随着人工关节置换手术总数的不断增长，术后假体周围感染(periprosthetic joint infection, PJI)的绝对数量也在增加。人工全膝关节置换(total knee arthroplasty,TKA)和人工全髓关节置换(total hip arthroplasty,THA)术后假体周围感染的治疗目前仍具有挑战性。在现有的几种治疗方案中,一期植 入抗生素负载的骨水泥间隔物，二期再行假体植入被认为是治疗PJI的金标准⑴。但因其治疗周期长， 且需要行多次手术，使得相当一部分的患者在植入间隔物后未再行二期手术植入新的假体。随着间隔 物制作技术的成熟，已经有越来越多的学者报道了保留抗生素骨水泥间隔物治疗PJI取得了较为满意 的临床疗效。本文综述了抗生素骨水泥间隔物的材料特性、保留间隔物的临床应用现状,归纳总结了临 床疗效，分析了目前其优势及缺点，并对未来的发展做了展望。

[1 ] Garvin KL, Hanssen AD. Infection after total hip arthroplasty. Past,present,and future[ J]. Joumalof Bone and Joint Surgery- American Volume, 1995,77( 10) : 1576—1588.

[2 ] Lichstein P ,Su S, Hedlund H, et al. Treatment of periprosthetic knee infection with a two-stage protocol using static spacers[ J]. Clinical Orthopaedicsand Related Research, 2016 , 474 ( 1 )：?120-125.

[3 ] Mahmud T, Lyons M, Naudie D, et al . Assessing the goldstandard: a review of 253 two-stage revisions for infected TKA [J]. Clinical Orthopaedics And Related Research, 2012,470: 2730-2736.

[4 ] Huang R, Buckley PS, Scott B, et al. Administration of aspirin as a prophylaxis agent against venous thromboembolism results in lower incidence of periprosthetic joint infection [ J ] . Journal of Arthroplasty,2015,30( 9) ：39-41.

[5 ]张磊，唐晓菊,黄有荣，等.聚甲基丙烯酸甲酯骨水泥及磷酸 钙骨水泥的材料性能及改性的研究进展[J].广西医学， 2019,41(16) ：2114-2118,2122.

[6 ] Galvez-Lopez R, Pena-Monje A,Antelo-Lorenzo R,et al. Elution kinetics, antimicrobial activity, and mechanical properties of 11 different antibiotic loaded acrylic bone cement [ J ]. Diagnostic Microbiology and Infectious Disease,2014,78( 1) ：70—74.

[7]郭新辉，吕扬阳，范积平，等.磷酸钙与聚甲基丙烯酸甲酯制 备复合型骨水泥的生物安全性研究[J].中国骨与关节损伤

杂志,2016,31(5) ：506-510.

Guo XH,Lyu YY,Fan JP,et al. Preparation of composite bone cement ( CPC/PMMA) and its biological safety [ J ]. Chinese Journal of Bone and Joint Injury,2016,31(5) ：506—510.

[8 ] Diken ME, Dogan S, Turhan Y, et al. Biological properties of PMMA/nHAp and PMMA/3-APT-nHAp nanocomposites[ J]. International Journal of Polymeric Materials and Polymeric Biomaterials,2018,67(13) :783-791.

[9 ]高山，周方，吕扬，等.新型多孔聚甲基丙烯酸甲酯骨水泥的 制备及性能分析[J].中国组织工程研究,2019,23(2)：?204-210.

Gao S,Zhou F,Lyu Y,et al. Preparation and property analysis of new porous polymethyl methacrylate bone cement[ J]. Chinese Journal of Tissue Engineering Research,2019,23 (2) ：204-210.

[10] Dall9?Oca C,Maluta T, Micheloni GM,et al.The biocompatibility of bone cements: progress in methodological approach [ J ]. European Journal of Histochemistry,2017,61(2) ：2673.

[11 ] Lyons ST,Wright CA,Knite CN,et al. Confoming sterility of an autoclaved infected femoral component for use in an articulated antibiotic spacer：?a pilot study [ J ]. The Journal of Arthroplasty, 2016,31：245-249.

[12]?Lausmann C,Citak M,Hessling U,et al. Preliminary results of a novel spacer technique in the management of septic revision hip arthroplasty [ J ] . Archives of Orthopaedic and Trauma Surgery, 2018,138:1617-1622.

