탈회 염산농도가 동종골 이식 치유 과정에 미치는 영향에 관한 실험적 연구

엄인웅(In Woong Um),김은철(Eun Cheol Kim) 대한구강악안면외과학회 1993 대한구강악안면외과학회지 Vol.19 No.2

It is generally beleived that the demineralization process does not remove BMP, while the undemineralized bone contains this protein, the bone mineral seems to hinder its action so that the demineralization process make the bone inducing agents more available to the host tissue. The purpose of this study was to evaluate the influence of HC1 concentration o the healing process of 0.4N, 0.5N, and 0.6N HC1 demineralized allogenic bone graft respectively compared with the autografted bone. The results were as follows: 1. Inflammatory cell infiltration appeared at 2 weeks and disappeared at 4 weeks in all experimental groups, but especillay severe in 0.4N HC1 demineralized group at 2 weeks. 2. Neovascularization around graft material in 0.5 and 0.6N groups were more than in 0.4N HC1 group. 3. Osteoblastic activity in 0.5 and 0.6N groups were more than in0.4 HC1 group. 4. There were no significant differences of bone resorption among 0.4, 0.5 and k0.6N HC1 groups. 5. New bone formation and mineralization in 0.5 and 0.6N HC1 groups were more than in 0.4N group and were similar to autograft group.

자가 탈회골의 조직반응에 관한 실험적 연구

김장연,김영조,엄인웅,이동근,이재은 大韓顎顔面成形再建外科學會 1993 Maxillofacial Plastic Reconstructive Surgery Vol.15 No.3

Many surgeons are on the point of bone excision and reconstruction of the bone defects by autograft. xenograft, and allograft in the treatment fo begin and malignant tumors of bone. Of all type of bone grafts, we received the autograft as the best ideal bone graft. Of autogenic bone graft, replantation of excised autogenic bone for reconstructiong the bone defects has been the ideal method until now, but early bone healing reponses and tumor cell devitalization after replantation of excised autogenic bone have not been identified for clinical applications. So, to evaluate bone healing response after replantation in rabbit's calvarial bone, we divided the experimental group into three groups. Group 1 is a fresh autogenous bone group. Group 2 is a deep frozen group. Group 3 is freeze-dried demineralized group. Obtained result were as followed: 1. Inflammatory cell infiltration appeared at I week and disappeared at 4 weeks in all experimental group, Especially, severe inflammatory cell infiltration showed in fresh autogenous bone group at 2 weeks, Especially, severe inflammatory cell infitration showed n fresh autogenous bone group at 2 week Group 3 is the least showing group on the point of inflammatory cell infiltration. 2. Osteoblastic activity evenly increased upto 4 weeks and maintained to 6 weeks and decreased after this period, especially osteoblastic activity in group 2 is less than group 1 and group 3. We can't discriminate between osteoblastic activity of group 1 and that of group 3. 3. In new bone formation, group 3 was more active than any other groups at early stage, but there were little differences among three experimental groups at later state. 4. Bone resorption around the grafted bone slightly appeared at 1 week and disappeared at 4 weeks in all experimental groups. We can find the more bone resorption in group 2 at 2 weeks than any other groups. We could suggest, as appears from our results, that freeze-dried deminiralized bone graft is the useful bone graft in the clinical applications of excised autogenic bone.

하악골 과두돌기 골절시 개구범위에 관한 임상적 연구

엄인웅,김수남,우승철,이동근 大韓顎顔面成形再建外科學會 1992 Maxillofacial Plastic Reconstructive Surgery Vol.14 No.4

Functional recovery associated with mouth opening after mandibular condyle fracture was a contradictory result of many authors. The treatment goal of condyle fracture has been not only the good reduction and fixation but also the rapid functional recovery with mouth opening capacity. The purose of this study is to evaluate the mouth opening capacity after surgical or non-surgical treatment of condyle fracture according to the site, level, maxillomandibular fixation(MMF) and operation method based on 39 patents with condyle fracture who were admitted to the department of oral and maxillofacial surgery, Wonkwang Unversity Hospital from May.1, 1990 to Aug.31, 1992. The results were as follows. 1. The most common fracture site was level IV (17 cases : 42.2%) and level Ⅰ (14 cases : 36.8%), level Ⅱ(5 cases: 13.2%) and level Ⅲ(3 cases : 7.9%) were in decreasing order of frequency. Compound fracture with symphysis was more frequent (69.2%) than simple fracture(30.8%). 2. The mouth opening capacity was increased in the level Ⅰ compared with level Ⅳ. 3. The mouth opening capacity was increased in the group of segment removal. 4. The mouth opening capacity was increased in the MMF period was decreased. 5. Better mouth opening capacity was recorded in the physical therapy group of more than 3-4 weeks of treatment period.

