凝胶敷料用于骨外露创面的修复:创新与发展
|
摘要
背景:骨外露创面是骨科临床常需要处理的问题,涉及到开放性骨折、骨肿瘤、骨髓炎等诸多疾病的治疗,其中尤其以开放性骨折所致的软组织缺损骨外露的处理最为困难。常规的清创换药或负压封闭引流技术很难使骨外露创面获得愈合,且过程繁琐,给患者造成痛苦。目的:评价各种类型的敷料的优缺点,并从新型水凝胶敷料所具有的使创面环境保持水分湿润、恢复皮肤的物理屏障、有利于日常敷料更换等优点对其在骨外露创面中的在骨组织应用进行综述。方法:以英文检索词为"hydrogel dressing,bone exposure wound,traditional wound dressing,antibiotic"及中文检索词为"骨外露创面,水凝胶敷料,传统创面敷料,生长因子",由第一作者检索2000至2016年Pub Med数据库及中国知网中文科技数据库,查阅近年相关文献,最终保留53篇文献,从中对传统敷料与新型敷料在骨组织工程中的应用进行综述。结果与结论:骨外露创面的治疗由于其涉及到开放性骨折、骨肿瘤、骨髓炎等诸多疾病的治疗,仍然是是骨科临床亟需处理的问题。目前,新型水凝胶敷料所具有的各项独特的优点,能够为骨外露创面的患者提供更加完善的治疗方案,解决了骨外露创面的再生修复,抗菌感染等相关的问题,另外,凝胶敷料所具有的稳定的药物缓释的特性,使得载药水凝胶敷料成为目前的研究热点之一。
BACKGROUND:Bone exposed wounds are frequently required to deal with in orthopaedic surgeries,involving the treatment of open fractures,bone tumors,osteomyelitis,and many other diseases,in which the defect of soft tissue caused by open fractures is the most difficult to deal with.Conventional debridement or negative pressure closed drainage technology is difficult to make bone exposed wounds heal,and the process is extremely cumbersome,during which,patients suffer a lot of pain.OBJECTIVE:To evaluate the advantages and disadvantages of the various types of dressings,and review the application of new hydrogel dressing in bone exposed wounds based on its advantages,such as keeping wound environment moisture,restoring skin physical barrier,contributing to routine dressing change.METHODS:A computer-based online retrieval of Pub Med and CNKI databases was performed to search papers published between 2000 and 2016 using the key words "hydrogel dressing,bone exposed wound,traditional wound dressing,antibiotic" in English and Chinese,respectively.A total of 55 papers suitable for final analysis from the application of traditional and new dressings in bone tissue engineering were reviewed.RESULTS AND CONCLUSION:The treatment of bone exposed wounds involves the treatment of many diseases,such as open fractures,bone tumors,osteomyelitis,which is still an orthopedic problem to solve.The novel hydrogel dressings with unique advantages are able to provide better plans for bone exposed wounds,and the use of these dressings solves the regeneration and repair of exposed bone,and improves the infection of antibiosis.In addition,the gel dressings currently have become a hot spot of research because of the characteristics of sustained-release.
BACKGROUND:Bone exposed wounds are frequently required to deal with in orthopaedic surgeries,involving the treatment of open fractures,bone tumors,osteomyelitis,and many other diseases,in which the defect of soft tissue caused by open fractures is the most difficult to deal with.Conventional debridement or negative pressure closed drainage technology is difficult to make bone exposed wounds heal,and the process is extremely cumbersome,during which,patients suffer a lot of pain.OBJECTIVE:To evaluate the advantages and disadvantages of the various types of dressings,and review the application of new hydrogel dressing in bone exposed wounds based on its advantages,such as keeping wound environment moisture,restoring skin physical barrier,contributing to routine dressing change.METHODS:A computer-based online retrieval of Pub Med and CNKI databases was performed to search papers published between 2000 and 2016 using the key words "hydrogel dressing,bone exposed wound,traditional wound dressing,antibiotic" in English and Chinese,respectively.A total of 55 papers suitable for final analysis from the application of traditional and new dressings in bone tissue engineering were reviewed.RESULTS AND CONCLUSION:The treatment of bone exposed wounds involves the treatment of many diseases,such as open fractures,bone tumors,osteomyelitis,which is still an orthopedic problem to solve.The novel hydrogel dressings with unique advantages are able to provide better plans for bone exposed wounds,and the use of these dressings solves the regeneration and repair of exposed bone,and improves the infection of antibiosis.In addition,the gel dressings currently have become a hot spot of research because of the characteristics of sustained-release.
