가토의 하악골에서 골간 철선고정과 미니프래이트를 사용한 경우 골유합 및 성장에 대한 비교 연구

박종범,김종환,장효죽,이세일,홍인표 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

The miniplate and wiring have been used in the treatment of craniofacial fracture and in the osteotomies for correction of posttraumatic deformities, congenital craniofacial deformities and secondary bony deformities due to pathologies such as hemangioma and neuro-fibroma. An infant rabbit model was used to examine the effect on growth of mandible caused by osteotomy on the mandibular body an two types of fixation; interfragmentary wiring, miniplate and screw fixation. The microscopic examination and direct measurement was obtained Animals (n=15) were randomly assigned to one of three experimental groups, Gorup Ⅰ; rigid fixation with miniplate and screw (n=6), Group Ⅱ; rigid fixation with wiring (n=6), Group Ⅲ; the periosteum was only elevated (n=3, control group). A visible disturbance of growth occurred in rigid fixation group. The use of miniplate and screw caused the greater degree of growth disturbance than wring. Microscopic analysis showed fracture healing process and no differences in two fixation group.

The Influence of Fixation Rigidity on Intervertebral Joints - An Experimental Comparison between a Rigid and a Flexible System

Kim, Won-Joong,Lee, Sang-Ho,Shin, Song-Woo,Rivard, Charles H.,Coillard, Christine,Rhalmi, Souad The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.37 No.5

Objective: Spinal instrumentation without fusion often fails due to biological failure of intervertebral joints (spontaneous fusion, degeneration, etc). The purpose of this study is to investigate the influence of fixation rigidity on viability of intervertebral joints. Methods: Twenty pigs in growing period were subjected to posterior segmental fixation. Twelve were fixed with a rigid fixation system(RF) while eight were fixed with a flexible unconstrained implant(FF). At the time of the surgery, a scoliosis was created to monitor fixation adequacy. The pigs were subjected to periodic radiological examinations and 12pigs (six in RF, six in FF) were euthanized at 12-18months postoperatively for analysis. Results: The initial scoliotic curve was reduced from $31{\pm}5^{\circ}$ to $27{\pm}8^{\circ}$ in RF group (p=0.37) and from $19{\pm}4^{\circ}$ to $17{\pm}5^{\circ}$ in FF group (p=0.21). Although severe disc degeneration and spontaneous fusion of facet joints were observed in RF group, disc heights of FF group were well maintained without major signs of degeneration. Conclusion: The viability of the intervertebral joints depends on motion spinal fixation. Systems allowing intervertebral micromotion may preserve the viability of intervertebral discs and the facet joint articular cartilages while maintaining a reasonably stable fixation.

시상분할 절골술후 강직고정을 이용한 하악전돌증의 수술적 교정시 안정성

강민혁,박상훈,고경석,윤근철,박인권 대한성형외과학회 2003 Archives of Plastic Surgery Vol.30 No.4

Sagittal split ramus osteotomy(SSRO) has become one of the most popular procedure for correction of mandibular prognathism. Rigid fixation is favored for its stability and patient comfort. But there were few data presented about skeletal stability and factors contributing to relapse for sagittal split ramus osteotomy with rigid fixation. From August 1997 to August 2002, eleven patients, who underwent sagittal split osteotomy with rigid fixation, were studied. Patients with genioplasty or any other orthognatic surgical procedures were excluded from sample. Lateral cephalograms were analyzed before surgery, 1 month after surgery, and 12 months after surgery. The mean amount of surgical setback was 6.29 mm at pogonion and the mean amount of skeletal relapse was 1.29mm at pogonion. The mean postoperative horizontal change of soft tissue pogonion was 5.66mm posteriorly, vertical change of menton was 1.83mm superiorly, and angular change of ramus inclination was 5.88 degree increased. The mean amount of postoperative movement was 1.9mm anteriorly at soft tissue pogonion, 2.13mm superiorly at menton, 0.8 degree was decreases at ramus inclination. The amount of skeletal relapse is related to the amount of setback. The results of this study present that the bilateral sagittal split osteotomy with rigid fixation has many advantages and stable procedure for the correction of mandibular prognathism.

