Department of Orthopaedics and Traumatology, Sakarya University Medical School, Sakarya, Turkey.
J Orthop Res. 2014 Jun;32(6):752-6. doi: 10.1002/jor.22604. Epub 2014 Feb 20.
Implant-related chronic osteomyelitis is a serious complication of orthopedic surgery requiring implant removal and radical debridement. Extracorporeal shockwave (ESW) have demonstrated significant bactericidal effectiveness in vitro and effectiveness and safety were evaluated in an animal model of osteomyelitis. In this experimental study, we aimed to test our hypothesis that the use of ESW together with systemic antibiotic treatment will provide synergy for the treatment of implant-related chronic osteomyelitis caused by methicillin-susceptible Staphylococcus aureus (MSSA). The proximal tibia of 32 rats was contaminated with (10) 8 CFU/ml methicillin-sensitive S. aureus (MSSA-ATCC 29213) and Kirschner-wires were placed into the medulla of the tibia. After 4 weeks, Kirschner-wires were removed and the rats were randomly divided into four groups: group I, untreated contaminated control group; group II, receiving only ESW therapy; group III, receiving only systemic teicoplanin; group IV, treated with a combination of ESW and systemic teicoplanin. ESW was applied twice to the infected limbs and all rats were sacrificed at the end of 8th week. The degree of tibial osteomyelitis was assessed by quantitative culture analysis. Bacterial counts in groups III and IV were significantly reduced relative to the control (p=0.002 and 0.001, respectively). The decrease in bacterial counts was more pronounced and significant in group IV compared to group III (p=0.024). In group II, bacterial counts also decreased, but the differences were in significant (p=0.068). Our experimental model suggests that ESW provides significant synergy for systemic antibiotic treatment. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of implant-related chronic osteomyelitis in rats.
植入物相关的慢性骨髓炎是骨科手术的严重并发症，需要取出植入物并进行彻底清创。体外冲击波（ESW）已证明在体外具有显著的杀菌效果，并在骨髓炎动物模型中评估了其有效性和安全性。在这项实验研究中，我们旨在验证我们的假设，即使用 ESW 联合全身抗生素治疗将为治疗耐甲氧西林金黄色葡萄球菌（MSSA）引起的植入物相关慢性骨髓炎提供协同作用。32 只大鼠的胫骨近端被（10）8 CFU/ml 耐甲氧西林金黄色葡萄球菌（MSSA-ATCC 29213）污染，克氏针被放置到胫骨的髓腔内。4 周后，取出克氏针，将大鼠随机分为四组：第 I 组，未处理的污染对照组；第 II 组，仅接受 ESW 治疗；第 III 组，仅接受全身替考拉宁治疗；第 IV 组，接受 ESW 和全身替考拉宁联合治疗。ESW 应用于感染肢体两次，所有大鼠在第 8 周结束时处死。通过定量培养分析评估胫骨骨髓炎的程度。与对照组相比，第 III 组和第 IV 组的细菌计数显著减少（p=0.002 和 0.001）。与第 III 组相比，第 IV 组的细菌计数减少更为明显和显著（p=0.024）。第 II 组的细菌计数也减少了，但差异无统计学意义（p=0.068）。我们的实验模型表明，ESW 为全身抗生素治疗提供了显著的协同作用。然而，为了在患者中安全地使用这种治疗方式，还需要进一步的临床试验，尽管我们的研究在治疗大鼠植入物相关慢性骨髓炎方面取得了成功的结果。