引文
[1]Dong Y,Hassan WU,Kennedy R,et al.Performance of an in situ formed bioactive hydrogel dressing from a PEG-based hyperbranched multifunctional copolymer.Acta Biomater.2014;10(5):2076-2085.
[2]Klotz BJ,Gawlitta D,Rosenberg AJ,et al.Gelatin-Methacryloyl Hydrogels:Towards BiofabricationBased Tissue Repair.Trends Biotechnol.2016;34(5):394-407.
[3]Knuever J,Willenborg S,Ding X,et al.Myeloid Cell-Restricted Insulin/IGF-1 Receptor Deficiency Protects against Skin Inflammation.J Immunol.2015;195(11):5296-5308.
[4]Jensen M,Moran SL.Soft tissue coverage of the elbow:a reconstructive algorithm.Orthop Clin North Am.2008;39(2):251-264,vii.
[5]Pereira RF,Barrias CC,Granja PL,et al.Advanced biofabrication strategies for skin regeneration and repair.Nanomedicine(Lond).2013;8(4):603-621.
[6]Zahedi P,Rezaeian I,Ranaei-Siadat SO,et al.A review on wound dressings with an emphasis on electrospun nanofibrous polymeric bandages.Polym Adv Technol.2010;21(2):77-95.
[7]Groeber F,Holeiter M,Hampel M,et al.Skin tissue engineering--in vivo and in vitro applications.Adv Drug Deliv Rev.2011;63(4-5):352-366.
[8]Cutting KF,White RJ.Maceration of the skin and wound bed.1:Its nature and causes.J Wound Care.2002;11(7):275-278.
[9]Chen WY,Rogers AA,Lydon MJ.Characterization of biologic properties of wound fluid collected during early stages of wound healing.J Invest Dermatol.1992;99(5):559-564.
[10]Bjarnsholt T,Kirketerp-M?ller K,Jensen P?,et al.Why chronic wounds will not heal:a novel hypothesis.Wound Repair Regen.2008;16(1):2-10.
[11]Biswas S,Roy S,Banerjee J,et al.Hypoxia inducible micro RNA 210 attenuates keratinocyte proliferation and impairs closure in a murine model of ischemic wounds.Proc Natl Acad Sci U S A.2010;107(15):6976-6981.
[12]Kirker KR,Secor PR,James GA,et al.Loss of viability and induction of apoptosis in human keratinocytes exposed to Staphylococcus aureus biofilms in vitro.Wound Repair Regen.2009;17(5):690-699.
[13]Fisher TK,Wolcott R,Wolk DM,et al.Diabetic foot infections:A need for innovative assessments.Int J Low Extrem Wounds.2010;9(1):31-36.
[14]刘银平.创伤后瘢痕形成机制及治疗的研究[D].广州:南方医科大学,2012.
[15]刘兴炎,葛宝丰,甄平,等.带血供腓骨移植Ⅰ期修复小儿慢性骨髓炎死骨缺损[J].中华小儿外科杂志,2002,23(1):40-42.
[16]杨丽丽,汤苏阳,田建广,等.新型创面敷料的研究现状与进展[J].社区医学杂志,2008,6(14):8-10.
[17]Chang KW,Alsagoff S,Ong KT,et al.Pressure ulcers--randomised controlled trial comparing hydrocolloid and saline gauze dressings.Med J Malaysia.1998;53(4):428-431.
[18]朱圆,曹伟新.外科伤口敷料的选择[J].解放军护理杂志,2005,22(4):56-58.
[19]罗建斌,方国芳,谢兴益,等.水凝胶烧伤敷料研究进展[J].生物医学工程学杂志,2004,21(1):156-159.
