Neslihan AKSU, V. M. Murat HIZ, Mustafa BİLGİLİ, Oktay DÜZGÜN, Taner AKSU, Sergülen DERVİŞOĞLU

Lokal agresif kemik tümörlerinde alternatif bir adjuvan tedavi olarak sıcak su uygulaması

Amaç: Lokal agresif tümörlerde küretaj sonrası kavite duvarında kalan mikroskobik kontaminasyonun biyolojik inaktivasyonu için alternatif bir termoinaktivasyon yöntemi geliştirmek amacıyla, turnikeli ve turnikesiz ortamda kemik kavitelerine uygulanan değişik sıcaklıklardaki suyun, kavite duvarındaki kemik bölgesinde oluşturduğu sıcaklıklar ve etkileri in vivo olarak araştırıldı. Çalışma planı: Dokuz adet dişi erişkin koyunun turnikeli veya turnikesiz arka bacaklarında, kondiler bölgelerde 12 cm3 hacminde açılan kavitelere her biri 12 dakika süreyle aralıklı 60, 70, 75, 80 veya 100 °C sıcaklıkta serum fizyolojik uygulandı. Isının kavite duvarına 1, 2, 3 ve 10 mm uzaklıklarda yarattığı sıcaklıklar kaydedildi. Deneklerin yaşamı işlem sonrası 2. gün, 3 ve 6. haftalarda ve 3 ve 7. aylarda sonlandırılarak histolojik olarak incelendi. Sonuçlar: Ameliyat öncesinde deneklerin vücut ısısı ortalama 38.1 °C, kemik içi ısısı ortalama 27.4 °C ölçüldü. Turnike uygulaması, kemikte ortalama 1.5 °C (dağılım 1-2 °C) sıcaklık azalmasına neden oldu. Seksen derecenin altındaki ve 80 °C’deki uygulamalarda kemik kavitesi içinde ölçülen en yüksek sıcaklıklar sırasıyla 55.5 °C ve 62.5 °C, kemikte ölçülen en yüksek sıcaklıklar 40.5 °C ve 42.5 °C idi. Sıcaklık 100 °C’ye çıkarıldığında yumuşak doku, kas dokusu ve kemikte yeşil-kahverengi-siyah renk değişikliği görüldü ve denek ameliyat sonrası ikinci günde kaybedildi. Diğer sıcaklıklarda çevre kemik, kas, yumuşak dokular normal renkteydi ve bu deneklerde ameliyat sonrası erken komplikasyon gelişmedi. Histolojik incelemede, 60 °C uygulamalarında kavitede kemik iliği ve kemikte nekroz görülmezken, 70 ve 75 °C’de kemik iliği nekrozu görüldü; 80 °C’de ise kemik iliği nekrozuna ek olarak, kemik nekrozu izlendi. Bu sıcaklıklarda deneklerin hiçbirinde yumuşak doku nekrozu görülmedi. Çıkarımlar: Bulgularımız, kemik kavitelerindeki sıcak serum fizyolojik uygulamalarında, kavite duvarındaki 1-2 mm’lik kemik bölgesinde kemik nekrozu oluşturabilecek en uygun sıcaklığın 80 °C olduğunu göstermektedir.

Anahtar Kelimeler:

Sodyum klorür, Alt ekstremite, Kombine tedavi uygulaması, Hayvanlar, Isı, Kemik neoplazmları, Küretaj, Koyun

Hot saline irrigation as an alternative local adjuvant therapy in local aggressive bone tumors

Objectives: This study aimed to develop an alternative thermoinactivation method for biological inactivation of microscopic contamination on the cavity wall following curettage of local aggressive tumors. Hot saline irrigation was applied at various temperatures to bone cavity, with or without tourniquet on the extremity and temperature changes and local effects were investigated in vivo. Methods: Bone cavities 12 cm3 in size were created in the condylar regions of the hind legs in nine female adult sheep. The cavities were irrigated by hot saline solution at 60, 70, 75, 80, or 100 °C, with and without the presence of a tourniquet, and the temperatures 1, 2, 3, and 10 mm distant to the cavity wall were recorded. The animals were sacrificed postoperatively at 2 days, 3 and 6 weeks, and 3 and 7 months for histologic studies. Results: The mean body temperature and temperature inside the bone prior to surgery were measured as 38.1 °C and 27.34 °C, respectively. Tourniquet application caused a mean decrease of 1.5 °C (range 1-2 °C) in bone temperature. The highest temperatures measured below 80 °C and at 80 °C were 55.5 °C and 62.5 °C in the cavity, and 40.5 °C and 42.5 °C in the bone, respectively. At 100 °C application, the color of the bone together with the surrounding soft tissue and muscle tissue turned to yellow-brown-black, and the animal died on the second postoperative day. At temperatures ≤80 °C, the color of the bone and surrounding tissues appeared normal and no early complications were encountered. Histologic studies showed no bone marrow or bone necrosis at 60 °C, only bone marrow necrosis at 70 °C and 75 °C, and in addition to bone marrow necrosis, bone necrosis at 80 °C. At these temperatures no evidence for soft tissue necrosis were observed. Conclusion: Our results show that, in order to achieve bone necrosis at 1-mm and 2-mm distances from the cavity wall, the optimum temperature for hot saline irrigations applied to the bone cavity is 80 °C.

Keywords:

Sodium Chloride, Hindlimb, Combined Modality Therapy, Animals, Heat, Bone Neoplasms, Curettage, Sheep,

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