S. Schulz, H. Steinhart, R. Mutters.
Philipps UnivesitŠt Marburg, Germany.

For hyperbaric oxygen therapy a minimal blood supply is needed, but in chronic osteomyelitis there are usually necrotic infected areas which are not nutrified and therefore not assessable for hyperbaric oxygen therapy. Ozone is known to be an oxidizing medium with strong bactericide effect. The standard therapy for the treatment of chronic osteomyelitis are antibiotics and surgical procedures. Hyperbaric oxygen therapy seems to be a further useful instrument in refractory cases of chronic osteomyelitis. We investigated the influence of locally applied ozonated oxygen on the progress of chronic osteomyelitis in an experimental model (femur of the rabbit). Forty rabbits were prepared at the proximal side of the femur and needle was inserted into the intremedullary cavity. Osteomyelitis was induced with Staphyloccus aureus (3x106 CFU/mL) and sodium morrhuate. The needle was left intramedullary. After a latency period of four weeks the animals were randomly divided in control and therapy groups. The infected femur was treated three times a day with 20 mL of ozonated oxygen (ozone concentration 107 µg/mL) over periods of two or four weeks. Clinical, radiographic and microbiological results were documented. We were able to induce a chronic osteomyelitis in all animals. Ten rabbits were excluded during the investigation, because of loss of 15% of the original weight. Microbiological evaluation showed no sterile femur neither in control group nor in therapy group. In eight femurs from animals of the therapy groups (out of 17) the culture revealed possible polymicrobial infections with concomitant gramnegative species. Comparison of radiographic results revealed less serious osteomyelitis related bone damages in the therapy groups (p: 0.01). Ozonated oxygen therapy was not able to heal chronic osteomyelitis, but radiographic and clinical evaluations showed significant less severe damages in the therapy groups. In cases of serious and refractory osteomyelitis in the head and neck region the locally applied therapy with ozonated oxygen may be useful in combination with the standard therapies (antibiotics, surgery, hyperbaric oxygen).