동종 탈회골의 크기가 유도골 형성에 미치는 영향에 관한 실험적 연구

엄인웅,이동근,민승기,방만혁 大韓顎顔面成形再建外科學會 1995 Maxillofacial Plastic Reconstructive Surgery Vol.17 No.4

As early as 1889, treatment of ostemyelitis was reported using xenogeneic demineralized bone. In 1965, Urist discovered that demineralized long bone fragment, even when implanted in nonskeletal tissue, would stimulate osteogenesis. The clinical use of demineralized bone of Oral and Maxillofacial surgery is not new. The demineralized bone implants were used for 1) interposition within osteotomy gaps, cystic detects, alveolar clefts ; 2) augmentation, over intact bone surfaces ; 3) construction of new bone within soft tissue. Demineralized bone grafts invokes a induced osteogenesis which is transformation of host cells into osteoblasts. Demineralized bone has identified several factors that modulate the osteogeneic response : sterilization method, recipient age, particle size etc. Especially, pulverization of bone matrix may enhance its osteoinductive properties, to allow rapid, efficient bridging of large defects. the purpose of the present report was to describe the potential efficacy of demineralized allogeneic bone powder of skull of rabbits as a particle size ; 212 ㎛, 710㎛, 1 mm each other. Microscopic finding in our experimental studies shown that 710㎛ demineralized bone powder is the most potent osteogenic response, and then 212㎛, 1mm size. Densitometric analysis shown that density of all group was continue to increase until 4 weeks after operation, and then continue to decrease.

동결 건조한 한국인 상하악골에 대한 실험적 연구 : Ⅰ. A microbiologic study of the sterility on the fresh-frozen and freeze-dried bone of human Ⅰ. 단순냉동 및 냉동 건조된 동종골의 멸균에 관한 실험적 연구

엄인웅 大韓顎顔面成形再建外科學會 1991 Maxillofacial Plastic Reconstructive Surgery Vol.13 No.4

To determine the sterility of the prepared allogeneic bone of the human, culture of the allografts prior to implantation was performed on fresh-frozen and freeze-dried bone. Before the use of ailografts to the patients, it must be confirmed about the sterility, cellular cytotoxicity, immune reaction, and osteoinductive potential as a biomaterials. Oral and maxillofacial surgeons demand for allograft bone will be increased in the future. Wonkwang Bone Bank attempted to meet this demand, has performed series of experimental study on the allograft bone of the Koreans to evaluate the physical and chemical suitability of the bone since the surgeons applications will have broadened from benign cystic lesions to fracture malunions and non-unions, large segmental defects, and whole-bone allorgrafts after tumor surgery. The results obtained were as follows: 1. Freeze-drying(FD) only shoed some bactericidal effects of the normal and osteo bone but in cases of performing EO gas sterilization, the FD effects was not clear. 2. The fact that FD has little effect than theEO gas sterilization on normal bone postulated that the presence of microbiota may be due to an operation and bone processing procedure. 3. FD and EO gas sterilization had a remarkable effect on the osteo bone. 4. The sterilization effect were EO gas, Freeze-drying, Fresh-Frozen with descending order. But all sterilization method were not complete to preserve and implant allograft bone. We are now performing further continuous study on the radiation and chemical sterilization procedure to make safe and complete allograft bone.

