Otoklavizasyon, pastörizasyon yöntemlerinin kemik kaynamasına etkisi
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Date
2006
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Uludağ Üniversitesi
Abstract
Günümüzde kemik tümörlerinin tedavisinde radikal rezeksiyon ön plandadır. Ancak radikal rezeksiyon sonrası meydana gelen kemik kayıplarının yeniden doldurulması önemli cerrahi sorunlardan bir tanesidir. Çıkarılan tümörlü kemikten tümör hücrelerinin uzaklaştırılıp yeniden kullanılması fikri son yıllarda üzerinde birçok araştırma yapılan konudur. Çıkarılan tümörlü kemik; Radyasyon, Likit Nitrojen, Otoklavizasyon (120 C0) işlemlerine tabi tutularak tümör hücrelerinden arındırılmaktadır. Bu işlemlerle tümör hücreleri yok edildiği gibi kemik kaynamasını sağlayacak olan, kemik yapım hücrelerinin de ortadan kalkması adı geçen yöntemlerin olumsuz yönüdür. Son yıllarda literatürde az sayıda yer almakla birlikte Pastörizasyon yöntemi (60 C0) ile de tümör hücrelerinin ortamdan uzaklaştırıldığı ancak kemik yapım hücrelerinin korunduğu ileri sürülmektedir. Planladığımız bu çalışmadaki amacımız; yukarıda bahsi geçen yöntemlerden Otoklavizasyon ile Pastörizasyon arasında kemik kaynamasına etki açısından bir fark olup olmadığının deneysel olarak araştırılmasıdır. Sonuçların istatistiksel analizlerinde; Heiple’nin histolojik değerlendirme skorlarına göre proksimal uç için grup 1-2-3 ve distal uç için grup 1-2, grup 2-3 arasında ki fark anlamlı bulundu (p<0.05), grup 1-3 arasında ki fark ise anlamsızdı (p>0.05); üçüncü hafta radyolojik skorlarında proksimal uç için gruplar arasında fark saptanmadı (p>0.05), distal uç için grup 1-2 ve grup 2-3 arasında anlamlı fark tespit edildi (p<0.05), grup 1-3 arasında ise anlamlı fark tespit edilemedi (p>0.05); altıncı hafta radyolojik skorlarında proksimal ve distal uç için guplar arasında fark saptanmadı (p>0.05). Altıncı hafta sonunda her ne kadar radyolojik olarak gruplar arasında istatistiksel olarak fark saptanamasa da histolojik olarak kaynamanın grup 3 de grup 2 den üstün olduğu gösterilmiştir. Ortopedik tümör cerrahisinde tümörlü kemik dokunun uzaklaştırılması sonrası oluşan kemik boşluğun yeniden oluşturulması ekstremite koruyucu yaklaşım ve ekstremite fonksiyonları açısından önem arz eder. Hastanın çıkarılan kemik dokusuna uygulanan işlemler, tümörlü hücreleri tamamen ortadan kaldırmalı ve kemiğin biyolojik ve mekanik özelliklerini korumalıdır. Sonuç olarak; çıkarılan kemik dokusunun Pastörizasyon işlemine tabi tutulması, bu deneysel çalışmada histolojik olarak üstünlüğü gösterildiği gibi kemiğin kaynama özelliklerini koruması nedeniyle kullanılabilecek daha iyi yöntem olduğu kanısındayız.
