庆大霉素阳离子脂质体同种异体骨治疗兔慢性骨髓炎的实验研究  

TREATMENT OF CHRONIC OSTEOMYELITIS OF RABBIT WITH LIPOSOMAL GENTAMICIN-IMPREGNATED ALLOGENEIC CORTICAL BONE

作　　者：唐辉[1] 徐永清[1] 李刚[1] 游永刚[1] 赵玺龙[2] 梅良斌[1] 范新宇[1] 杨军[1] 赵万秋[1] 丁晶[1] 李军[1] 汤迅[1] 林月秋[1] 

机构地区：[1]成都军区昆明总医院全军骨科中心,昆明650032 [2]成都军区昆明总医院病理科,昆明650032

出　　处：《中国修复重建外科杂志》2010年第4期482-486,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：全军医学科学技术研究"十一五"科技攻关项目(08G035)~~

摘　　要：目的细菌生物膜常于骨感染灶滋生,导致难以根除的慢性感染;庆大霉素阳离子脂质体同种异体骨在体外可有效抑制金黄色葡萄球菌生物膜的生长。探讨庆大霉素阳离子脂质体同种异体骨对兔慢性骨髓炎的治疗作用。方法取40只6月龄新西兰大白兔,左下肢构建胫骨金黄色葡萄球菌慢性骨髓炎模型,右下肢为阴性对照侧。造模后2周行大体及X线片观察。造模后10d内死亡4只动物,余36只于造模后2周根据不同治疗方法分为6组,每组6只。A组:无抗生素;B组:庆大霉素静脉注射;C组:庆大霉素阳离子脂质体静脉注射;D组:植入2粒庆大霉素同种异体骨(0.5cm×0.3cm);E组:植入2粒庆大霉素阳离子脂质体同种异体骨(0.5cm×0.3cm);F组:植入2粒同种异体骨(0.5cm×0.3cm)。治疗后2周行X线检查并行Norden评分,抽取静脉血行细菌学检查;然后处死动物,取标本行HE染色及骨髓细菌学检查。结果造模后2周大体及X线片观察均提示兔胫骨金黄色葡萄球菌慢性骨髓炎模型制备成功。治疗后2周行X线检查提示A、B、C、F组均有不同程度骨质破坏以及骨膜反应;D、E组未见明显骨质破坏和骨膜反应。A～F组Norden评分分别为(2.5±0.3)、(2.1±0.2)、(1.5±0.3)、(1.5±0.2)、(0.9±0.3)、(2.7±0.3)分,A组与B～E组比较差异均有统计学意义(P<0.05),与F组比较差异无统计学意义(P>0.05);B～F组中除C、D组间比较差异无统计学意义(P>0.05)外,其余各组间比较差异均有统计学意义(P<0.05)。A、F组血液及骨髓培养均呈金黄色葡萄球菌阳性;其余4组血液培养均为阴性;骨髓培养B、C、D组各有6、4、3只兔为金黄色葡萄球菌阳性,E组为阴性。HE染色示A、F组均有脓肿、死骨形成,未见新骨形成;B、C组均有不同程度中性粒细胞聚集;D组部分出现中性粒细胞聚集,并见植入骨周围骨母细胞及破骨细胞;E组无中性粒细胞聚集,大量肉芽组织长入,植入骨周围有骨�Objective It is difficult to treat chronic osteomyelitis due to the formation of the Staphylococcus aureus biofilms.Liposomal gentamicin-impregnated allogeneic cortical bone can inhibit the formation of the Staphylococcus aureus biofilms.To explore the treatment of chronic osteomyelitis of rabbit by liposomal gentamicin-impregnated allogeneic cortical bone.Methods The liposomal gentamicin,liposomal gentamicin-impregnated allogeneic cortical bone and gentamicinimpregnated allogeneic cortical bone were produced.Then the chronic Staphylococcus aureus osteomyelitis models of rabbit were made in left lower limbs of 40 6-month-old rabbits and the right lower limbs were used as controls.After 2 weeks,the observations of gross and X-ray were done.Four rabbits died within 10 days after the models were made and other 36 rabbits were devided into 6 groups：group A（no antibiotics）,group B（intravenous injection of gentamicin）,group C（intravenous injection of liposomal gentamicin）,group D（implantation of gentamicin-impregnated allogeneic cortical bone）,group E（implantation of liposomal gentamicin-impregnated allogeneic cortical bone）,and group F（implantation of allogeneic cortical bone）.After 2 weeks of treatment,the bacterial culture,X-ray and HE staining were done.Results The chronic Staphylococcus aureus osteomyelitis model of rabbit was made successfully.The X-ray showed dissolution of bone and periosteal reaction in groups A,B,C,and F,and no obvious dissolution of bone and periosteal reaction in groups D and E.The Norden scores were（2.5±0.3）,（2.1±0.2）,（1.5±0.3）,（1.5±0.2）,（0.9±0.3）,and（2.7±0.3）points in groups A-F,respectively;showing significant differences between group A and groups B-E（P0.05）,between groups B,E,F and other groups（P0.05）.The results of blood and marrow cultures for Staphylococcus aureus were positive in groups A and F,and negative in other 4 groups;the results of bone marrow culture for Staphylococcus aureus were positive in 6 rabbits of grou

关 键 词：庆大霉素阳离子脂质体 细菌生物膜 骨髓炎 同种异体骨 兔 

分 类 号：R687[医药卫生—骨科学]