Kobayakawa H
Nihon Seikeigeka Gakkai Zasshi. 1979 Jul;53(7):761-75.
The author undertook the experiments as described below in order to determine the preferential site of hematogenous osteomyelitis and possible effects of foreign bodies in the bone marrow on development of infection. I) In the first experiment, mice were inoculated with 10(7) cells of staphylococcus aureus intravenously into the tail vein and examined for the distribution and proliferation of the organisms in the bones, all over the body. It was found that the orgaisms in the blood stream were distributed to the bones all over the body almost evenly and that after prolonged observation, remarkable proliferation was noted in both femur and tibia. This bacteriological fact was supported by roentgenographic examination of all the bones. II) In the second experiment, inoculation of staphylococcus aureus into the tail vein was made after a foreign body (No. 5 sterile silk thread of 3 mm in lenght) had been inserted into the proximal metaphysis of a tibia of mice. The tibia of both legs was divided into 3 parts: proximal metaphysis, diaphysis and distal metaphysis. Observation were made for the distribution of organisms and state of proliferation in each of these three parts. In order to elucidate how the inserted foreign body promoted the establishment of infection, the group inserted with silk thread was compared with the control group (un-inserted group). The following results were obtained: 1. Although after 2 weeks of inoculation, the foreign body exerted no influences on the distribution and proliferation of organisms, but it was experimentally demonstrated to play a very important role for retention of organisms and maintenance of infection for a long period. 2. When the inoculum size was 10(6) to 10(7), the organisms were distributed evenly throughout the tibia. However, in the diaphysis the organisms tended to disappear, while in the metaphyseal area the organisms were easy to proliferate. It was also shown that at least 10(5) of organisms were needed for the establishment of infection and that the success or failure of establishment of infection is determined usually within 24 hours after inoculation of the organisms. As described above, from this study it was demonstrated that the femur and tibia were the preferential site of hematogenous osteomyelitis and that metaphyseal areas of the long bones were commonly affected. Once hematogenous invasion of organisms occurred, administration of antibiotics should be started as soon as possible, no later than 24 hours. According to our common experience, removal of foreign body is necessary for the complete cure of the injection.
作者进行了如下实验，以确定血源性骨髓炎的优先发病部位以及骨髓中异物对感染发展的可能影响。I）在第一个实验中，将10⁷个金黄色葡萄球菌细胞经静脉注射到小鼠尾静脉中，并检查全身骨骼中细菌的分布和增殖情况。结果发现，血流中的细菌几乎均匀地分布到全身骨骼，经过长时间观察，发现股骨和胫骨中细菌有显著增殖。所有骨骼的X线检查证实了这一细菌学事实。II）在第二个实验中，先将一个异物（长度为3mm的5号无菌丝线）插入小鼠胫骨近端干骺端，然后经尾静脉注射金黄色葡萄球菌。将双腿的胫骨分为三个部分：近端干骺端、骨干和远端干骺端。观察细菌在这三个部分中的分布和增殖情况。为了阐明插入的异物如何促进感染的发生，将插入丝线的组与对照组（未插入组）进行比较。得到以下结果：1. 接种2周后，异物对细菌的分布和增殖没有影响，但实验证明它对细菌的滞留和长期维持感染起着非常重要的作用。2. 当接种量为10⁶至10⁷时，细菌均匀分布于整个胫骨。然而，在骨干中细菌倾向于消失，而在干骺端区域细菌易于增殖。还表明，至少需要10⁵个细菌才能建立感染，并且感染的成功与否通常在接种细菌后24小时内决定。如上所述，从这项研究中证明，股骨和胫骨是血源性骨髓炎的优先发病部位，长骨干骺端区域通常会受到影响。一旦发生细菌的血源性入侵，应尽快在不迟于24小时开始使用抗生素。根据我们的经验，为了完全治愈感染，取出异物是必要的。