TightRope$^{TM}$ Device를 이용한 족근 중족 관절 손상의 치료(1예 보고)

조재호,오인석,Cho, Jae-Ho,Oh, In-Suk 대한족부족관절학회 2011 대한족부족관절학회지 Vol.15 No.4

Lisfranc injury is complex and difficult to treat. Making the correct diagnosis and achieving an anatomical reduction are important factors in regard to achieving a favorable outcome with this injury. We describe a new technique that we have found to be useful for stabilizing Lisfranc injury. This method is relatively fast and simple, and it provides non-rigid fixation. Also, it eliminates the need for implant removal. To date, we have achieved predictable results for stabilizing and treating this injury with the use of a $TightRope^{TM}$ Device, instead of traditional interfragmental screw fixation. In this report, we describe a case in which this method was used with satisfactory short-term results.

An in vitro comparison between two different designs of sagittal split ramus osteotomy

Valdir Cabral Andrade,Leonardo Flores Luthi,Fabio Loureiro Sato,Leandro Pozzer,Sergio Olate,Jose Ricardo Albergaria-Barbosa 대한구강악안면외과학회 2015 대한구강악안면외과학회지 Vol.41 No.3

Objectives: To evaluate the influence of the type of osteotomy in the inferior aspect of the mandible on the mechanical performance. Materials and Methods: The study was performed on 20 polyurethane hemimandibles. A sagittal split ramus osteotomy (SSRO) was designed in 10 hemimandibles (group 1) with a vertical osteotomy in the buccal side (second molar level) and final osteotomy was performed horizontally on the lingual aspect, while the mandible body osteotomy was finalized as a straight osteotomy in the basilar area, perpendicular to the body. For group 2, the same osteotomy technique was used, but an oblique osteotomy was done in the basilar aspect of the mandibular body, forming continuity with the sagittal cut in the basilar area. Using a surgical guide, osteosynthesis was performed with bicortical screws using an inverted L scheme. In both groups vertical compression tests were performed with a linear load of 1 mm/min on the central fossa of the first molar and tests were done with models made from photoelastic resin. Data were analyzed using Student’s t-test, establishing a statistical significance when P<0.05. Results: A statistical difference was not observed in the maximum displacements obtained in the two osteotomies (P<0.05). In the extensiometric analysis, statistically significant differences were identified only in the middle screw of the fixation. The photoelastic resin models showed force dissipation towards the inferior aspect of the mandible in both SSRO models. Conclusion: We found that osteotomy of the inferior aspect did not influence the mechanical performance for osteosynthesis with an inverted L system

하악골 절단술후 강성고정과 반강성고정이 골치유과정에 미치는 영향에 관한 병리조직학적 연구

윤규호,이희철 인제대학교 1999 仁濟醫學 Vol.20 No.1

하악골 절단술 후 강성고정과 반강성고정이 골치유과정에 미치는 영향에 관한 병리조직학적 연구

윤규호,이희철 인제대학교 1999 仁濟醫學 Vol.20 No.1S

이 연구의 목적은 성견의 하악골을 인위적으로 골절단술을 시행하여 강성 및 반강성고정을 한 후 골치유과정을 육안적, 병리조직학적으로 비교 관찰하는데 있다. 체중 10∼12kg 정도의 성견 3두를 자웅 구별없이 선택하여 Ketamine-Hcl로 전신 마취하에 제4 소구치와 제1 대구치 사이의 하악골 양측 골체부를 인위적으로 단순 골절시켰으며, 이때 구강내로 골절편이 개방되지 않도록 그리고 하치조신경 및 혈관에 손상을 주지 않도록 주의하였다. 우측 골절단부에는 비압접성 소형금속판과 나사를 이용하여 고정하였고 좌측 부위는 직경 0.46mm의 강선을 이용하여 결찰하였다. 수술 4주, 6주 및 8주 경과 후 실험동물을 희생시켜 하악골을 절제하고 연조직을 제거하였으며, 골절부위의 치유 과정을 육안적 및 병리조직학적으로 광학현미경상에서 관찰하였다. 이 연구를 통해서 강성고정군 4주 소견에서 이미 판상골에 의한 신속한 골유합 양상을 보임으로써 반강성고정군에 비해 양호한 골치유과정을 보여준다는 것을 확인할 수 있었다. The purpose of this study was to investigate the histopathologic difference of the repair process between rigid and semi-rigid fixation applied after mandibular osteotomy in dogs. Three Korean dogs weighting about 10∼12kg were selected in order to carry out this sxperiment. Under the general anesthesia with Ketamine-Hcl, in order to make a fracture with minimal bony defect between fragments and without copuound fracture into the oral cavity and damage of the inferior bur, disc and osteotome. In the right side of osteotomy site was fixed with noncompressive miniplate and screws and in the left side, fixation was performed with stainless steel wire in 0.46mm diameter. Experimental dogs were sacrificed at 4. 6 and 8 weeks after surgery and soft tissues were dissected from the mandible. The fracture sites were observed grossly and examined under the light microscope to observe the bony repair process histopathologically. It has been confirmed through this study that the bony union process of rigid fixation group was filled with lamellated bone more rapidly at 4th week and therefore showed better healing process than semirigid fixation group.

