Addressing the challenge of infectious bone defects in extremities requires equal emphasis on technology and materials
10.3760/cma.j.cn121113-20250112-00036
- VernacularTitle:攻克四肢感染性骨缺损难题需技术与材料并重
- Author:
Jianzhong XU
1
;
Fei LUO
1
;
Zhao XIE
1
Author Information
1. 陆军军医大学第一附属医院（西南医院）骨科，重庆 400038
- Publication Type:Journal Article
- Keywords:
Extremities;
Diaphyses;
Infections;
Bone repair;
Bone defect
- From:
Chinese Journal of Orthopaedics
2025;45(20):1291-1297
- CountryChina
- Language:Chinese
-
Abstract:
Infectious bone defects refer to bone defects accompanied by infection or those that occur during the treatment of bone infection and require surgical intervention. Due to the prolonged course of the disease and the destruction of the osteogenic microenvironment, the treatment is extremely difficult, and two major problems need to be solved: infection control and bone defect repair. In recent years, breakthrough progress has been made in this field. In mechanism research, the pathways by which pathogenic bacteria activate inflammatory responses to disrupt bone repair and the drug-resistance mechanism of methicillin-resistant Staphylococcus aureus (MRSA) have been clarified, providing molecular targets for targeted intervention. In terms of technology, interdisciplinary breakthroughs, such as the combination of targeted release of antibacterial drugs with microcarrier-controlled release systems, low-temperature additive manufacturing, and percutaneous sealing technology for external fixators, have solved key clinical problems. In material development, functional materials like cobalt-titanium-based implants and composite systems integrating antibiotics with bone growth factors have achieved synergy between anti-infection and bone repair. Clinical translation has yielded systematic solutions, and multicenter trials have confirmed that their efficacy is superior to traditional methods, breaking the dilemma that anti-infection and bone repair cannot be achieved simultaneously. For bone defect repair, bone repair materials include autologous bone, allogeneic bone, heterologous bone, and artificial bone. Autologous bone is regarded as the gold standard, and technologies to enhance biological activity have emerged in recent years. The Masquelet technique (membrane-induced technique) involves a two-stage surgery; the induced membrane exerts multiple effects, and its large-scale application in our center has achieved favorable outcomes. The Ilizarov technique is based on the Law of Tension-Stress, which has both advantages and limitations, and has been modified in multiple dimensions to form a mature technical system. However, the treatment of infectious bone defects still faces challenges such as unclear mechanisms of persistent infection and intracellular colonization of bacteria. In the future, interdisciplinary collaboration is required to establish an infection control-microenvironment remodeling-structural reconstruction system, promoting the development of personalized, minimally invasive, and intelligent treatment. Additionally, synergistic breakthroughs in clinical technology and biomaterials are needed to overcome this intractable orthopedic disease.
