RESUMO
PURPOSE: This study aimed to construct drug-loading and drug-releasing quantitative equations for gentamicin sponges in addition to realizing a gentamicin sponge for wound infection prevention and treatment. METHODS: Sterile sponges were cut into pieces of 1×1 × 0.5 cm and immersed in 40, 16, 8, 4, 1.6, 0.8, or 0 mg/mL of gentamicin solution for 12, 24, 48, 96, or 120 h to evaluate their gentamicin loading. The sponges were subsequently immersed in the gentamicin solution of different concentrations for 48 h, air-dried, and then immersed in 10 mL of 0.9% physiological saline to evaluate the gentamicin release. Methicillin-sensitive Staphylococcus aureus (MSSA) and Pseudomonas aeruginosa were used to explore the sponges' infection prevention scheme. In addition, a rat femur fracture with wound infection model was used to assess the infection treatment scheme. RESULTS: The antibacterial zone sizes of the sponges immersed in 40, 16, 8, 4, 1.6, and 0.8 mg/mL of the gentamicin solution were larger than those of the 0 mg/mL air-dried sponge, and the difference was statistically significant (p < 0.01, p < 0.01, p < 0.01, p < 0.01, p < 0.01, and p < 0.01, respectively). The rats in the 40, 16, and 8 mg/mL air-dried sponge groups had no wound suppuration in either the MSSA or P. aeruginosa rat infection models. CONCLUSION: A quantified equation for the sponges' gentamicin loading and release was achieved with high accuracy. Furthermore, we recommend the 40, 16, or 8 mg/mL air-dried sponge for the treatment of wounds with antibiotic-sensitive bacterial infections.
RESUMO
OBJECTIVE: To study the biomechanical effects and the clinical outcome of different internal fixation methods in treating posterior malleolus fractures. METHODS: (1) Biomechaniccal study of 18 pairs of posterior malleolus fracture models was conducted, in which all the cases were divided into 3 groups as I, II and III (n=12), according to different fracture degrees that included specimens with 1/4, 1/3 and 1/2 of articular facets fractured respectively; Each group was further divided into 2 subgroups as group A and group B. Group A was fixed with 2 steel half-thread tensile screws whose diameter was 4.0 mm; and group B was fixed with "T-shaped" steel distal-radius plates and 4 screws. The uploading experiment was carried out by settling the specimen on an experiment machine at its neutral position, and the data were collected and managed. (2) Clinical Applications: 31 cases with closed trimalleolar fractures were treated from 2009.1-2010.12 in our hospital, in which 14 with posterior malleolus fractures ≤ 2 5% of the capital diameter of the tibial plafond were fixed with screws, and 17 with posterior malleolus fractures >25% of the capital diameter of the tibial plafond were fixed with steel plates. Prospective cohort study of these cases were carried out. The outcome was assessed using a Leeds Scoring System. RESULTS: The mechanical fixation strengths of the plates for 1/4, 1/3 and 1/2 facets of posterior malleolus fractures were all higher than those of the screw groups [(4.10 ± 0.13) kN vs. (4.6 0 ± 0.27)kN, (3.20 ± 0.12)kN vs. (4.12 ± 0.14)kN and (1.98 ± 0.18)kN vs. (3.72 ± 0.18)kN, respectively, P<0.05]. For the clinical study ,the mean follow-up period was 12 months (6-18 months), all the cases acquired bone union, and the mean time for healing was 10 weeks ( 8-12 weeks). In the evaluation of therapeutic effects, we found that 28 cases were excellent and 3 good, which was 100% satisfying. CONCLUSION: If only 1/4 of the posterior articular facet is involved, 2 screws are enough to supply the stability; but for the fractures involve more than 1/4 facet, the plate fixation supplies more stable fixation and is superior to simply screws.