[13]?Sporer SM. Spacer design options and consideration for periprosthetic joint infection [ J ] . The Journal of Arthroplasty, 2020,35(3) ：S31-S34.

[14]?王宏，伍权，汤耿，等.个性化膝关节抗生素骨水泥占位器的设 计及临床应用[J].中国组织工程研究,2020 , 24 ( 6)：?821-826.

Wang H,Wu Q,Tang G,et al. Design and clinical application of personalized knee joint antibiotic bone cement placeholder [ J]. Chinese Journal of Tissue Engineering Research, 2020,24 ( 6 ): 821-826.

[15]?孙海滨，吕尚军,朱书朝，等. 3D打印技术在制作人工髄关节 置换术后感染临时间隔器中的临床应用[J] .中国矫形外科 杂志,2016,24(13) ：?1239-1241.

[16]?周广福，朱伟民,唐本森，等.3D打印技术在髓关节置换术后 感染II期翻修手术中应用[J].重庆医学,2018,47 ( 13)：?1746-1748.

Zhou GF, Zhu WM, Tang BS, et al. Application of 3D printing technology in the second staged revision of infection after hip replacement [ J ]. Chongqing Medicine, 2018, 47 ( 13 ): 1746-1748.

[17]?Zhao QH, Zhu FB ,Cai XZ, et al. Effects of low-frequency pulsed wave ultrasound on the shear properties of the interface of vancomycin-loaded acrylic bone cement-stem [ J ]. Zhonghua Yi

Xue Za Zhi,2017,97(7) ：545-550.

[18]?Zalavras CG, Patzakis MJ, Holtom P. Local antibiotic therapy in the treatment of open fractures and osteomyelitis [ J]. Clinical Orthopaedicsand Related Research, 2004( 427 ) ：?86—93.

[19]?Luo S, Jiang T, Yang Y, et al. Combination therapy with vancomycin loaded calcium sulfate and vancomycin-loaded PMMA in the treatment of chronic osteomyelitis [ J ]. BMC Musculoskeletal Disorders, 2016,17 ：?502.

[20]?沈潑，王俏杰,陈云苏，等.关节型全骨水泥间隔物治疗膝关 节假体感染的中长期转归[J].中华关节外科杂志(电子 版),2016,10(4) ：370-375.

Shen H, WangQJ, Chen YS, et al. Medium and long tenn outcomes of treatment using cement-on-cement antibiotic-loaded articulating spacers for knee prosthetic infection [ J ]. Chinese Journal of Joint Surgery ( Electronic Edition) , 2016, 10 ( 4)：?370-375.

[21 ] Bernard L, Legout L, Ziircher-Pfiind L, et al. Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty[ J]. Journal of Infection,2010,61(2) : 125-132.

[22]?Vielgut I, Sadoghi P, Wolf M, et al. Two-stage revision of prosthetic hip joint infections using antibiotic-loaded cement spacers: When is the best time to perform the second stage? [ J]. International Orthopaedics,2015,39(9) : 1731—1736.

[23]?Dusane DH, Diamond SM, Knecht CS, et al. Effects of loading concentration, blood and synovial fluid on antibiotic release and anti-biofilm activity of bone cement beads [ J ]. Journal of Controlled Release,2017,248:24—32.

[24]?Elmarsafi T, Oliver NG, Steinberg JS ,et al. Long-term outcomes of pennanent cement spacers in the infected foot [ J ]. Journal of Footand Ankle Surgery, 2017,56(2) ：?287—290.

[25]?Cyteval C, Bourdon A. Imaging orthopedic implant infections [ J ]. Diagnostic and Interventional Imaging, 2012,93(6) ：?547—557.

[26]?Choi H, Freiberg A, Malchau H, et al. The fate of unplanned retention of prosthetic articulating spacers for infected total hip and total knee arthroplasty [ J ]. The Journal of Arthroplasty, 2014,29(4) ：690-693.

[27]?Lyons S,Downes K,Habeck J,et al. Early to midterm results of w?low-frictionM?articulating antibiotic spacers for septic total knee arthroplasty[ J]. Arthroplasty Today,2019,5(2) :221-225.

[28]?刘思杰，鄂晓强，潘琦，等.关节置换后假体周围感染的规范 化治疗[J]?中国组织工程研究,2019,23(32) =5195-5202.

