치아회분말과 치과용 연석고의 혼합매식과 동결건조경막을 이용한 조직유도 재생술에 관한 실험적 연구

김영균(Young Kyun Kim) 대한구강악안면외과학회 1996 대한구강악안면외과학회지 Vol.22 No.2

The purpose of this investigation was to evaluate the healing process of toothash-plaster mixture combined with lyophilized dura mater membrane at the bony defects. Full-thickness bony defects were made on the three sites of dog calvaria. Group 1 was filled with the blood clots, group 2 : toothash-plaster mixture, Group 3 : toothash-plaster mixture covered with lyophilized dura mater. Radiographic, macroscopic and microscopic examinations were taken after 2, 4, 8, 12 and 24 weeks after operation. Radiographically, the early new bone formation was appeared from the host bone at group 3. Macros copically, the defect of group 1 was collapsed and filled with connective tissue throughout the experimental period. But the defect of group 2 and 3 was tightly united with the host bone and showed the hard consistency on palpation. Lyodura was partially resorbed and still remained at the original site Microscopically, the inflammatory and foreign body reaction were disappeared as time is over. There were much connective tissue at the central part of group 1. But the defects of group 2 and 3 were filled with the mature bony trabeculae. The implanted particles were resorbed gradually and replaced with the newly formed bone. This results suggest that a lyophilized dura mater can effectively be used as a barrier membrane for guided bony regeneration and toothash-plaster mixture combined with GBR may be a useful adjunct in cases requiring the reconstruction of bony defects.

Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty

( Seung Wook Baek ),( Chul Woong Kim ),( Choong Hyeok Choi ) 대한슬관절학회 2013 대한슬관절학회지 Vol.25 No.1

Purpose: To analyze minimum 2-year clinical and radiological follow-up results of primary total knee replacement arthroplasty (TKRA) with metal block augmentation for tibial bony defect. Materials and Methods: We analyzed 67 cases (52 patients) of primary TKRA with metal block augmentation for tibial bony defects from March 1999 and March 2008. Clinical results were evaluated using the Knee Society clinical rating system and the Western Ontario and McMaster University (WOMAC) score. Radiologic results were evaluated using the Knee Society roentgenographic evaluation system. Results: The mean knee score and function score improved from 42.0 and 45.6 preoperatively to 94.5 and 85.4 postoperatively. At last follow-up, the mean WOMAC score was 16.8. The incidence of radiolucent lines was 10% (7 cases) during the follow-up period, but there was no case of progression. There were no statistically significant differences between the groups divided according to the block size (below 5 mm and over 8 mm) and between the stem and no-stem groups for all parameters. Conclusions: Primary TKRA with a metal block produced satisfactory results for the minimum 2-year follow-up and can be considered as a simple and effective method for the treatment of tibial bony defect in primary TKRA.

Periodontal healing in one-wall intra-bony defects in dogs following implantation of autogenous bone or a coral-derived biomaterial

Kim, Chang-Sung,Choi, Seong-Ho,Cho, Kyoo-Sung,Chai, Jung-Kiu,Wikesjö,, Ulf ME.,Kim, Chong-Kwan Munksgaard 2005 Journal of Clinical Periodontology Vol.32 No.6

<P>Abstract</P><P>Aim</P><P>Autogenous bone grafts and bone biomaterials are being used as part of protocols aiming at reconstruction of periodontal defects. There is a limited biologic information on the effect of such materials on periodontal healing, in particular aberrant healing events that may prevent their general use. The objective of this study was, using histological techniques, to evaluate periodontal healing with focus on root resorption and ankylosis following implantation of autogenous bone and a coral-derived biomaterial into intra-bony defects in dogs.</P><P>Methods</P><P>One-wall intra-bony periodontal defects were surgically created at the distal aspect of the second and the mesial aspect of the fourth mandibular premolars in either right or left jaw quadrants in four Beagle dogs. Each animal received particulated autogenous bone and the resorbable calcium carbonate biomaterial into discrete one-wall intra-bony defects. The mucoperiosteal flaps were positioned and sutured to their pre-surgery position. The animals were euthanized 8 weeks post-surgery when block sections of the defect sites were collected and prepared for qualitative histological analysis.</P><P>Results</P><P>There were no significant differences in periodontal healing between sites receiving autograft bone and the coral-derived biomaterial. A well-organized periodontal ligament bridging new bone and cementum regeneration was observed extending coronal to a notch prepared to delineate the apical extent of the defect. Osteoid and bone with enclosed osteocytes were formed onto the surface of both autograft and coral particles. Although small resorption pits were evident in most teeth, importantly none of the biomaterials provoked marked root resorption. Ankylosis was not observed.</P><P>Conclusion</P><P>Particulated autogenous bone and the coral-derived biomaterial may be implanted into periodontal defects without significant healing aberrations such as root resorption and ankylosis. The histopathological evaluation suggests that the autogenous bone graft has a limited osteogenic potential as demonstrated in this study model.</P>