냉동 건조 탈회 동종골 이식후 골막이 골 형성 과정에 미치는 영향에 관한 실험적 연구

이동근,엄인웅,민승기,권혁도 大韓顎顔面成形再建外科學會 1995 Maxillofacial Plastic Reconstructive Surgery Vol.17 No.4

Periosteum in general is described as a specialized fibrous membrane of mesenchymal origin consisting of two basis layers : outer fibrous layer consists of irregularly arranged dense connective-tissue with fibroblasts, and inner osteogenic or cambial layer is composed of more loosely arranged fibers, greater vascularity and flatted spindle-shaped pre-osteoblasts. This periosteum may serve in controlling bone growth, especially mandibular growth has been emphasized. But, the periosteum enwrapping the facial skeleton have been studied for many years leaving a controversy in opinion regarding the function of these structures. We evaluated the bone formation activity of te periosteum in allogeneic bone grafts which bones are made of freeze-dried preparation preoperatively. We made the calvarial bone defects, 5×7mm sized, amd grafted with allogeneic bone in rats, which a half of specimens has dissected the overlying periosteum and a rest intacted. After bone grafting, we evaluated the capacity ofbone formation of periosteum, 1, 2, 4, 6, 8 weeks postoperatively. There are subtle differences of bone formation during early healing period after demineralized allogeneic bone grafting between control groups with periosteum and experimental groups without periosteum.

구강외과 영역의 수술에 있어서 Emazon의 진통·소염효과

김창수,엄인웅,민병국 최신의학사 1990 最新醫學 Vol.33 No.8

악골결손 재건을 위한 탈회 및 비탈회 동결건조 동종골의 이용

이기혁,박인순,김영균,김수관,엄인웅,여환호,이병준 大韓顎顔面成形再建外科學會 1996 Maxillofacial Plastic Reconstructive Surgery Vol.18 No.3

Bone graft has been used to repair one defect caused by disease and trauma, congenital and acquired deformities. Graft materials are autogenous bone, allogenic bone, xenogenic bone, synthetics. Autogenous bone graft is the most superior to other materials for immunologic reaction, compatibility to host tissue, and revascularization. However, autogenous bone graft is required for additional operation and the amount of taking is limited. Autografts are obtained at own expense and also limited in size, shape. In order to compensate these problems, allogenic bone graft has been used increasingly. But allogenic bone graft encounters immunologic complications. Therefore, it has been used after freezing, lyophilization, or demineralization. Allogenic bone processed by only lyophilization includes potential antigenic properties on its surface, therefore it is demineralized to deplete immunologic reaction. Demineralized bone releases BMP and helps the mesenchymal cells transform to the chondroblast to produce cartilage and bone. This reaction is called osteoinducation. Many authors have reported that mineralized lyophilized bone had less antigenicity clinically and favorable bony consideration with host bone. In our department from 1995 to now, we have used banked allogenic bone graft that has been prepared from Wonkwang Bone Bank in 5 cases and mineralized lyophilized bone graft in 2 cases to reconstruct the maxillofacial bone defect after tumor resection and cyst enucleation and cleft alveolus. We will report with literature review that the result is favorable functionally and esthetically.

한국인 전상환자의 악안면결손에 대한 임상적연구

민승기,김수남,최규환,엄인용 大韓顎顔面成形再建外科學會 1992 Maxillofacial Plastic Reconstructive Surgery Vol.14 No.4

Maxillofacial war injures is specific representative of severe hard and soft tissue defect. This type of injuries were different from the trauma because it may be fatal. The purpose of this study was to evaluate the injury type base on the retrograde medical record in the 104 patients from Feb. 1991 to Aug. 1992 in Korea Veterans Hospital. The obtained results were as follows. 1. Among 104 cases, 51 cases(49.0%) were classified as mandibular defects only, and 53 cases (51.0%) were classified as maxillary with mandibular defect (combined). 2. The etiologic factors of injury were gunshot, artillery and grenade or shell: 33 cases, 14cases, and 10 cases respectively in Korea War, 19 cases, 5 cases, and 8 cases respectively in Vietnam War. 3. In 57 cases of mandibular partial defect, the angle area showed the highest frequencies, 18 cases(31.6%). 4. In 42 cases of mandibular segmental defect, the area between the 1st molar and the ascending ramus showed the highest frequencies. 17 cases(40.4%), and almost all cases were unilateral defect (40 cases, 95.0%) 5. Reconstruction method performed for segmental mandibular defect were wire or plate(15 cases, 35.7%) and soft tissue closure only(12 cases, 28.7%), respectively.

악골 및 연조직에 발생한 혈관종 치험례 : 5증례 보고

엄인웅,김명진,김종원,민병일 대한악안면성형외과학회 1986 대한악안면성형외과학회지 Vol.8 No.1