Bhandari M, Adili A, Schemitsch E H
Department of Clinical Epidemiology and Biostatistics, McMaster University Medical Centre, Hamilton, ON, Canada.
J Bone Joint Surg Am. 2001 Mar;83(3):412-9. doi: 10.2106/00004623-200103000-00014.
Recent studies have suggested that high-pressure irrigation may have adverse effects on bone. However, the use of low-pressure irrigation may not remove all adherent bacteria from bone. The type of irrigating solution may be an important factor in the removal of adherent bacteria with pulsatile lavage. In this study, we compared the effects of various irrigating solutions on the number and function of osteoblasts and osteoclasts and we examined the effectiveness of these solutions in removing adherent bacteria from bone.
To examine the effect of irrigating solutions on the number and activity of osteoblasts, we isolated calvarial cells from newborn C57BI/6 mice and exposed the cells to equivalent concentrations of ethanol, povidoneiodine, liquid soap, antimicrobial wash (50 U/L of bacitracin), or chlorhexidine gluconate, for two, ten, or twenty minutes. The cells were then cultured in the presence of bone-nodule-enhancing medium (beta-glycerophosphate and ascorbic acid) for twenty-one days. The medium was changed every three or four days. Mineralized nodules were stained with alizarin red S, and osteoblasts were stained with a histochemical stain for alkaline phosphatase. Osteoclasts were identified with tartrate-resistant acid-phosphatase staining. In a second experiment, canine cortical tibiae were contaminated with Staphylococcus aureus for six hours and subjected to different irrigating solutions with or without low-pressure lavage. Bacterial colony-forming units were quantitated under each set of conditions.
Each solution resulted in a time-dependent decrease in the number of calvarial osteoblasts and osteoclasts compared with that in the controls. The 1% soap solution resulted in greater preservation of both alkaline-phosphatase activity and bone-nodule formation than did the other solutions. Moreover, the soap solution preserved the number of osteoclasts to the greatest extent. The povidone-iodine and chlorhexidine-gluconate solutions resulted in the largest decline in bone-nodule formation, alkaline-phosphatase activity, and number of osteoclasts. Low-pressure pulsatile lavage with the soap solution removed the most bacteria from the contaminated tibia when compared with either the soap solution alone or low-pressure irrigation with saline solution.
Our findings suggest that certain solutions may be more effective in removing bacteria from bone than mechanical irrigation with saline solution alone. Among the various solutions examined, the soap solution preserved the number and activity of osteoblasts the most. Low-pressure lavage with the soap solution resulted in the greatest removal of adherent bacteria from bone.
近期研究表明，高压冲洗可能对骨骼产生不良影响。然而，使用低压冲洗可能无法清除骨骼上所有附着的细菌。冲洗液的类型可能是脉冲冲洗清除附着细菌的一个重要因素。在本研究中，我们比较了各种冲洗液对成骨细胞和破骨细胞数量及功能的影响，并检测了这些冲洗液清除骨骼上附着细菌的有效性。
为检测冲洗液对成骨细胞数量和活性的影响，我们从新生C57BI/6小鼠分离颅盖细胞，并将细胞暴露于等效浓度的乙醇、聚维酮碘、液体肥皂、抗菌洗剂（50 U/L杆菌肽）或葡萄糖酸氯己定中2分钟、10分钟或20分钟。然后将细胞在骨结节增强培养基（β-甘油磷酸酯和抗坏血酸）存在的情况下培养21天。每三或四天更换一次培养基。用茜素红S对矿化结节进行染色，并用碱性磷酸酶组织化学染色法对成骨细胞进行染色。用抗酒石酸酸性磷酸酶染色法鉴定破骨细胞。在第二个实验中，犬的皮质胫骨用金黄色葡萄球菌污染6小时，然后用不同的冲洗液进行冲洗，冲洗时有无低压灌洗。对每组条件下的细菌集落形成单位进行定量分析。
与对照组相比，每种冲洗液均导致颅盖成骨细胞和破骨细胞数量呈时间依赖性减少。1%肥皂溶液比其他溶液能更好地保留碱性磷酸酶活性和骨结节形成。此外，肥皂溶液在最大程度上保留了破骨细胞数量。聚维酮碘和葡萄糖酸氯己定溶液导致骨结节形成、碱性磷酸酶活性和破骨细胞数量下降幅度最大。与单独使用肥皂溶液或用盐溶液进行低压冲洗相比，用肥皂溶液进行低压脉冲冲洗从受污染的胫骨中清除的细菌最多。
我们的研究结果表明，某些溶液在从骨骼清除细菌方面可能比单独用盐溶液进行机械冲洗更有效。在所检测的各种溶液中，肥皂溶液对成骨细胞数量和活性的保留效果最佳。用肥皂溶液进行低压冲洗能最大程度地清除骨骼上附着的细菌。
