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오창욱,김풍택,박병철,송해룡,박일형,백준호,박형진 경북대학교 병원 2003 경북대학교병원의학연구소논문집 Vol.7 No.1
목적 : 골 연장술 후 생기는 연장 가골에 황화 칼슘과 이종 이식골을 투여하여 골 경화 속도에 대한 영향을 알아보기 위한 실험이었다. 연구대상 및 방법 : 성장중인 뉴질랜드 화이트 토끼(2.0-2.5㎏)의 경골 간부에 골막을 보호하고, 절골술을 시행하고, 5일간의 휴지기후 외고정 장치를 이용하여 1주일 동안 7㎜가 연장될 때까지 하루 1㎜씩 2회의 리듬을 가지고 골 연장을 실시하였다. 제1 실험 군 7마리에는 연장이 끝난 직후 황화 칼슘(Osteoset^(ⓡ), Wright medical USA) 1정, 제 2 실험 군 7마리에는 이종 이식골의 일종인 Lubboc 5㎟을 각각 연장된 가골 부에 주입하고, 단순 연장한 대조군 7마리와 함께, 방사선 및 골 밀도비를 측정하고 추시하여, 골 경화의 진행속도를 비교하였다. 방사선 촬영은 전후면 및 측면사진을 1주 간격으로 촬영하였고, 골밀도 측정은 DEXA(dual energy X-ray absorptionmetry, Lunar^(ⓡ)) 장치를 2주일 간격으로 시행하였다. 결과 : 방사선 소견상, 제 1실험군의 연장가골의 완전 경화시간은 평균 14주, 제 2실험군은 154 주로 각각 대조군의 16.9주보다 단축되었으며, 골 밀도 비에서도, 두 실험군에서 최고치가 대조군의 값보다 높고, 최고치까지의 경과기간도 빨랐다. 결론 : 본 연구에서 연장 가골에 황화칼슘 및 이종 이식골의 투여가 골 경화의 기간을 단축시킬 수 있고, 외고정 장치의 빠른 제거에 도움이 될 수 있음을 알았다. Purpose : This study was designed to know the effect of calcium-sulfate and xenograft on the distracted callus after lengthening. Materials & Methods : We had operation of subperiosteal osteotomy and external fixation on the tibial diaphysis of young New Zealand White rabbits(2.0-2.5㎏); after 5 days of latency period, 7㎜(1㎜/day, 2times/day) of tibial lengthening was reached in a week. At 1 week after lengthening, the 1st experimental group of 7 rabbits received a pellet of calcium sulfate(Osteoset, Wright medical, USA) in the distraction gap, and the 2nd experimental group of 7 rabbits received 5㎜ 2 of xenogrfat(Lubboc) in the distraction gap. But, the control group of 7 rabbits did not receive any of above materials. We compared three groups with the changes of radiographic findings at every week and bone mineral ratio(DEXA) at every two weeks. Results : The time to complete consolidation of distraction callus of both experimental group(calcium sulfate;14 weeks, xenograft; 15.4 weeks) was shorter than that of control group(16.9 weeks) in radiographic findings. Maximum value of bone mineral ratio of distraction callus was higher and the time to reach the highest value was also shortened in the both experimental group compared to control group. Conclusion : By use of bone substitutes as like calcium sulfate or xenograft in the distraction callus with external fixator, it may be possible to shorten the consolidation period and the fixator-wearing period.
연장 가골에 골 이식 대체물 투여가 골 경화에 미치는 영향 : 가토 경골에서의 방사선 및 골 밀도의 변화
송해룡,박병철,박형진,김풍택,오창욱,백준호,박일형 대한골절학회 2000 대한골절학회지 Vol.13 No.4
Purpose: This study was designed to know the effect of calcium-sulfate and xenograft on the distracted callus after lengthening. Materials & Metbods: We had operation of subperiosteal osteotomy and external fixation on the tibial diaphysis of young New Zealand White rabbits(2.0-2.5kg); after 5 days of latency period, 7 mm(1mm/day, 2 times/day) of tibial lengthening was reached in a week. At 1 week after lengthening, the 1st experimental group of 7 rabbits received a pellet of calcium sulfate(Osteoset, Wright medical, USA) in the distraction gap, and the 2nd experimental group of 7 rabbits received Smm2 of xenogrfat(Lubboc ) in the distraction gap. But, the control group of 7 rabbits did not receive any of above materials. We compared three groups with the changes of radiographic findings at every week and bone mineral ratio(DEXA) at every two weeks. Results: The time to complete consolidation of distraction callus of both experimental group(calcium sulfate;14 weeks, xenograft; 15.4 weeks) was shorter than that of control group(16.9 weeks) in radiographic findings. Maximum value of bone mineral ratio of distraction callus was higher and the time to reach the highest value was also shortened in the both experimental group compared to control group. Conclusion: By use of bone substitutes as like calcium sulfate or xenograft in the distraction callus with external fixator, it may be possible to shorten the consolidation period and the fixator-wearing period.
