摘要
人工关节假体周围感染是关节置换术后的灾难性并发症,对关节功能损害严重,治疗花费巨大.近年来,将利福平应用于假体周围感染的治疗成为骨科新的研究热点,并取得了明确的疗效.通过检索PubMed、Cochrane Library、Embase、Web of Science、CNKI、万方和维普数据库,筛选应用利福平治疗假体周围感染的相关文献,对利福平应用于假体周围感染的发展过程及应用现状、利福平治疗假体周围感染的机制及其应用方法进行分析.国内尚未见应用利福平治疗假体周围感染的相关报道.文献综述结果提示,致病菌定植于关节假体表面并形成不可逆的生物膜是假体周围感染的主要发病机制,生物膜形成的特殊环境既有利于致病菌生长,又可使其抵御大剂量的抗生素,其存在时间越长对抗生素的耐药性也越强.利福平能有效渗透入生物膜的多糖基质,并杀灭生物膜内的葡萄球菌属等致病菌,同时还具有较高的生物利用度,能很好地分布于骨内.假体周围感染的治疗方式包括保留假体的清创术、一期和二期翻修术等,在正确选择手术适应证的前提下利福平的应用能极大地提高保留假体的清创术的成功率及一期、二期翻修术的成功率.规范应用是避免细菌对利福平产生耐药的前提.目前研究已证实了利福平在假体周围感染治疗中的重要作用,但其最佳的应用疗程、剂量及给药途径尚需进一步探讨.
Prosthetic joint infection （PJI） is a devastating complication that can occur after any arthroplasty procedure and is associated with significant morbidity and substantial healthcare costs.Recently,the use of Rifampicin in PJI subjects has become a hot research direction in the field of orthopaedics,its efficacy is definite and encouraging.But till date,to the best of our knowledge,we still have no associated reports about the application of Rifampicin on PJI.Therefore,articles concerned with the administration of Rifampicin in PJI subjects published till date were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang and Weipu databases.The articles,which met the inclusion and exclusion criteria,were summarized into the following categories：1） The development and the application status of Rifampicin on PJI;2） The therapeutic mechanism of Rifampicin on PJI;3） The usage of Rifampicin in the postoperative antimicrobial therapy.By reviewing the associated articles,we found out that PJI is difficult to treat,because the causative bacteria forms and exists in a biofilm that is adherent to the prosthetic surface.The formation and maturation of the bacterial biofilm is a time dependent process.The longer the biofilm exists,the troublesome it gets to eradicate.Rifampicin not only has an excellent anti-staphylococcal activity,but also has a very good oral bioavailability and good bone penetration.The application of Rifampicin may significantly improve the surgical success rate especially after debridement and retention in PJI subjects.However,the optimal course,dosage and route of administration still need further exploration.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第19期1263-1267,共5页
Chinese Journal of Orthopaedics
基金
国家自然科学基金（81371940）