골 결손을 동반한 견관절 불안정성의 관절경적 재건술

김양수(Yang-Soo Kim),옥지훈(Ji-Hoon Ok) 대한견주관절의학회 2011 대한견주관절학회지 Vol.14 No.1

목적: 골성 방카르트 병변의 여러 가지 치료 방법 중 관절경적 재건술에 대하여 문헌 고찰과 함께 대략적으로 설명하기로 한다. 대상 및 방법: 견관절 전방 불안정성의 치료에 있어 관절경적 복원술의 임상결과 향상으로 개방적 수술보다 관절경적 수술을 더욱 선호하게 되었고 점차 표준 치료법으로 인정받게 되었다. 그러나 관절와의 골 결손이 있는 경우 골 결손의 정도를 측정하는 방법은 연구자에 따라 다양하며 관절경적 복원술의 방법 또한 지속적 발전과 함께 다양하게 소개되고 있다. 결과: 골 결손의 관절경적 재건술 중 방카르트 병변의 이열 봉합술은 일열 봉합술의 단점을 보완하여 보다 견고한 고정과 해부학적 복원을 위해 최근에 소개되었으나 앞으로 많은 증례와 장기간 추시를 통해 그 결과가 입증되어야 할 것이다. 또한 관절경을 이용한 오구돌기 이전술, 즉 Bristow-Latarjet 술식 등 여러 가지 방법이 시도되고 있다. 결론: 전방 불안정성 환자의 관절경적 치료 방법은 다양하게 시도되고 있으며 지속적인 발전을 거듭하고 있다. 성공적인 결과를 얻기 위해서는 수술 전 환자의 골 결손 상태를 정확히 파악해야 하며 치료와 연관된 술 중, 술 후 요소들을 잘 알고 있어야 한다. Purpose: We reviewed arthroscopic reconstruction among the several treatment options for anterior shoulder instability with a bony Bankart lesion. Materials and Methods: Although open Bankart repair has long been considered the optimal surgical management of anterior shoulder instability, advancements in arthroscopic techniques have led to a recent shift to arthroscopic Bankart repair. However, for cases of a glenoid bony defect, several authors have reported various methods to accurately measure the amount of bony defect. Results: The arthroscopic technique of bony Bankart reconstruction continues to evolve and various methods have followed. To overcome the limitations of single fixation of a Bankart lesion, arthroscopic dual fixation (2 point fixation) has recently been tried to anatomically repair and restore the rigid fixation of a bony fragment. The concept of performing the Bristow-Latarjet transfer procedure under arthroscopy has also recently emerged. However, a large series of cases and long term follow up are required to prove the better results. Conclusion: To obtain a successful outcome for patients with anterior instability with a glenoid bony defect, it is imperative that the surgeon be aware of the accurate status of the bony defect and the intraoperative, postoperative factors associated with the proper treatment of this unstable pathology.

Osseous Defects Seen in Patients with Anterior Shoulder Instability

Nobuyuki Yamamoto,Eiji Itoi 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.4

Shoulder surgeons need to be aware of the critical size of the glenoid or humeral osseous defects seen in patients with anterior shoulder instability, since the considerable size of osseous defect is reported to cause postoperative instability. Biomechanical studies have identified the size of the osseous defect which affects stability. Since engagement always occurs between a Hill- Sachs lesion and the glenoid rim, when considering the critical size of the Hill-Sachs lesion, we have to simultaneously consider the size of the glenoid osseous defect. With the newly developed concept of the glenoid track, we are able to evaluate whether a large Hill-Sachs lesion is an “on-track” or “off-track” lesion, and to consider both osseous defects together. In case of an offtrack Hill-Sachs lesion, if the glenoid defect is less than 25%, no treatment is required. In this case, the Latarjet procedure or arthroscopic remplissage procedure can be a treatment option. However, if the glenoid defect is more than 25%, treatment such as bone grafting is required. This will convert an off-track lesion to an on-track lesion. After the bone graft or Latarjet procedure, if the Hill-Sachs lesion persists as off-track, then further treatment is necessitated. In case with an on-track Hill-Sachs lesion and a less than 25% glenoid defect, arthroscopic Bankart repair alone is enough.

