Osteomyelitis is a devastating disease caused by microbial infection in deep bone tissue. Its high recurrence rate and impaired restoration of bone deficiencies are major challenges in treatment. Microbes have evolved numerous mechanisms to effectively evade host intrinsic and adaptive immune attacks to persistently localize in the host, such as drug-resistant bacteria, biofilms, persister cells, intracellular bacteria, and small colony variants (SCVs). Moreover, microbial-mediated dysregulation of the bone immune microenvironment impedes the bone regeneration process, leading to impaired bone defect repair. Despite advances in surgical strategies and drug applications for the treatment of bone infections within the last decade, challenges remain in clinical management. The development and application of tissue engineering materials have provided new strategies for the treatment of bone infections, but a comprehensive review of their research progress is lacking. This review discusses the critical pathogenic mechanisms of microbes in the skeletal system and their immunomodulatory effects on bone regeneration, and highlights the prospects and challenges for the application of tissue engineering technologies in the treatment of bone infections. It will inform the development and translation of antimicrobial and bone repair tissue engineering materials for the management of bone infections.

骨髓炎是一种由深层骨组织微生物感染引起的破坏性疾病。其高复发率和骨缺损恢复受损是治疗的主要挑战。微生物已经进化出多种机制来有效逃避宿主内在和适应性免疫攻击，从而持续定位在宿主体内，例如耐药细菌、生物膜、持久细胞、胞内细菌和小菌落变体（SCV）。此外，微生物介导的骨免疫微环境失调会阻碍骨再生过程，导致骨缺损修复受损。尽管过去十年来治疗骨感染的手术策略和药物应用取得了进展，但临床管理仍然面临挑战。组织工程材料的开发和应用为骨感染的治疗提供了新的策略，但缺乏对其研究进展的全面综述。该综述讨论了骨骼系统中微生物的关键致病机制及其对骨再生的免疫调节作用，并重点介绍了组织工程技术在骨感染治疗中应用的前景和挑战。它将为用于骨感染管理的抗菌和骨修复组织工程材料的开发和转化提供信息。