[20]Sibbald RG,Orsted H,Schultz GS,et al.Preparing the wound bed 2003:focus on infection and inflammation.Ostomy Wound Manage.2003;49(11):24-51.
[21]Mathus-Vliegen EM.Old age,malnutrition,and pressure sores:an ill-fated alliance.J Gerontol A Biol Sci Med Sci.2004;59(4):355-360.
[22]Queen D,Gaylor JD,Evans JH,et al.The preclinical evaluation of the water vapour transmission rate through burn wound dressings.Biomaterials.1987;8(5):367-371.
[23]Pinho E,Grootveld M,Soares G,et al.Cyclodextrin-based hydrogels toward improved wound dressings.Crit Rev Biotechnol.2014;34(4):328-337.
[24]Lay-Flurrie K.The properties of hydrogel dressings and their impact on wound healing.Prof Nurse.2004;19(5):269-273.
[25]Hoffman AS.Hydrogels for biomedical applications.Adv Drug Deliv Rev.2002;54(1):3-12.
[26]Lee KY,Mooney DJ.Hydrogels for tissue engineering.Chem Rev.2001;101(7):1869-1879.
[27]Morgan DA.Wounds—What should a dressing formulary include?Hosp Pharm.2002;9:261-266.
[28]Martin L,Wilson CG,Koosha F,et al.The release of model macromolecules may be controlled by the hydrophobicity of palmitoyl glycol chitosan hydrogels.J Control Release.2002;80(1-3):87-100.
[29]Hutmacher DW.Scaffold design and fabrication technologies for engineering tissues--state of the art and future perspectives.J Biomater Sci Polym Ed.2001;12(1):107-124.
[30]Finnegan S,Percival SL.Clinical and Antibiofilm Efficacy of Antimicrobial Hydrogels.Adv Wound Care(New Rochelle).2015;4(7):398-406.
[31]Reimer K,Vogt PM,Broegmann B,et al.An innovative topical drug formulation for wound healing and infection treatment:in vitro and in vivo investigations of a povidone-iodine liposome hydrogel.Dermatology.2000;201(3):235-241.
[32]Lee AL,Ng VW,Wang W,et al.Block copolymer mixtures as antimicrobial hydrogels for biofilm eradication.Biomaterials.2013;34(38):10278-10286.
[33]Chu HQ,Xiong H,Zhou XQ,et al.Aminoglycoside ototoxicity in three murine strains and effects on NKCC1 of stria vascularis.Chin Med J(Engl).2006;119(12):980-985.
[34]Ng VW,Chan JM,Sardon H,et al.Antimicrobial hydrogels:a new weapon in the arsenal against multidrug-resistant infections.Adv Drug Deliv Rev.2014;78:46-62.
[35]Nelson EA,O'Meara S,Craig D,et al.A series of systematic reviews to inform a decision analysis for sampling and treating infected diabetic foot ulcers.Health Technol Assess.2006;10(12):iii-iv,ix-x,1-221.
[36]Harihara Y,Konishi T,Kobayashi H,et al.Effects of applying povidone-iodine just before skin closure.Dermatology.2006;212 Suppl 1:53-57.
[37]Patrick BN,Rivey MP,Allington DR.Acute renal failure associated with vancomycin-and tobramycin-laden cement in total hip arthroplasty.Ann Pharmacother.2006;40(11):2037-2042.
[38]谭慧心.万古霉素2001-2013年不良反应报道文献的分析[J].现代药物与临床,2013,28(4):598-601.
[39]曲连悦,李紫璇,初阳,等.万古霉素相关肾毒性危险因素分析[J].中国医院药学杂志,2016,36(14):1216-1219.
[40]Cheng F,Gao J,Stan L,et al.Aluminum plasmonic metamaterials for structural color printing.Opt Express.2015;23(11):14552-14560.
[41]Sakai S,Khanmohammadi M,Khoshfetrat AB,et al.Horseradish peroxidase-catalyzed formation of hydrogels from chitosan and poly(vinyl alcohol)derivatives both possessing phenolic hydroxyl groups.Carbohydr Polym.2014;111:404-409.