미니피그에서 자가치아뼈 이식의 골형성 효과에 대한 연구

정혜린(Hye Rin Jeong),황주홍(Ju Hong Hwang),이정근(Jeong Keun Lee) 대한구강악안면외과학회 2011 대한구강악안면외과학회지 Vol.37 No.5

Introduction: This study examined the effect of autogenous tooth bone used as a graft material for bone regeneration in an artificial bony defect of minipigs. Materials and Methods: Four healthy minipigs, weighing approximately 35-40 kg, were used. Four standardized artificial two-walled bony defects, 5 mm in length and depth, were made on the bilateral partial edentulous alveolar ridge on the mandible of minipigs, and autogenous tooth bone was augmented in the right side as the experimental group. On the other hand, only alloplastic bone graft material HA was grafted with the same size and manner in the left side as the control group. All minipigs were sacrificed at 4 weeks after a bone graft and evaluated histologically by Haematoxylin-eosin staining. The specimens were also evaluated semi-quantitatively via a histomorphometric study. The percentage of new bone over the total area was evaluated using digital software for an area calculation. Results: All specimens were available but one in the left side (control group) and two in the right side (experimental group) were missing during specimen preparation. The amount of bone formation and remodeling were higher in all experimental groups than the control. The mean percentage area for new bone in the experimental and control groups was 43.74±11.96% and 30.79±2.93%, respectively. Conclusion: Autogenous tooth bone is a good alternative to autogenous bone with the possible clinical feasibility of an autogenous tooth bone graft in the reconstruction of bony defects.

골결손을 동반한 상완골 불유합에서 골단축술을 이용한 치료

이재성 ( Jae Sung Lee ),강수용 ( Soo Yong Kang ),유재현 ( Jae Hyun Yoo ) 대한골절학회 2008 대한골절학회지 Vol.21 No.1

목적: 상완골의 골결손을 동반한 불유합을 골중첩과 골단축을 이용해 치료하였고 치료 결과를 분석하여 이 술기의 장점을 보고하고자 한다. 대상 및 방법: 상완골의 골결손을 동반한 불유합으로 진단되어 골중첩 및 골단축술을 시행한 후 1년 이상(70개월, 16~156개월) 추시관찰이 가능한 8예를 대상으로 하였다. 남, 녀 각각 4명이었고 평균 연령은 60.5세(48~75세)였다. 불유합의 위치에 따라 근위부 3예, 간부 3예, 원위부 2예가 있었고, 평균 골 결손은 3.3 ㎝ (2~5 ㎝)였다. 임상적 결과는 최종 추시 시 골유합 유무, 골유합에 걸린 시간, 상지의 길이 차이, 견, 주관절 운동 범위 등의 기능적 평가, 외관상 만족도 및 합병증 유무를 조사하였다. 결과: 전 예에서 방사선학적 임상적 골유합을 보였으며 평균 유합 기간은 10.2주 (8~14주)였다. 건측과 비교하였을 때 길이의 차이는 평균 2.3 ㎝였고, 견관절 및 주관절 운동범위는 수술 전보다 향상되었으며 미용상 7예에서 만족하였고 단축으로 인한 기능상의 제한을 보인 예는 없었다. 결론: 골중첩과 골단축술은 상완골의 골결손을 동반한 난치성 불유합의 치료에 있어 기능적 제한 없이 골유합기간을 단축시킬 수 있고, 인근 관절 운동 범위를 향상시킬 수 있는 좋은 치료법의 하나로 생각한다. Purpose: To evaluate clinical results and advantage of interposition and shortening technique for the treatment of the humeral nonunion with bone defect. Materials and Methods: Eight patients with the humeral nonunion with bone defect underwent interposition of fragments and shortening had been followed-up for more than one year (mean 70 months, 16~156). There were 4 men and 4 women with a mean age of 60.5 years (range, 48 to 75 years). There included 3 proximal, 3 diaphysis and 2 distal metaphysis according to the site, mean size of the bone defect was 3.3 ㎝ (2~5). The time to union, discrepancy of upper extremity, functional results, cosmetic satisfaction and postoperative complications were assessed. Results: All patients achieved to bone union, average union time was 10.2 weeks (range 8~14). Average limb discrepancy was 2.3 ㎝. All had improvement in shoulder and elbow motion after operation. Seven patients were satisfied with the cosmetic result and none had functional deficit due to limb discrepancy. Conclusion: Treatment by Interposition of fragments and shortening in the intractable nonunion of humerus with a bony defect can achieve not only good functional result, shortened bone union time and improved in shoulder and elbow motion.

Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty

백승욱,김철웅,최충혁 대한슬관절학회 2013 대한슬관절학회지 Vol.25 No.1

Purpose: To analyze minimum 2-year clinical and radiological follow-up results of primary total knee replacement arthroplasty (TKRA) with metal block augmentation for tibial bony defect. Materials and Methods: We analyzed 67 cases (52 patients) of primary TKRA with metal block augmentation for tibial bony defects from March 1999 and March 2008. Clinical results were evaluated using the Knee Society clinical rating system and the Western Ontario and McMaster University (WOMAC) score. Radiologic results were evaluated using the Knee Society roentgenographic evaluation system. Results: The mean knee score and function score improved from 42.0 and 45.6 preoperatively to 94.5 and 85.4 postoperatively. At last follow-up, the mean WOMAC score was 16.8. The incidence of radiolucent lines was 10% (7 cases) during the follow-up period, but there was no case of progression. There were no statistically significant differences between the groups divided according to the block size (below 5 mm and over 8 mm) and between the stem and no-stem groups for all parameters. Conclusions: Primary TKRA with a metal block produced satisfactory results for the minimum 2-year follow-up and can be considered as a simple and effective method for the treatment of tibial bony defect in primary TKRA.

성견 치주질환 이환치아의 수평이동이 치주조직에 미치는 영향

김경호(Kyung-Ho Kim),유영규(Young-Kyu Ryu) 대한치과교정학회 1994 대한치과교정학회지 Vol.24 No.3

Most adults, unlike growing children, have some periodontal problems which can influence the outcome of the orthodontic treatment. In cases where periodontal disease progression resulted in marked reduction of periodontium, orthodontic treatment could result in the worsening of the periodontal conditions, and therefore orthodontic treatment planning in such adult patients requires special considerations for the periodontal problems. This study investigates the effects of horizontal orthodontic tooth movement on the changes in the mesial, distal and furcation areas of the disease affected periodontium of adult dogs with advanced bone loss. Six adult dogs with healthy periodontium were selected, and mandibular 2nd premolars were extracted. In the mandibular 3rd premolars, angular bony defects in the mesial and distal sides, and horizontal bony defects in the furcation areas were created. Those that received the flap operation and plaque control were designated as the control, those that had horizontal tooth movement without plaque control after the flap operation as Experimental group I, those that had horizontal tooth movement under plaque control without the flap operation as Experimental group II, and those that had horizontal tooth movement under plaque control after the flap operation as Experimental group III. The control group was sacrificed 2 months postoperatively, and the experimental groups were sacrificed 5 months after the initiation of tooth movement. Specimens were histologically analyzed under light microscope. The results were as follows; 1. After the horizontal tooth movements, Experimental group I and II showed angular bony defects in the mesial sides of the roots and the distal side of the furcation areas, which correspond to the pressure sides. 2. After the horizontal tooth movements, Experimental group I and II showed decreased level of alveolar bone crest in the distal sides of the roots, which correspond to the tension sides. 3. Long junctional epithelium in the control group has not been replaced by periodontal connective tissue after the horizontal tooth movements. 4. Limited formation of new bone was observed in the angular bony defects in the mesial and distal aspects of the roots in the control group. 5. Inflammatory cell infiltration in the connective tissue was most severe in the Experimental group I, followed by Experimental group II, III, and the control group in that order. These results seem to indicate that plaque control was the most influencing factor in the alteration of the periodontal tissue after the horizontal tooth movements in the periodontal tissue with alveolar bone defects.

특발성 골결손에 의한 자발성 뇌척수액 비루 2예

허준영,윤성재,박수찬,김정수 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.1

Cerebrospinal fluid rhinorrhea can be caused by head trauma, brain or sinus surgery or neoplastic sinonasal disease. In addition, CSF rhinorrhea may develop spontaneously in some cases. We experienced two cases of spontaneous CSF rhinorrhea caused by idiopathic bony defect. The first case was a 47-year old female who complained of a persistent rhinorrhea for 2 months without surgical or traumatic history. The second case was a 40-year old female. Having no surgical or traumatic history, she also suffered from a persistent rhinorrhea for thirteen years. For diagnosis of CSF rhinorrhea, we carried out endoscopic examination, glucose test of rhinorrhea, computed tomograph, magnetic resonance imaging and 99mTc-DTPA cisternography. We found bony defect in the cribriform plate of the two cases. Patients were treated successfully with endoscopic approach. Leak sites were repaired with free graft materials. There has not been any recurrence or complications since the endoscopic closure.