Liu SJ, E XQ, Pan Q, et al. Standardized treatment of infection around the prosthesis after joint replacement [ J ]. Chinese Journal of Tissue Engineering Research,2019,23(32) ：5195-5202.

[29]?Stephen MP, Kevin IP, Mark WP, et al. Retained antibiotic spacers after total hip and knee arthroplastyresections: high complication rates [ J ]. The Journal of Arthroplasty, 2017, 32 (11) ：3510-3518.

[30]?Namba RS, Inacio M, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty an analysis of 56216 knees [ J]. The Journal of Bone and Joint Surgery. American Volume,2013,95(9) ：775-782.

[31]?杜银桥，周勇刚,郝立波，等.术中自制抗生素骨水泥占位器 在治疗髏关节置换术后感染的并发症研究[J].中国骨伤， 2017,30(5)：436-440.

Du YQ, Zhou YG, Hao LB, et al. Mechanical complications with self-made, antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement [ J] . China Journal of Orthopaedics and Traumatology ,2017,30(5) ：?436-440.

[32]?Hofmann A, Goldberg T, Tanner A, et al. Ten-year experience using an articulating antibiotic cement hip spacer for the treatment of chronically infected total hip[ J]. The Journal of Arthroplasty, 2005,20(7) ：874-879.

[33]?Kuzyk P, Dhotar H, Stemheim A, et al. Two-stagerevision arthroplasty for management of chronic periprosthetic hip and kneeinfection: techniques, controversies, and outcomes [ J]. The Journal of the American Academy of Orthopaedic Surgeons,2014, 22(3):153-164.

[34]?Ewald F. The knee society total knee arthroplasty roentgenographic evaluation and scoring system [ J ]. Clinical Orthopaedicsand Related Research, 1989,248(248) ：9—12.

[35]?Engh G, Ammeen D. Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction [ J ]. InstructionalCourse Lectures, 1999, 48: 167-175.

[36]?Abdel M,von Roth P,Harmsen W,et al. What is the lifetime risk of revisionfbr patients undergoing total hip arthroplasty? A 40- year observational study of patients treated with the Chamley cemented total hip arthroplasty [ J ]. Bone and Joint Journal, 2016,98-B( 11) ：?1436-1440.

[37]?Galvez-Lopez R,Pena-Monje A,Antelo-Lorenzo R,et aL Elution kinetics, antimicrobial activity, and mechanical properties of 11 different antibiotic loaded acrylic bone cement [ J ]. Diagnostic Microbiology and Infectious Disease,2014,78( 1) ：70-74.

[38]?Barreira P, Leite P, Neves P, et al. Preventing mechanical complications of hip spacer implantation: technical tips and pearls [J]. Acta Orthopaedica Belgica,2015,81(2) :344—348.

[39]?Luk MH, Ng FY, Fu H. Retention of prosthetic articulating spacer after infected hip arthroplasty as a semipermanent implant: a case report[ J]. Journal of Orthopaedics, Trauma and Rehabilitation, 2019,26：105-107.

[40]?Kaku N, Tabata T, Tsumura H. Mechanical evaluation of hip cement spacer reinforcement with stainless steel Kirschner wires , titanium and carbon rods,and stainless steel mesh[ J]. European Journal of Orthopaedic Surgery & Traumatology, 2015,25 ( 3): 489-496.

[41 ] Kuzyk P, Dhotar H, Stemheim A, et al. Two-stagerevision arthroplasty for management of chronic periprosthetic hip and kneeinfection: techniques, controversies, and outcomes [ J ]. The Journal of the American Academy of Orthopaedic Surgeons, 2014, 22(3):153-164.

[42]?Voleti P,Baldwin K,Lee G. Use of static or articulating spacers for infection following total knee arthroplasty: a systematic literature review [ J ]. The Journal of Bone and Joint Surgery. American Volume,2013,95(17) : 1594—1599.

[43]?Cancienne JM, Wemer BC, Bolarinwa SA, et al. Removal of an infected total hip arthroplasty: risk factors for repeat debridement, long-term spacer retention, and mortality [ J ] , The Journal of Arthroplasty,2017,32(8) ：2519-2522.

Zmistowski B, Karam JA, Dminka JB, et al. Periprosthetic joint infection increases the risk of one-year mortality[ J]. The Journal of Bone and Joint Surgery. American Volume, 2013,95 ( 24)：?2177-2184.

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