Kaya Göksel Şimşek, Kaya Mahir, Gürsan Nesrin, Kireççi Ekrem, Güngörmüş Metin, Balta Hilal
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Atatürk University, Erzurum, Turkey.
Photomed Laser Surg. 2011 Jun;29(6):405-12. doi: 10.1089/pho.2010.2807. Epub 2011 Jan 10.
In vivo and in vitro studies have reported that laser energy in differing wavelengths and irradiation regimes has a potential bactericidal effect on Staphylococcus aureus.
The purpose of this study was to investigate whether a light wavelength of 808 nm in varying doses has an effect on chronic osteomyelitis induced experimentally in the rat tibia.
Intramedullary cavities were surgically created in the left tibias of 39 adult Wistar albino rats. Five randomly selected subjects were injected with a sterile saline solution, and methicillin-resistant S. aureus (MRSA) was used to induce osteomyelitis in the remaining rats. After 3 weeks, rats with evidence of osteomyelitis were treated with debridement alone (n = 7), with debridement plus laser irradiation to induce photoeradication (n = 21), or were not treated at all [negative control, (n = 6)]. Active irradiation was performed using an 808 nm, 100 mW continuous-wave diode laser with a beam spot size of 0.7854 cm(2) (irradiance = 127.3 mW/cm(2)). Laser treatment commenced immediately after debridement surgery and was applied daily for 5 consecutive days. Irradiation lasted 60 secs (6 J at 7.64 J/cm(2): n = 7), 120 secs (12 J at 15.29 J/cm(2): n = 7), or 180 secs (18 J at 22.93 J/cm(2): n = 7). Rats in the sham and negative control groups were killed 21 days post-induction surgery, and those in the treatment groups were killed after 42 days. Following killing, tibias were removed and analyzed histopathologically, radiographically, and microbiologically.
Histopathological analysis showed that infection levels had decreased by 37%, 67%, 81%, and 93% in the groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93 J/cm(2) light therapy, respectively, compared to the negative control group. Osteomyelitis-induced rats had the highest bacteria count (5 × 10(5)). Bacterial counts fell to 1.6 × 10(4), 4.3 × 10(2), 5.5 × 10(1), and 3.3 × 10(0) in groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93 J/cm(2) light therapy, respectively, compared to the negative control group.
Within the limitations of this study, laser phototherapy with the appropriate irradiation parameters appears to be a promising adjunct and/or alternative technique to pharmacological agents in the treatment of osteomyelitis. The 808 nm 100 mW (127.3 mW/cm(2)) laser device used in this study achieved a maximum effect with an irradiation time of 180 secs, delivering 18 J at an energy density of 22.93 J/cm(2).
体内和体外研究均报道，不同波长和照射方式的激光能量对金黄色葡萄球菌具有潜在杀菌作用。
本研究旨在探讨不同剂量的808 nm光波长对大鼠胫骨实验性诱导的慢性骨髓炎是否有影响。
对39只成年Wistar白化大鼠的左胫骨进行手术造髓腔。随机选取5只大鼠注射无菌生理盐水，其余大鼠用耐甲氧西林金黄色葡萄球菌（MRSA）诱导骨髓炎。3周后，对有骨髓炎迹象的大鼠分别进行单纯清创治疗（n = 7）、清创加激光照射以诱导光清除治疗（n = 21）或不进行任何治疗（阴性对照组，n = 6）。使用波长808 nm、功率100 mW的连续波二极管激光进行主动照射，光斑尺寸为0.7854 cm²（辐照度 = 127.3 mW/cm²）。激光治疗在清创手术后立即开始，连续5天每天照射。照射持续60秒（能量密度7.64 J/cm²时为6 J：n = 7）、120秒（能量密度15.29 J/cm²时为12 J：n = 7）或180秒（能量密度22.93 J/cm²时为18 J：n = 7）。假手术组和阴性对照组大鼠在诱导手术后21天处死，治疗组大鼠在42天后处死。处死大鼠后，取出胫骨进行组织病理学、影像学和微生物学分析。
组织病理学分析显示，与阴性对照组相比，单纯清创组或清创加7.64、15.29和22.93 J/cm²光疗组的感染水平分别降低了37%、67%、81%和93%。诱导骨髓炎的大鼠细菌计数最高（5×10⁵）。与阴性对照组相比，单纯清创组或清创加7.64、15.29和22.93 J/cm²光疗组的细菌计数分别降至1.6×10⁴、4.3×10²、5.5×10¹和3.3×10⁰。
在本研究的局限性范围内，具有适当照射参数的激光光疗似乎是治疗骨髓炎的一种有前景的辅助和 / 或替代药物治疗的技术。本研究中使用的808 nm 100 mW（127.3 mW/cm²）激光设备在照射时间为180秒、能量密度为22.93 J/cm²时达到最大效果，能量为18 J。