[42]Zhang HH,Lv XX,Zhang XP,et al.Antibacterial and hemostatic performance of chitosan–organic rectorite/alginate composite sponge.RSC Adv.2015;5(62):50523-50531.
[43]Jiang B,Zhang G,Brey EM.Dual delivery of chlorhexidine and platelet-derived growth factor-BB for enhanced wound healing and infection control.Acta Biomater.2013;9(2):4976-4984.
[44]Judith R,Nithya M,Rose C,et al.Application of a PDGF-containing novel gel for cutaneous wound healing.Life Sci.2010;87(1-2):1-8.
[45]Walraven M,Beelen RH,Ulrich MM.Transforming growth factor-β(TGF-β)signaling in healthy human fetal skin:a descriptive study.J Dermatol Sci.2015;78(2):117-124.
[46]Pyun do G,Choi HJ,Yoon HS,et al.Polyurethane foam containing rh EGF as a dressing material for healing diabetic wounds:Synthesis,characterization,in vitro and in vivo studies.Colloids Surf B Biointerfaces.2015;135:699-706.
[47]Kolostova K,Taltynov O,Pinterova D,et al.Wound healing gene therapy:cartilage regeneration induced by vascular endothelial growth factor plasmid.Am J Otolaryngol.2012;33(1):68-74.
[48]Mizuno K,Yamamura K,Yano K,et al.Effect of chitosan film containing basic fibroblast growth factor on wound healing in genetically diabetic mice.J Biomed Mater Res A.2003;64(1):177-181.
[49]Ribeiro MP,Morgado PI,Miguel SP,et al.Dextran-based hydrogel containing chitosan microparticles loaded with growth factors to be used in wound healing.Mater Sci Eng C Mater Biol Appl.2013;33(5):2958-2966.
[50]廖灯彬,左建容,宁倩,等.片状水凝胶敷料治疗静脉炎的效果[J].中华现代护理杂志,2012,18(8):967-968.
[51]Yannas IV,Burke JF,Orgill DP,et al.Wound tissue can utilize a polymeric template to synthesize a functional extension of skin.Science.1982;215(4529):174-176.
[52]Suzuki S,Matsuda K,Isshiki N,et al.Experimental study of a newly developed bilayer artificial skin.Biomaterials.1990;11(5):356-360.
[53]Ulubayram K,Nur Cakar A,Korkusuz P,et al.EGF containing gelatin-based wound dressings.Biomaterials.2001;22(11):1345-1356.
[2]Klotz BJ,Gawlitta D,Rosenberg AJ,et al.Gelatin-Methacryloyl Hydrogels:Towards BiofabricationBased Tissue Repair.Trends Biotechnol.2016;34(5):394-407.
[3]Knuever J,Willenborg S,Ding X,et al.Myeloid Cell-Restricted Insulin/IGF-1 Receptor Deficiency Protects against Skin Inflammation.J Immunol.2015;195(11):5296-5308.
[4]Jensen M,Moran SL.Soft tissue coverage of the elbow:a reconstructive algorithm.Orthop Clin North Am.2008;39(2):251-264,vii.
[5]Pereira RF,Barrias CC,Granja PL,et al.Advanced biofabrication strategies for skin regeneration and repair.Nanomedicine(Lond).2013;8(4):603-621.
[6]Zahedi P,Rezaeian I,Ranaei-Siadat SO,et al.A review on wound dressings with an emphasis on electrospun nanofibrous polymeric bandages.Polym Adv Technol.2010;21(2):77-95.
[7]Groeber F,Holeiter M,Hampel M,et al.Skin tissue engineering--in vivo and in vitro applications.Adv Drug Deliv Rev.2011;63(4-5):352-366.
[8]Cutting KF,White RJ.Maceration of the skin and wound bed.1:Its nature and causes.J Wound Care.2002;11(7):275-278.
[9]Chen WY,Rogers AA,Lydon MJ.Characterization of biologic properties of wound fluid collected during early stages of wound healing.J Invest Dermatol.1992;99(5):559-564.
[10]Bjarnsholt T,Kirketerp-M?ller K,Jensen P?,et al.Why chronic wounds will not heal:a novel hypothesis.Wound Repair Regen.2008;16(1):2-10.
