光动力抗菌化学疗法联合庆大霉素骨水泥治疗金黄色葡萄球菌性骨髓炎的实验研究  

Experimental Study on Photodynamic Antibacterial Therapy Combined with Gentamicin Bone Cement on the Treatment of Staphylococcus Aureus Osteomyelitis

作　　者：叶正从 李守伟 董琪峰 卢军 朱芳兵 曹国平[1] YE Zhengcong;LI Shouwei;DONG Qifeng;LU Jun;ZHU Fangbing;CAO Guoping(Jiangnan Hospital Affiliated to Zhejiang Chinese Medical Univesity(Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine),Hangzhou 311201,China)

机构地区：[1]浙江中医药大学附属江南医院(杭州市萧山区中医院),杭州311201

出　　处：《中国中医骨伤科杂志》2024年第6期13-18,共6页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：杭州市医药卫生科技计划项目(B20200286)。

摘　　要：目的:通过大鼠实验探究光动力抗菌化学疗法联合庆大霉素骨水泥治疗金黄色葡萄球菌性骨髓炎的效果。方法:采用手术构建SD大鼠股骨金黄色葡萄球菌性骨髓炎模型,将大鼠分为假手术组(空白组)、骨髓炎组(模型组)、庆大霉素骨水泥组(对照组)和光动力抗菌化学疗法联合庆大霉素骨水泥组(观察组)共4组。造模后第4周取骨组织进行细菌分离培养鉴定造模成功,空白组仅手术打开组织,模型组开窗清创后不做任何处理,对照组开窗清创后在感染股骨骨髓腔内填入庆大霉素骨水泥,观察组开窗清创后在感染股骨骨髓腔内填入庆大霉素骨水泥并联合光动力抗菌化学疗法治疗。术后第4周和第12周X线观察术后骨质改变,并进行改良Norden评分。在术后第4周,取骨组织和术周肌肉组织行苏木精-伊红(HE)染色观察其病理改变及细菌培养鉴定。结果:造模后第4周鉴定造模成功。治疗后第12周X线结果可见在模型组手术部位有明显的骨质破坏伴有死骨形成;而对照组和观察组可见手术部位骨膜连接,观察组愈合更良好。改良Norden评分表明,对照组和观察组评分在治疗后第4周和第12周均显著降低,表明骨髓炎有好转;模型组评分无降低,与观察组比较差异有统计学意义(P<0.05)。HE检测第4周时的手术部位肌肉组织和骨组织,结果表明:模型组骨组织可见大量炎症浸润,肌肉组织可见大量胶原增生,肌纤维减少;对照组炎症浸润减轻,肌纤维增多,胶原比例减少;观察组炎症浸润好于对照组,肌纤维恢复更多更完整,胶原比例低于对照组,表明观察组具有更佳的抑制骨髓炎炎性浸润效果。细菌培养结果表明:模型组细菌繁殖明显,观察组和对照组细菌增生较少,并且观察组对比对照组具有更佳的抑菌效果,差异有统计学意义(P<0.05)。结论:光动力抗菌化学疗法能抑制金黄色葡萄球菌繁殖,联合庆大霉素�Objective:To investigate the efficacy of photodynamic antibacterial therapy combined with gentamicin bone cement on the treatment of staphylococcus aureus osteomyelitis through rat experiments.Methods:A SD rat model of femoral staphylococcus aureus osteomyelitis was constructed using surgery.The rats were divided into 4 groups:sham surgery group(blank group),osteomyelitis group(model group),gentamicin bone cement group(control group),and photodynamic antibacterial therapy combined with gentamicin bone cement group(observation group).Bone tissue was taken for bacterial isolation,culture,and identification after 4 weeks of modeling.The modeling was successful.The blank group only underwent surgery to open the tissue at the same time.The model group did not undergo any treatment after window opening and debridement.Gentamicin bone cement was injected into the bone marrow cavity of the infected femur in the control group after fenestration and debridement.Gentamicin bone cement was injected into the infected femoral bone marrow cavity and combined with photodynamic antibacterial therapy for treatment after fenestration and debridement in the observation group.X-ray observation of postoperative bone changes was performed at 4 and 12 weeks after surgery,and a modified Norden score was performed.Bone tissue and muscle tissue were taken for Hematoxylin-eosin(HE)staining to observe their pathological changes and bacterial culture identification at 4 weeks after surgery.Results:The identification and modeling were successful 4 weeks after modeling.The X-ray results showed significant bone destruction accompanied by dead bone formation at the surgical site in the model group after 12 weeks of treatment.It was observed that the periosteal connection at the surgical site was observed in the control group and observation group,and the observation group had better healing.The improved Norden score showed that the scores of the control group and the observation group decreased significantly at 4 and 12 weeks of treatment,indicat

关 键 词：光动力抗菌化学疗法 庆大霉素 骨水泥 骨髓炎 金黄色葡萄球菌 

分 类 号：R-33[医药卫生]