Dynamic of tissue changes in oneand twostage treatment of chronic osteomyelytis using bioresorbable matirial impregnated with vancomicin (comparative experimental morphological study)

Abstract

The use of modern antibacterial agents and antiseptics in modern orthopedics does not always prevent infectious complications. Currently, two-stage surgical treatment with the implantation of an antimicrobial spacer is common. This method increases the duration of treatment, causing additional surgical trauma. The use of bioresorbable material with additional antibiotic impregnation simultaneously with the rehabilitation of the infectious focus can be considered a promising direction for improving the effectiveness of treatment of chronic osteomyelitis and reducing the treatment time of this group of patients. The main group consisted of rabbits with an experimental model of osteomyelitis followed by rehabilitation and one-stage replacement of the bone defect with bioresorbable material impregnated with vancomycin (n=12), and in animals of the comparison group (n=12) - two-stage surgical intervention with a similar material. Morphological studies were performed on animals of both groups on the 45th and 90th days after operations with replacement of a bone defect with a bioresorbable material with vancomycin. On the 45th day after the operation, the intensity of the processes of formation of newly formed bone tissue and restructuring of the osteoarthritis replacement material was more pronounced in the main group (28,2 vs 23,5%). Two-stage treatment is characterized by a more pronounced formation of fibrous tissue, the area of which in dynamics increased by 1,4 times (from 27,6 to 39,3%), with a single-stage method of treatment, this indicator increased only by 2% (from 22,9 to 24,9%). The infectious process was stopped in all experimental animals. The effectiveness of one-stage surgical treatment seems to be determined by a faster onset of osteohistogenesis in the area of a local osteomyelic defect when biocomposite is administered immediately after the purulent focus is sanitized. In addition, the absence of repeated surgical trauma with the loss of additional bone volume when removing the cement spacer during two-stage treatment is likely to play a significant role.