[11]Biswas S,Roy S,Banerjee J,et al.Hypoxia inducible micro RNA 210 attenuates keratinocyte proliferation and impairs closure in a murine model of ischemic wounds.Proc Natl Acad Sci U S A.2010;107(15):6976-6981.
[12]Kirker KR,Secor PR,James GA,et al.Loss of viability and induction of apoptosis in human keratinocytes exposed to Staphylococcus aureus biofilms in vitro.Wound Repair Regen.2009;17(5):690-699.
[13]Fisher TK,Wolcott R,Wolk DM,et al.Diabetic foot infections:A need for innovative assessments.Int J Low Extrem Wounds.2010;9(1):31-36.
[14]刘银平.创伤后瘢痕形成机制及治疗的研究[D].广州:南方医科大学,2012.
[15]刘兴炎,葛宝丰,甄平,等.带血供腓骨移植Ⅰ期修复小儿慢性骨髓炎死骨缺损[J].中华小儿外科杂志,2002,23(1):40-42.
[16]杨丽丽,汤苏阳,田建广,等.新型创面敷料的研究现状与进展[J].社区医学杂志,2008,6(14):8-10.
[17]Chang KW,Alsagoff S,Ong KT,et al.Pressure ulcers--randomised controlled trial comparing hydrocolloid and saline gauze dressings.Med J Malaysia.1998;53(4):428-431.
[18]朱圆,曹伟新.外科伤口敷料的选择[J].解放军护理杂志,2005,22(4):56-58.
[19]罗建斌,方国芳,谢兴益,等.水凝胶烧伤敷料研究进展[J].生物医学工程学杂志,2004,21(1):156-159.
[20]Sibbald RG,Orsted H,Schultz GS,et al.Preparing the wound bed 2003:focus on infection and inflammation.Ostomy Wound Manage.2003;49(11):24-51.
[21]Mathus-Vliegen EM.Old age,malnutrition,and pressure sores:an ill-fated alliance.J Gerontol A Biol Sci Med Sci.2004;59(4):355-360.
[22]Queen D,Gaylor JD,Evans JH,et al.The preclinical evaluation of the water vapour transmission rate through burn wound dressings.Biomaterials.1987;8(5):367-371.
[23]Pinho E,Grootveld M,Soares G,et al.Cyclodextrin-based hydrogels toward improved wound dressings.Crit Rev Biotechnol.2014;34(4):328-337.
[24]Lay-Flurrie K.The properties of hydrogel dressings and their impact on wound healing.Prof Nurse.2004;19(5):269-273.
[25]Hoffman AS.Hydrogels for biomedical applications.Adv Drug Deliv Rev.2002;54(1):3-12.
[26]Lee KY,Mooney DJ.Hydrogels for tissue engineering.Chem Rev.2001;101(7):1869-1879.
[27]Morgan DA.Wounds—What should a dressing formulary include?Hosp Pharm.2002;9:261-266.
[28]Martin L,Wilson CG,Koosha F,et al.The release of model macromolecules may be controlled by the hydrophobicity of palmitoyl glycol chitosan hydrogels.J Control Release.2002;80(1-3):87-100.
[29]Hutmacher DW.Scaffold design and fabrication technologies for engineering tissues--state of the art and future perspectives.J Biomater Sci Polym Ed.2001;12(1):107-124.
[30]Finnegan S,Percival SL.Clinical and Antibiofilm Efficacy of Antimicrobial Hydrogels.Adv Wound Care(New Rochelle).2015;4(7):398-406.
[31]Reimer K,Vogt PM,Broegmann B,et al.An innovative topical drug formulation for wound healing and infection treatment:in vitro and in vivo investigations of a povidone-iodine liposome hydrogel.Dermatology.2000;201(3):235-241.
[32]Lee AL,Ng VW,Wang W,et al.Block copolymer mixtures as antimicrobial hydrogels for biofilm eradication.Biomaterials.2013;34(38):10278-10286.
[33]Chu HQ,Xiong H,Zhou XQ,et al.Aminoglycoside ototoxicity in three murine strains and effects on NKCC1 of stria vascularis.Chin Med J(Engl).2006;119(12):980-985.