Today, radical resection is foremost important issue in the treatment of bone tumors. However, filling the bone defects after radical resection is one of the most important surgical problems. The idea of re-implantation of removed bone after being cleared of tumoral tissues came to mind during recent years in several investigations. For this purpose, radiation, liquid nitrogen, autoclavization (120 C0) is applied to the resected bone tissues to remove the tumoral tissues from them. With those techniques, the tumoral tissues are removed but the disadvantage is that they have a negative effect on bone producing cells that are involved in healing the bone. Few studies in the literature in recent years stated that pasteurization method (60 C0) preserved biological characteristics of the bone while removing tumor cells. Our study is an experimental study in which we planned to compare the autoclavization and pasteurization effects on bone healing. The experiment construct consisted of 25 New Zealand male rabbits which were randomly distributed to 3 groups. About 20 mm portion of the bone was removed from the 1/3 of middle part of ulna, in all animals. Group 1 was designated as the control group. In 5 rabbits of group 1, the removed 20 mm bone block replaced in its place without undergoing any process. Group 2, autoclavization was performed to osteotomized bones before re-implantation (bone blok kept in 120 C0 for 20 min., than at room temperature for 15 min., in serum physiologic solution for 15 min.). In group 3, pasteurization was performed to osteotomized bones before re-implantation (bone blok kept in 60 C0 serum physiologic solution for 30 min., than at room temperature for 15 min., in serum physiologic solution for 15 min.). In all groups resected bone blocks are re-implanted with intramedullary K-wire. All groups were compared to each other statistically in terms of histological and radiological findings. The statistical analysis of results, by using Heiple histological assessment scoring system, showed significant differences between group 1-2-3 for proximal end of the osteotomy and group 1-2, group 2-3 for distal end (p<0.05); and no difference between group 1-3 (p>0.05). For radiological findings; no statistical differences were found between the groups at the end of three weeks for proximal osteotomy site (p>0.05); and there was a statistically difference between group 1-2 and group 2-3 (p<0.05) and no difference between group 1-3 (p>0.05) at the end of three weeks for distal osteotomy site. At the end of six weeks proximal and distal ends, there were no statistical differences between the groups (p>0.05). However there were no statistical differences in radiological evaluations between the groups for six weeks time for proximal and distal osteotomy sites, it is showed that histological union in group 3 is better than group 2 in six weeks. The reconstruction of bone defect after tumor resection is important for limb-salvage surgery and for preservation of extremity functions. The procedures that are to be applied to the removed bone must make sure that it removes all tumor tissues while preserving the biological and mechanical characteristics of the bone. While comparing autoclavization and pasteurization; although both procedures have been reported to remove all tumoral tissue from the bone, in other investigations it was concluded that pasteurization is better than autoclavization in preserving biological and mechanical characteristics of the bone. This experimental study showed statistically significant superiorty in histological healing process of osteotomy sites in pasteurization group when compared to autoclavization group.
Today, radical resection is foremost important issue in the treatment of bone tumors. However, filling the bone defects after radical resection is one of the most important surgical problems. The idea of re-implantation of removed bone after being cleared of tumoral tissues came to mind during recent years in several investigations. For this purpose, radiation, liquid nitrogen, autoclavization (120 C0) is applied to the resected bone tissues to remove the tumoral tissues from them. With those techniques, the tumoral tissues are removed but the disadvantage is that they have a negative effect on bone producing cells that are involved in healing the bone. Few studies in the literature in recent years stated that pasteurization method (60 C0) preserved biological characteristics of the bone while removing tumor cells. Our study is an experimental study in which we planned to compare the autoclavization and pasteurization effects on bone healing. The experiment construct consisted of 25 New Zealand male rabbits which were randomly distributed to 3 groups. About 20 mm portion of the bone was removed from the 1/3 of middle part of ulna, in all animals. Group 1 was designated as the control group. In 5 rabbits of group 1, the removed 20 mm bone block replaced in its place without undergoing any process. Group 2, autoclavization was performed to osteotomized bones before re-implantation (bone blok kept in 120 C0 for 20 min., than at room temperature for 15 min., in serum physiologic solution for 15 min.). In group 3, pasteurization was performed to osteotomized bones before re-implantation (bone blok kept in 60 C0 serum physiologic solution for 30 min., than at room temperature for 15 min., in serum physiologic solution for 15 min.). In all groups resected bone blocks are re-implanted with intramedullary K-wire. All groups were compared to each other statistically in terms of histological and radiological findings. The statistical analysis of results, by using Heiple histological assessment scoring system, showed significant differences between group 1-2-3 for proximal end of the osteotomy and group 1-2, group 2-3 for distal end (p<0.05); and no difference between group 1-3 (p>0.05). For radiological findings; no statistical differences were found between the groups at the end of three weeks for proximal osteotomy site (p>0.05); and there was a statistically difference between group 1-2 and group 2-3 (p<0.05) and no difference between group 1-3 (p>0.05) at the end of three weeks for distal osteotomy site. At the end of six weeks proximal and distal ends, there were no statistical differences between the groups (p>0.05). However there were no statistical differences in radiological evaluations between the groups for six weeks time for proximal and distal osteotomy sites, it is showed that histological union in group 3 is better than group 2 in six weeks. The reconstruction of bone defect after tumor resection is important for limb-salvage surgery and for preservation of extremity functions. The procedures that are to be applied to the removed bone must make sure that it removes all tumor tissues while preserving the biological and mechanical characteristics of the bone. While comparing autoclavization and pasteurization; although both procedures have been reported to remove all tumoral tissue from the bone, in other investigations it was concluded that pasteurization is better than autoclavization in preserving biological and mechanical characteristics of the bone. This experimental study showed statistically significant superiorty in histological healing process of osteotomy sites in pasteurization group when compared to autoclavization group.
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Keywords
Kemik tümörü, Cerrahi tedavi, Otoklavizasyon, Pastörizasyon, Kemik kaynama, Bone tumor, Surgical treatment, Autoclavization, Pasteurization, Bone healing
Citation
Vural, R. (2006). Otoklavizasyon, pastörizasyon yöntemlerinin kemik kaynamasına etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.