蒸馏水煮沸、碘伏浸泡及抗生素冲洗对兔慢性骨髓炎病骨的杀菌效果比较

摘要

目的：比较蒸馏水煮沸、碘伏浸泡及抗生素冲洗对兔慢性骨髓炎病骨的杀菌效果。方法选择50只新西兰大白兔，制备感染金黄色葡萄球菌的兔胫骨慢性骨髓炎模型，造模4周后分别从大体观察、X 线检测判断其是否形成骨髓炎，然后截取病骨分别用碘伏浸泡30 min （A 组）、蒸馏水煮沸30 min （B 组）、抗生素冲洗15 d （C 组），处理后分别进行细菌学培养、病理学检查，比较3种方法对病骨的杀菌效果。结果3组兔胫骨经杀菌处理后，均未出现骨皮质碎裂，均能保持较好的形态，肢体长度及力学轴线无明显异常。A 组骨缺损周围组织细菌培养可见明显菌落形成1例，阳性率为7％；B 组可见明显菌落形成4例，阳性率27％；C 组可见明显菌落形成7例，阳性率为47％。其中，A、C 组的阳性率比较差异有统计学意义（P ＜0.017）。高倍显微镜下，A 组骨组织无明显水肿，大片死骨形成，呈片状或条带状，伴或不伴有少量成骨母细胞。B 组骨组织轻度水肿，无死骨形成，少量稀疏成骨细胞存在。C 组明显水肿，成骨细胞散在分布。结论3种不同处理方法对兔胫骨慢性骨髓炎病骨均有一定的杀菌效果，且杀菌后均能保持良好的胫骨结构形态，蒸馏水煮沸法能在短时间内达到良好的灭菌效果且有成骨母细胞存在。%Objective To compare the sterilizing effect of boiling distilled water,iodine soaking and antibiotic irrigation upon chronic osteomyelitis of the tibia in rabbit models.Methods Fifty New Zealand white rabbits were used to establish rabbit models with chronic osteomyelitis of the tibia by staphylococcus aureus in-fection.At 4 weeks after model establishment,gross observation and X-ray examination were performed to eval-uate the formation of osteomyelitis.The diseased bone was obtained and subject to 30-min iodine soaking (group A),30-min boiling distilled water (group B)and antibiotic irrigation for 15 d (group C).Subsequent-ly,the sterilizing effect of three techniques upon the diseased bone was statistically compared by bacterial cul-ture and pathological examination.Results In three groups,no fragmentation of the bone cortex was noted af-ter sterilization treatment.Normal morphology was observed.No evident abnormality was documented in the limb length and mechanical axial line.In group A,significant colony formation was noted in the tissues sur-rounding bone defects in 1 rabbit with a positive rate of 7%,4 (27%)in group B and 7 (47%)in group C.The positive rate considerably differed between groups A and C (P =0.017).Under high-power microscope, no evident edema of bone tissues was observed,and necrotic bone formed in lamellar or stripped shape accom-panied with/without osteoplasts in group A.In group B,mild edema of bone tissues was noted.No necrotic bone formed.A small amount of spare osteoblasts was observed.In group C,significant edema of bone tissues was noted.The osteoblasts were distributed diffusely.Conclusions All three techniques exert sterilizing effect upon the diseased bone in rabbit models with chronic osteomyelitis of the tibia.Original structure and shape can be maintained after sterilization.Distilled water boiling can achieve high sterilization effect in short time withexistence of a large quantity of osteoblasts.