化膿性骨髄炎に対する局所持続洗浄療法

抗生物質の局所投与と全身への移行

抄録

In 1962, E. L. COMPERE reported on the successful use of topical treatment in a few cases of osteomyelitis and postoperative pyogenic bone and joint infections. We have continued to use this method, and most of the 70 cases of osteomyelitis so treated have healed. We began to use Alevaire and Urokinase in the antibiotic solutions instilled for the treatment of osteomyelitis or postoperative infections by the closed irrigation technique. Seventy patients were treated by this technique, and 65 patients did not show recurrences one year or more after treatment. Thirty-one of 70 infections were caused by hematogenous infection, and 18 of 70 infections were postoperative. Twenty-eight infections were caused by Staphylococcus aureus, 12 infections were caused by Pseudomonas aeruginosa and 6 infections were caused by Escherichia coli. Duration of infection prior to closed irrigation was from 5 days to 50 years, and 24 cases were 10 years or more. Duration of irrigation was from 5 days to 40 days. Most of them were from 11 days to 30 days. We made a special circulation system using double tube to keep the irrigation from obstruction of the tube. We call it 4 channel method. Since then we have not worried obstruction of the tube or leak of the solution.
We examined blood concentration of ABPC, CBPC, SBPC, CET and TPG during closed irrigation. But the blood concentration of these antibiotics were very low, from zero to 31. 9 μg/ml. On the contrary, however, we found high concentration of antibiotics in the egress fluids, from 75. 7 μg/ml to 1, 577. 2μg/ml.