크루존씨 병에서 최소침습 절개법 Le Fort III 절골술을 통한 RED II 골신연술 후 조기 고정 1례

김영석,이지나,박병윤 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.1

Purpose: Rigid external distraction(RED) is a highly effective technique for correction of maxillary hypoplasia in patients with cleft or syndromic craniosynostosis. Despite many advantages of RED, it also has the problem of relapse as the conventional advancement surgery. Bicoronal approach, that is the common approach to gain access to the craniofacial skeleton, had some morbidity, such as hair loss, sensory loss, wide scar and temporal hollowing. We present our clinical experience of RED distraction with minimal invasive approach and early rigid fixation to overcome these disadvantages. Methods: A 27-year-old female patient with Crouzon's disease underwent Le Fort III osteotomy and RED device application through the minimal invasive direct skin incisions. After the latent period of 5 days, distraction was undertaken until proper convexity and advancement were obtained. During the rigid retention period, inflammation occurred on the right cheek, and proper conservative managements were done including continuous irrigation. To maintain the stability of distraction, early rigid fixation was undertaken on the osteotomy sites through another skin incisions. Preoperative and postoperative orthodontic treatments were performed. Serial photographs and cephalometric radiographs were obtained preoperatively, after distraction and 6 months after distraction. Results: The cephalometric analysis demonstrated postoperatively significant advancement of the maxilla and improvement of facial convexity. After 6-month follow-up period, the maxilla was stable in the sagittal plane and no relapse was found. Facial scars were not noticeable and other deformity and morbidity did not occur. Conclusion: This effective and stable technique will be a good alternative for the patients who need large amount of distraction and for adult patients with severe maxillary hypoplasia or syndromic craniosynostosis.

