OP-1 이 첨가된 Lyophilized Cartilage Allografts를 이용한 관절연골결손의 재생

신영진,김태준 大韓成形外科學會 2000 Archives of Plastic Surgery Vol.27 No.2

Joint cartilage defects do not heal and lead to post traumatic arthritis or degenerative joint diseases. The clinical problem is that so far, we have been unable to induce true cartilage healing and regeneration. Experimental attempts at repairing joint cartilage defects with various means have usually led to the formation of cartilage-like fibro-hyaline scars. We have recently shown that treatment of lyophilized allografts with recombinant osteoinductive protein-1 (OP-1 also known as BMP 7) induced the regeneration of articular cartilage over the head of lyophilized hemijoint allografts. A standardized 3 mm circular defect was created on the articular surface of the knee joint of 12 NZW rabbits. The defect was into carried as full thickness down to subchondral bone. In a blinded and randomized fashion, the rabbits were divided into four groups. In group 1(n=4), the ulcer was left untreated; in group Ⅱ(n=3), the ulcer was reconstructed with a 3 mm disk of lyophilized cartilage allograft; in group Ⅲ(n=2), the allograft used was pre-treated with low dose (20㎍) OP-1, and in group 1V(n=3), the allograft used was pre-treated with high dose(100㎍) OP-1. The range of motion was normal in all groups. The gross appearance of the untreated defect was still depressed and appeared like a big crater. The lyophilized allograft has a level surface which was not smooth. In high dose OP-1 group, the defect was healed much better than the lower dose treated OP-1 group. Under the histologic examination, untreated ulcer group never heals to the cartilage of around defect, a fissure always remains. Lyophilized allograft and low dose OP-1 treated lyophilized allograft groups seem to inhibit healing and there is fibrous scar in ulcer. In the high dose OP-1 treated lyophilized allograft group, new cartilage heals very well all around of the defect margin without fissure. The cartilage has a normal sequence of cellular maturation. In conclusion, in this study of full thickness joint cartilage defects, we confirmed finding in the literature that defect heals with cartilage like tissue which does not fuse with the surrounding cartilage. We found that lyophilize allograft prevents healing of defect, while lyophilized allograft treated with high dose (100㎍) OP-1 seems to induce regeneration of articular cartilage that heals very well to the surrounding defect without any crack or fissure.

단분절 후방 요추체간 유합술에서 Cage 내고정군과 자가 골수 혼합 동종골군의 방사선학적 및 임상 결과 비교

임채현,최용수,김대희,안상호 대한척추외과학회 2012 대한척추외과학회지 Vol.19 No.4

Study Design: A retrospective study. Objectives: To compare the radiological and clinical results between cage and cancellous allograft mixed with bone marrow for monosegmental instrumented posterior lumbar interbody fusion (PLIF). Summary of the Literature Review: Allograft has potential problems, such as delayed union. Autologous bone marrow provides for improving the capability of bone induction with allograft. There are rare reports on PLIF using allograft mixed with autologous bone marrow. Materials and Methods: Monosegmental instrumented PLIF was performed on 51 patients who had lumbar degenerative disease, cage for 28 patients (cage group) and allograft mixed with bone marrow for 23 patients (allograft group). The clinical and radiological results in each group were compared. Results: The mean follow-up was 45 (30 - 111) months. At the final follow up, there was no significant difference between the cage group and the allograft group in the Korean Version Oswestry Disability Index (p=0.72) and Visual Analogue Score for back pain (p=0.54)and radiating pain to the leg (p=0.26). The radiological fusion rate was 92.8% in the cage group, and 82.6% in the allograft group (p=0.02). At the last follow up, disc height was decreased to 1.5±0.8 mm of the cage group, and 3.0±1.5 mm of the allograft group (p=0.0001). Conclusions: PLIF using cancellous allograft mixed bone marrow has low fusion rate contrast to good clinical results. It is necessary to take a careful selection of the allograft mixed bone marrow for PLIF. 연구계획: 후향적 연구목적: 퇴행성 요추 질환에서 단분절 추체간 유합술을 위해 cage 내고정술과 자가 골수 혼합 해면 동종골 삽입술의 방사선학적 및 임상 결과를 비교 하였다. 선행문헌의 요약: 동종골의 문제로 유합 기간 지연이 지적되고 있다. 자가 골수 이식은 신생골 형성에 우수한 것으로 알려져 있어 요추 질환에서 추체간유합술을 위해 자가 골수 혼합 동종골 삽입술 결과 보고는 드물다. 대상 및 방법: 퇴행성 요추 질환으로 단분절 추체간 유합술을 시행하였던 51예를 대상으로 하였다. Cage를 이용한 28예를 Cage 군으로, cage없이 해면 동종골과 자가 골수를 혼합하여 후방 요추체간 유합술을 시행 받은 23예를 동종골 군으로 분류하였다. 두 군간의 임상적 및 방사선학적 결과를 비교분석하였다. 결과: 45(30-111)개월 추적 조사되었다. 최종 추시상 한국어판 장애지수 (p=0.72), 요통 (p=0.54)과 하지 방사통 (p=0.26)의 시각통증지수에서 Cage 군과 동종골 군간 차이를 보이지 않았다. 방사선학적 추체간 유합율은 Cage군 92.8%, 동종골군이 82.6%로 동종골군의 유합률이 낮았다(p=0.02). 최종 추시 상 추체간 높이가 Cage군 평균1.5±0.8mm, 동종골군 평균 3.0±1.5mm 소실되어 Cage군이 추체간 높이 유지에 양호한 결과를 얻었다(p=0.0001). 결론: 요추 후방 추체간 유합술에서 자가골수 혼합 해면 동종골은 임상적으로 양호한 결과를 얻었으나 방사선학적으로 추체간 유합에 불량한 결과로자가 골수 혼합 해면 동종골 이식술의 요추 후방 추체간 유합술 적용에 신중한 선택이 필요하리라 사료된다.