[34]Ng VW,Chan JM,Sardon H,et al.Antimicrobial hydrogels:a new weapon in the arsenal against multidrug-resistant infections.Adv Drug Deliv Rev.2014;78:46-62.
[35]Nelson EA,O'Meara S,Craig D,et al.A series of systematic reviews to inform a decision analysis for sampling and treating infected diabetic foot ulcers.Health Technol Assess.2006;10(12):iii-iv,ix-x,1-221.
[36]Harihara Y,Konishi T,Kobayashi H,et al.Effects of applying povidone-iodine just before skin closure.Dermatology.2006;212 Suppl 1:53-57.
[37]Patrick BN,Rivey MP,Allington DR.Acute renal failure associated with vancomycin-and tobramycin-laden cement in total hip arthroplasty.Ann Pharmacother.2006;40(11):2037-2042.
[38]谭慧心.万古霉素2001-2013年不良反应报道文献的分析[J].现代药物与临床,2013,28(4):598-601.
[39]曲连悦,李紫璇,初阳,等.万古霉素相关肾毒性危险因素分析[J].中国医院药学杂志,2016,36(14):1216-1219.
[40]Cheng F,Gao J,Stan L,et al.Aluminum plasmonic metamaterials for structural color printing.Opt Express.2015;23(11):14552-14560.
[41]Sakai S,Khanmohammadi M,Khoshfetrat AB,et al.Horseradish peroxidase-catalyzed formation of hydrogels from chitosan and poly(vinyl alcohol)derivatives both possessing phenolic hydroxyl groups.Carbohydr Polym.2014;111:404-409.
[42]Zhang HH,Lv XX,Zhang XP,et al.Antibacterial and hemostatic performance of chitosan–organic rectorite/alginate composite sponge.RSC Adv.2015;5(62):50523-50531.
[43]Jiang B,Zhang G,Brey EM.Dual delivery of chlorhexidine and platelet-derived growth factor-BB for enhanced wound healing and infection control.Acta Biomater.2013;9(2):4976-4984.
[44]Judith R,Nithya M,Rose C,et al.Application of a PDGF-containing novel gel for cutaneous wound healing.Life Sci.2010;87(1-2):1-8.
[45]Walraven M,Beelen RH,Ulrich MM.Transforming growth factor-β(TGF-β)signaling in healthy human fetal skin:a descriptive study.J Dermatol Sci.2015;78(2):117-124.
[46]Pyun do G,Choi HJ,Yoon HS,et al.Polyurethane foam containing rh EGF as a dressing material for healing diabetic wounds:Synthesis,characterization,in vitro and in vivo studies.Colloids Surf B Biointerfaces.2015;135:699-706.
[47]Kolostova K,Taltynov O,Pinterova D,et al.Wound healing gene therapy:cartilage regeneration induced by vascular endothelial growth factor plasmid.Am J Otolaryngol.2012;33(1):68-74.
[48]Mizuno K,Yamamura K,Yano K,et al.Effect of chitosan film containing basic fibroblast growth factor on wound healing in genetically diabetic mice.J Biomed Mater Res A.2003;64(1):177-181.
[49]Ribeiro MP,Morgado PI,Miguel SP,et al.Dextran-based hydrogel containing chitosan microparticles loaded with growth factors to be used in wound healing.Mater Sci Eng C Mater Biol Appl.2013;33(5):2958-2966.
[50]廖灯彬,左建容,宁倩,等.片状水凝胶敷料治疗静脉炎的效果[J].中华现代护理杂志,2012,18(8):967-968.
[51]Yannas IV,Burke JF,Orgill DP,et al.Wound tissue can utilize a polymeric template to synthesize a functional extension of skin.Science.1982;215(4529):174-176.
[52]Suzuki S,Matsuda K,Isshiki N,et al.Experimental study of a newly developed bilayer artificial skin.Biomaterials.1990;11(5):356-360.
[53]Ulubayram K,Nur Cakar A,Korkusuz P,et al.EGF containing gelatin-based wound dressings.Biomaterials.2001;22(11):1345-1356.