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비 steroid성 소염진통제가 흰쥐의 대퇴골 골절치유에 미치는 영향
鄭賢基,金光會,李圭植 한양대학교 의과대학 1984 한양의대 학술지 Vol.4 No.1
More concern has been concentrated in the effects on fracture healing of nonsteroidal anti-inflammatory drugs which has generally been used to reduce pain and edema in the inflammatory regions. Recently many investigators have reported that anti-inflammatory drugs such as aspirin, ibuprofen and indomethacine bring about delay in bone healing following the fracture. The cause of delay in bone healing by treating anti-inflammatory drugs was presumably explained by the fact that the inhibition of synthesis or secretion of prostaglandins produced disturbances in clothing, organization, collagen synthesis and calcification taking place after the fracture. In the present study an experiment was carried out to substantiate the mechanism by which anti-inflammatory drugs delayed bone-healing following the fracture. Wistar rats weighing approximately 200gm were artificially made closed-fracture in femur shaft and were divided into three experimental groups; control, aspirintreated and ibuprofen-treated groups. The anti-inflammatory drugs were administered daily through a stomach tubing throughout the experiment in the amount of 250mg per Kg body weight for aspirin or 50mg per Kg body weight for ibuprofen. The fractured femurs were taken out of the rats at the interval of 2, 3, 4 and 5 weeks after the fracture and subjected to histochemical examinations using Mallory azan staining method to observe collagen fibers in the area of bone union and Alcian blue staining method known to be specific for detecting mucopoly saccharides to observe formation and transformation of bone healing area. The results obtained were as follows; 1) In case of control group, process of tissue differentiation went like below. After 2 weeks loose connective tissue accompanied by thrombos was formed at both fracture ends except thin layer of cartilage. After 3 weeks, most of the connective tissue was replaced by cartilage. After 4 weeks, bone healing was partly observed. The area where bone healing did not occur was connected by cartilage. After 5 weeks, bone healing was completed in the form of cancellous bone. In case of aspirin-treated and ibuprofen-treated groups, loose connective tissue accompanied by thrombos still remained to be seen after 2 and 3 weeks. After 4 weeks, cartilage wider than that of control group was observed and bone healing did not take place yet. After 5 weeks, bone healing was incompletely finished and the area disributed with cartilage was still observed. 2) In control group, mucopolysaccharide of matrix in the fracture area of femoral shaft indicated acidic nature at 2, 3 and 4 weeks after the fracture, but after 5 weeks, it indicated acidic nature untill 4 weeks after the fracture. At 5th week, it indicated mixture of acidic and neutral nature. In ibuprofen-treated group, from 2nd week to 4th week, acidic nature had been indicated. At 5th week, acidic nature was indicated in carilage and neutral nature was indicated in bone-tissue. With the resukts obtained in the present study, it can be concluded that a longterm treatment of non-steroidal anti-inflammatory drugs would cause delay in bonehealing following the fracture.
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슬관절 전 치환술에서 경골 골 결손시 사용한 나사못과 시멘트를 이용한 보강술 - 예비 보고 -
김종헌,정현기,최충혁,엄기영 대한슬관절학회 1999 대한슬관절학회지 Vol.11 No.2
Purpose : To evaluate clinical and radiographic results for screw and cement fixation of tibial bone defect in total knee replacement arthroplasty(TKRA) retrospectively. Materials and Methods : From march 1995 to May 1998, 23 total knee replacement arthroplasties were performed in 19 adults with screw and cement fixation for tibial bone defect. They were followed retrospectively for at least 12 months at mean 28 months(12~50). The average age of the patients at the time of operation was 64 years. The American Knee Society clinical rating system was used for the assessment of the results. We also used Knee Society roentgenographic evaluation and scoring system in all cases for assessment of radiolucent line between bone and cement interface, prothesis and cement, and around the threads of the screw within the bone. Results : The average 37.6 preoperative knee rating score and 41 functional score were improved to 94.9 and 95 retrospectively at the last follow-up. Roentgenographic evaluation revealed that no radiolucent line was detected between prothesis and cement, around the threads of the screws within the bone. Between bone and cement interface, we observed radiolucent line in 8 of 23 cases(34.8%) and they had no progression during follow-up. Conclusion : Screw and cement fixation may be tried when tibial bone defect are small and situated peripherally. But, we considered that more long-term follow-up evaluation must be needed.
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