Radyoterapiyi takiben kritik boyutta oluşturulan kemik defektlerinde antibiyotiklerin etkinliğinin deneysel olarak incelenmesi

Year 2020, Volume: 7 Issue: 2, 294 - 303, 01.08.2020

Özgün Günay Özge Doğanay Olgu Enis Tok Alper Alkan

https://doi.org/10.15311/selcukdentj.695767

Abstract

Amaç: Çenelerin osteoradyonekrozu (ORN), baş ve boyun kanserlerinde radyasyon tedavisinin bir komplikasyonu olarak karşımıza çıkmaktadır. Tanımı ve sınıflandırması yıllar içinde değişiklik göstermiş, patofizyolojisine dair teorileri geliştirilmiş ve buna bağlı olarak farklı tedavi prensipleri denenmiştir. Çalışmadaki amacımız, radyoterapiyi takiben alt çene kemiğinde cerrahi olarak oluşturulan kritik boyuttaki defektlerde klindamisin, metronidazol, rifamisin ve doksisiklin grubu antibiyotiklerin kemik iyileşmesi üzerindeki etkilerini incelemekti.
Gereç ve Yöntem: Anti-enflamatuar etkinliğin kemik iyileşmesi üzerindeki etkilerini değerlendirmek için, 50 adet Wistar cinsi albino türü sıçanlar kullanılmıştır. Tüm gruplara genel anestezi altında 30 Gy dozda radyoterapi uygulandıktan 8 hafta sonra sıçanların sağ mandibulasında 5 mm çapında bikortikal hazırlanan kemik defektlerine deney gruplarında ksenogreft ile karıştırılan antibiyotikler, kontrol gruplarında ise sadece ksenogreft partikülleri uygulanarak cerrahi saha iyileşmeye bırakılmıştır. Sakrifikasyon sonrasında elde edilen örneklerde enflamasyon, nekroz, fibrozis, yeni kemik yapım alanı, kalsifiye olmuş kemik alanı ve kapiller sayısı histopatolojik ve histomorfometrik olarak değerlendirildi.
Bulgular: İncelenen kesitlerde nekroz, enfeksiyon ya da fibrozis bulgusuna rastlanmamıştır. Kontrol grubu ile yapılan karşılaştırmalarda metronidazol ve klindamisin gruplarında yeni kemik yapım alanlarının anlamlı derecede yüksek olduğu görülmüştür (p<0.01, p<0.01). Kalsifiye kemik trabekül alanları incelendiğinde kontrol grubu ile klindamisin grubu arasında istatistiksel olarak ileri derecede anlamlı fark tespit edilmiştir (p<0.01). Klindamisin ile diğer gruplar karşılaştırıldığında ise aradaki fark anlamlı (p<0.05) bulunmuştur. Kontrol grubu ile yapılan karşılaştırmalarda kapiller sayısı metronidazol grubunda anlamlı (p<0.05), klindamisin grubunda (p<0.01) ise ileri derecede anlamlı olarak farklı bulunmuştur.
Sonuç: Antibiyotik uygulanan gruplarda iltihabi alanların sayısında azalma, yeni kemik yapım alanlarında ve damarlanmada artış gözlenmiştir. Çalışmada kullandığımız antibiyotiklerin antibakteriyel aktiviteden bağımsız olarak anti- enflamatuar etkinliklerinin olabileceği düşünülmektedir.

Keywords

Osteoradyonekroz, kemik iyileşmesi, klindamisin, antibiyotik, sıçan, radyoterapi, anti-enflamatuar etki

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