강직내고정이 성장기 가토의 두개안면골 성장에 미치는 영향

이종건,조문제 大韓成形外科學會 1994 Archives of Plastic Surgery Vol.21 No.2

Craniofacial surgery includes those surgical procedures to correct complex congenital and acquired deformities of cranial an facial bones. Miniplate and screw fixation has had a profound deffect on the recent development of craniofacial surgery. In recent years, craniofacial surgeons have extended the applicaion of rigid fixation on growth of the craniofacial skeleton is not entirely known and has not been qualified in infancy and childhood. This study is to determine which of the following theoretical possibilities : (1) craniofacial growth could continue unhindered by the rigid fixation, (2) growth could be limited either locally where the plate is applied or in an adjacent region, and (3) local growth restriction may be associated with a compensatory growth in an adjacent region. Thirty-one male New Zealand white rabbits weighing 500g to 600g were obtained immediately after weaning at the age of 6 to 7 weeks and were divided into 4 surgical groups. All rabbits in group Ⅰ,Ⅱ,Ⅲ, and Ⅳ were anesthetized with intramuscular ketamine 20 mg/kg. Identical midline sagittal skin incision was made in all operative groups. Periosteal elevation was performed with a periosteal elevator to the left of the midline over the nasal and frontal bone. In group I, a rotary saw was used to complete aosteotomy across the left frontonasal wuture with saline irrigtion. In group Ⅱ, 4 hole miniplates and self-tapping screws were used across the osteotomy lines. The plates and screws were removed after 4 weeks postoperatively under ketamine anesthesia. In rigid internal fixations were kept until sacrifice. In groupⅣ, interosseous wire techniques were used with 0.018 inch wires across the osteotomy lines. Skin and periosteum were closed with a running 4-0 chromic catgut sutures. All animals were housed and fed under identical conditions postoperatively for 12 weeks Dry skulls were made through the several steps. All dry skulls were taken photographs simultaneously with identical focal length and photographer. The 11 topographic landmarks made on each skull, and each landmarks were recorded using the image analysis system(Vidas, Kontron, Germany) interfaced with a personal computer. All digitizings were made by a single investigator. The results were as follows ; 1. Int group Ⅰand group Ⅳ,a significant growith restriction on the operated sides(P<0.05,P<0.05) was observed in nasoincisive suture length. However, no such changes were observed in nasal and cranial bone. 2. In group Ⅱ and group Ⅲ, more significant growth restriction on the operated side was observed in nasoincisive suture length(<0.0001,P<0.001), total length of lateral rim of nasal bone(P<0.001, )<0.0001), and nasal bone extent(P<0.005, P<0.001). But no such changes were observed in cranial bone. 3. A significant difference of mean length in nasal bone was observed on the operated side between group,Ⅰ,Ⅳand group Ⅱ,Ⅲ(P<0.05), but mean extent between group Ⅰand group Ⅲ only. The results showed that osteotomy and either plate or removal after union of growing craniofacial skeleton resulted in a statistically significant growth restriction on the operated side, with a statistically insignificant change on the osteotomy and wire fixation groups, when compared with unoperated sides. In conclusion, rigid internal fixation results in growth disturbance on growing craniofacial skeleton. It is recommended that the plates and screws are removed as early as possible after bony union.

The Effect of Rigid Internal Fixation on Growth of the Mandibulofacial Bone in Growing Rabbits

Yang, Sung-Yurl,Lee, Kwang-Choul,Kang, Nak-Heon,Wee, Sung-Shin,Chong Kun Lee 가톨릭대학교 2000 Bulletin of The Catholic Research Institutes of Me Vol.28 No.-

Craniofacial reconstructive procedures are frequently performed with rigid fixation of the bone. During the period of active bone growth such manipulation may influence bone development The purpose of this study was to determine the effects of metal plating of the mandible on the growth and morphology of the mandibulofacial skeleton. New Zealand white rabbits, 6 to 7 weeks of age, were divided into 5 groups. They were designated as group I(nonoperated control, n=10), group II (rigid fixation of mandibular body after vertical osteotomy, n=10), group III (rigid fixation without osteotomy, n=10), group IV(interosseous wire fixation after osteotomy, n=10), and grou V(rigid fixation and removal of plates and screws 4 weeks after osteotomy, n=7). Rabbits were sacrificed 12 weeks after operation and dry skull preparations were grossly measured and analyzed by direct measurement and by dorsoventral skull x-rays. Measurements taken were length thickness, angel, and area of the mandibulofacial skeleton. Three-dimensional CT was used for volumetric measurement of the mandible. The data were compared between the operated and nonoperated sides ans significant differences between groups were evaluated using the paired t-tests the ANOVA test, and Dunn's test. The following results were obtained: 1. The length of the whole mandible and the anterior mandibular segment was decreased in group II and III, compared with group I (p<0.05). These results show growth restriction of the plated mandible regardless of osteotomy. 2. The maxillary alveolus of the operated side was more anteriorly placed in groups II and III, compared with group I (p<0.05). 3. The thickness of the operated mandibular body showed a significant increase in groups II and III, compared with group I (p<0.05). 4. The length of the zygomatic arch of the operated side in all the experimental groups showed a significant decease, compared with group I (p<0.05). The angular divergence of the mandibular ramus from the sagittal midline of the skull was increased in the operated side of groups II and III, compared with the nonoperated side (p<0.05). 5. Volume measurements of the mandible in groups II and III showed a significant reduction of the volume on the operated sides in the anterior mandibular segments compared with group I (p<0.05). The volume of the operated mandibular body showed a signoificant increase in groups II and III, compared with group I (p<0.05). All groups showed no significant difference in total hemimandibular volume of the operated side compared with the nonoperated side. These results show that rigid fixation of mandibular fractures during the growth period causes a more severe growth restriction than either osteotomy or interosseous wiring. (Journal of Korean Society of Plastic and Reconstructive Surgery 104:118-132, 1999)