| Objective:Chronic osteomyelitis is a difficult and confused problem to the department of orthopedics circles,which is a chronic infection of bone tissue and can be derived from blood bacterial cultivation,local soft tissue infection,also derived from the trauma of bacteria planted directly leading to acute infection of bone tissue,quickly especially in the fast-paced modern society,trauma,traffic injuries belong to the high energy damage,often because of open bone injury without thorough debridement or after thorough debridement but trauma and heavy pollution,or by the operation of closed injury caused by strict aseptic operation,high rate of treatment failure,led to a shift from acute osteomyelitis for chronic osteomyelitis or recurrent chronic osteomyelitis,delayed healing the course of time can last for several months or even years,and repeated attacks,have reported recurrence rate of 20%-30%,resulting in psychological and economic burden on individuals and families;medical resources A lot of waste.The purpose of this study is in the diagnosis of rabbit chronic osteomyelitis of tibia model under the condition of relatively iodophor soaking,distilled water and boiling and irrigation 3 different sterilization effect,this study,in the clinical treatment of chronic osteomyelitis after debridement especially in sterilization methods provide reliable evidence.Methods:1 Rabbit tibial chronic osteomyelitis model making: Select 4--6 months old,weighing 1.5kg-2.5kg 50 rabbits,cleaning cages carve-class environment,easily movement.Anesthesia was performed by using 3% sodium 1.0/kg in the ear marginal vein.Located the rabbit with lateral position on the rabbit bench,Right medial tibial proximal skin,the size range of about 4cm,after the completion of skin from the right tibial medial longitudinal incision,the length of about 4cm,the sterile scalpel incision of skin and subcutaneous tissue,exposed right proximal tibia medial,blunt dissection of a size of about 2*2 with periosteum,3mm drill drill,only through the side of the cortex,and so method 9 big bone drill hole in periosteum separation,and then drilling and grinding of 1cm diameter circular bone defect,is made into a 1*1cm that bone window;and then use a small curette respectively along the proximal bone window were scraping part of cancellous bone,after the completion of 0.9% 5ml saline flushing near end medullary cavity.Take the train after inoculated with Staphylococcus aureus bacteria ring will be scraped,a disposable sterile test tube,select the standard turbidimetric tube as the concentration of standard reference materials,reference number standard tube,with 0.9% saline to absorb the burette titration,made concentration of 1 * 106cfu/ml Staphylococcus aureus 1ml,shaking uniform,disposable burette to suck liquid of Staphylococcus aureus 0.5ml injection from the bone window within the medullary cavity along the distal end,the static 5min,when bacteria spread fully,5% Cod Liver Oil acid sodium to the bone window along the distal end of 0.5ml injection,repeatedly wash the wound with saline and sutured the skin.During the operation,1 patients died,and after operation,the anesthetic effect disappeared and returned to normal feeding for 4 weeks.After 4 weeks respectively from general observation,X-ray examination and bacterial culture in three areas to determine whether the formation of 50 rabbits,osteomyelitis.2.Grouping: 50 New Zealand white rabbits were randomly divided into three groups,which were making model successfully.Each group had 50 rabbits,and reseted the the fracture fragments with external fixator and ensured the connecting of the fracture fragments.The experimental group rabbits use the "accordion" technology: With the external fixator in 0.5mm / d(complete in the morning and evening separately,each 0.25mm)rate of sustained pressure to four weeks,and then follow the 0.5mm / d(complete in the morning and evening separately,each 0.25mm)speed continuous retractor two weeks,and then at the same rate pressurized to 4 weeks;Control group pressurized with the external fixator after reseting fracture site,(complete in the morning and evening separately,each 0.25mm)according to 0.5mm / d rate of sustained pressure to 10 weeks;Animals in the blank control group to reset the fracture external fixator,ensure bone contact,no pressure and no retractor.2 Confirm the rabbit tibial osteomyelitis mode.After the experiment the rabbit showed varying degrees of fever,poor spirit,eating less,is the clinical manifestation of osteomyelitis after 2,only not successful model 2 only after surgery within 4 weeks of death.After 4 weeks,49 rabbits survived,in X-ray(42 K 4 V,m A s-1,1.0m)under X-ray,found 47 rabbits right tibia surgical site with chronic suppurative osteomyelitis,from the macroscopic observation showed local soft tissue swelling,may be associated with ulceration in part,bone destruction,bone hyperplasia,and dead bone formation;all rabbits from the original incision 4cm,remove the small part of the medullary contents for pathological and bacteriological detection.3 comprehensive imaging,pathological and bacteriological judgment,the bacteriological examination as the gold standard test.Detection of return 47 rabbits all meet the requirements,can be used as the rabbit tibial osteomyelitis model to do the next experiment.3 Comparison of germicidal efficacy of three different sterilization methods.The rabbits were successfully divided into 3 groups,respectively,to intercept the diseased bone,and then numbered,do different treatment.Group A: the interception of bone disease,with Iodophor rinse for 30 minutes;group B: 30 minutes of boiling distilled water;group C: antibiotics(sensitive to Staphylococcus aureus)wash,randomly selected portions of the treated bone disease were placed in standard bacterial culture and cultured for 24 hours.In combination with the results of the two methods,the detection of the content of the pulp cavity and the number of colonies after cultivation were the gold standard,so as to reasonably and reliably compare the germicidal efficacy of the three methods.Results:1 Roughly observation: after the treatment of the three groups,there was no bone destruction,which can maintain a good shape,and the original tibia have good morphological compatibility.2 Bacteriological culture:The results of bacterial culture in A group showed that there were 1 cases of colony formation,the positibles were,and the results of bacterial culture in group B were positive in 4 cases,the positive rate was 27%.The C group showed 7 cases of bacterial culture positive,the positive rate was 47%,22,there were significant differences.3 Pathological examination:A treatment group in HE staining showed no edema of bone tissue,the presence of a large dead bone,no eosinophils and other inflammatory cells,dead bone sheet or strip,and the scattered and irregular existence into osteoblasts;B treatment group showed mild edema in bone tissue by HE staining.No obvious bone formation,showing a few eosinophils and other inflammatory cells,and showed a large amount of osteoblasts;C treatment group in HE staining showed bone and soft tissue structure is confused with edema,no obvious bone formation,but visible eosinophils and other inflammatory cells and osteoblasts.Conclusion:Boiling distilled water,soaking and some antibiotic rinse iodophor sterilization effect on rabbit tibial chronic osteomyelitis bone disease were three,and can still maintain good tibial morphosis of the treatments,and distilled water and boiling can achieve sterilization effect in a short period of time,and still have the presence of osteoblasts. |
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