소아 대퇴골 간부 골절에 대한 역행성 유연 골수정을 이용한 치료
박병철,박형진,오창욱 대한골절학회 2001 대한골절학회지 Vol.14 No.2
Purpose : This study was designed to evaluate the clinical effectiveness including bone union, leg length discrepancy, after retrograde flexible intramedullary nailing for pediatric femoral fractures. Material and method: Nineteen cases (18 patients) with femur fracture at the age of 4 to 10 years (mean age 6.7) have been followed up over the minimum of one year. Under imaging intensifier, the fracture was temporarily reduced with manual traction, and 1 or 2 flexible nails were inserted at medial and lateral side of distal femur above the distal epiphysis. After two weeks of immobilization with long leg splint, joint motion was permitted. At 6-8 weeks, partial weight bearing was permitted, and at 10- 12 weeks, full weight bearing was permitted. Results: Time to radiologic union averaged 10.9 weeks. Limb length discrepancy ranged from 7mm of shortening to 6mm of overgrowth(mean; l. 1mm of overgrowth), but there was no severe limb length discrepancy over 10mm. As another complications, there were one case of limited motion of knee joint and one case of broken nail. Conclusion: We found that retrograde flexible intramedullary nailing is a safe, effective treatment for acute femoral shaft fractures in skeletally immature patients.
골결손을 동반한 감염성 불유합에 대한 Ilizarov를 이용한 치료
박병철,경희수,인주철,오창욱,박일형,조진흠 대한골절학회 1998 대한골절학회지 Vol.11 No.1
From June l993 to May 1997, 12 patients aged from 13 to 41 years were treated for infected nonunion with bone defect by the Ilizarov technique. Of 12 cases, 9 cases were tibia and 3 cases were femur. The cuases of nonunion were open comminuted fractures with initial bone loss and bone defect after removal of sequestrum. Infection was managed by radical resection of the infected necrotic bone and insertion of antibiotics mixed cement beads, Bony defects were gradually closed by the Ilizarov' s internal bone transport technique, and final equalization of leg length inequality was achieved by means of external lenghthening technique. Corticotomies were performed at the proximal level(7), at the distal level(5). The average optained length averaged 4.8cm in length and healing index averaged 67.4days/cm According to Paley and Catagni's calssification bony and functional results were either excellent or good except 1 case (nonunion, poor bony result). The complications (devided by Paley to 3 categories: problems, obstacles, complications) were pin tract infection(8), pain(5), mild flexion contracture of joint(1), delayed consolidation(3), soft tissue impingement(2), joint stiffness(3) and nonunion(1). We concluded that Ilizarov techinque was very effective for treatment of infected nonunion with bone defect and soft tissue defect.
비확공성 골수강내 교합정을 이용한 개방성 경골 골절의 치료
박병철,박형진,경희수,인주철,오창욱 대한골절학회 2000 대한골절학회지 Vol.13 No.2
Purpose: this paper was to evaluate the treatment results in the viewpoint of bone union, union time, and complications including infection of unreamed nailing of open tibial fractures. Materail & Methods: We reviewed 46 open tibial shaft fractures that were treated with unreamed tibial nail. AO unreamed tibial nail was inserted after reduction under image intensifier control. Considering factors were severity of open wound, type & location of fractures. Results: Average union time of open fractures was 21.3 weeks, nonunion rate was 2/46(4%). Average union time were 24.1, 19.7, 24, 24, 20 weeks in open grade I, II, IIIa, IIIb, IIIc fractures. According to the type of fractures, average union time were 20.4, 23.6, 25.7 weeks and nonunion rate were 0/22, 1/18, 1/6 in type A, B, C fractures. According to the level of fractures, average union time were 24.0, 20.0, 24.1 weeks in proximal, middle, and distal fractures. There was no significant differences in average period of radiologic union, infection rate and nonunion rate according to fracture level, open grade, but longer union time and higher nonunion rate were observed in complex and comminuted fractures(p$lt;0.05). Conclusion: With adequate soft tissue treatment, the unreamed intramedullary nailing can be a good treatment modality for open tibial shaft fractures, even to grade IIIB.