了较为理想的治疗效果。本文系统综述了ALBC在创面愈合中的作用机制、抗生素选择原则、临床疗效及安全性问题，回顾了近年来抗生素骨水泥在创面修复领域的研究进展，并探讨其在临床应用中面临的挑战与未来发展方向，以期为相关临床实践和进一步研究提供参考。

Abstract: Antibiotic-loaded bone cement (ALBC), as a local drug delivery system, has increasingly attracted attention in the treatment of infected wounds in recent years. It can provide sustained local release of high-concentration antibiotics at the wound site, effectively overcoming the limitations of systemic antibiotic therapy, including insufficient local drug concentration and systemic adverse effects. ALBC also contributes to infection control, granulation tissue formation, and angiogenesis, offering a novel strategy for managing complex infected wounds. With advances in materials science, novel modified bone cements, such as self-expanding bone cement and calcium phosphate bone cement, have emerged, improving antibiotic release efficiency while enhancing biocompatibility and tissue safety. Existing studies suggest that ALBC has considerable potential in the management of chronic, complicated wounds, such as diabetic foot ulcers and pressure injuries, significantly reducing infection recurrence, lowering amputation risk, and promoting wound repair and functional recovery. In recent years, various combined therapeutic strategies involving ALBC have been explored in soft tissue wound repair, including ALBC combined with glucocorticoid therapy, tibial transverse bone transport, propeller flap reconstruction, negative pressure wound therapy (NPWT), and ALBC filling combined with autologous platelet-rich plasma (PRP), all of which have achieved promising clinical outcomes. This review systematically summarizes the mechanisms of ALBC in wound healing, principles for antibiotic selection, clinical efficacy, and safety issues, highlights recent research progress in wound repair using ALBC, and discusses the challenges and future directions of its clinical application, aiming to provide guidance for both clinical practice and future investigations.