Small Size Autograft versus Large Size Allograft in Anterior Cruciate Ligament Reconstruction

Alper Kurtoğlu,Betül Başar,Gökhan Başar,Ömer Gezginaslan,Hakan Başar 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.1

Background: A small autograft diameter negatively affects functional outcomes, knee stability, and the risk of rerupture after anterior cruciate ligament (ACL) reconstruction, whereas the strength of allograft decreases over time. Therefore, it is not clear whether the use of smaller autografts or the use of larger allografts in ACL yields better results. The aim of this study was to compare the outcome of smaller autografts and larger allografts for ACL reconstruction. Methods: Fifty-one patients who underwent ACL reconstruction with hamstring tendon autografts (size ≤ 8 mm) and 21 patients who underwent ACL reconstruction with allografts (size ≥ 10 mm) were included in our study. All patients underwent the same aggressive early postoperative rehabilitation program. There were no significant differences between the autograft and allograft groups regarding the preoperative patient age, sex, time from injury to surgery, and average follow-up time. Results: The mean diameter of the 4-stranded hamstring tendon grafts used as autografts was 7.48 ± 0.33 mm and the mean diameter of the allografts was 10.76 ± 0.67 mm. According to specific tests for the ACL (anterior drawer, Lachman, and pivot shift) and clinical evaluation tests (Lysholm knee scoring scale and International Knee Documentation Committee questionnaire), the final follow-up results were significantly better than the preoperative status in both autograft and allograft ACL reconstruction groups. Therefore, there were no significant differences between the autograft and allograft groups preoperatively and at the final follow-up. Conclusions: The large size of the graft in ACL reconstruction has been reported to affect results positively. However, in our study, we could not find any significant differences between the smaller size autografts and larger size allografts in terms of inadequacy, rerupture, and final follow-up functional results. Although allografts were significantly larger than autografts, we did not have the positive effect of larger size grafts. Smaller size autografts were as effective as the larger size allografts.

생체에서 채취한 동종골의 세균 오염

강용구(Yong-Koo Kang),이한용(Han-Yong Lee),유기원(Kee-Won Rhyu),김건형(Kun-Hyung Kim),허성우(Sung-Woo Huh),이주엽(Joo-Yup Lee) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.1

목적: 생체에서 채취한 동종골에서 면봉법을 이용한 세균 배양을 시행하고, 동종골의 세균 오염 정도 및 추가적인 조직처리의 필요성을 확인하고자 하였다. 대상 및 방법: 2001년 9월부터 2004년 6월까지 인공 관절 수술 중 채취한 동종골 334예를 대상으로 하였다. 대퇴골두가 214예, 슬관절이 86예, 기타가 34예 있었다. 이 중 염증성 질환을 가진 공여자는 없었다. 수술 중 채취한 동종골의 표면에서 면봉을 이용하여 검체를 얻고, 이를 48시간 동안 혈액 배지에서 배양하여 세균 오염 여부를 확인하였다. 과거 병력이나 동종골의 기증에 동의하지 않은 경우, 혈액 검사 양성 등으로 폐기된 동종골에서는 조직 전체를 이용한 세균 배양을 시행하고, 이를 면봉법을 이용한 세균 배양 결과와 비교하였다. 결과: 총 334예의 동종골 중 20예(6%)에서 세균 배양 검사 양성을 나타내었다. 과거 병력이 있었던 경우 26예, 동종골의 기증에 동의하지 않은 경우 54예, 혈액 검사에서 양성 반응을 보인 10예 등 총 132예의 동종골이 폐기되었는데, 이중 20예(15%)에서 면봉법을 이용한 세균 배양 검사 양성 소견을 보인 반면에, 조직 전체를 이용한 세균 배양 검사에서는 25예(19%)에서 양성 소견을 나타내어 면봉법의 민감도는 44%에 불과하였다. 결론: 골면봉법을 이용한 세균 배양 검사는 민감도가 낮아 동종골의 세균 오염을 발견하는데 부적합하다. 따라서 세균 배양 검사가 음성일지라도 추가적인 조직 처리가 필요하며, 저자들은 저강도 감마선을 이용하여 조직 처리를 시행하고 있다. Purpose: To analyze the rate of allograft contamination from living donors using a swab culture method and to determine the necessity of antibacterial processing. Materials and Methods: From September 2001 to June 2004, 334 allografts were obtained from living donors undergoing total joint arthroplasty. Two hundred and fourteen allografts were obtained from the femoral heads, 86 from the knee joint, and 34 from other sources. All allografts from donors with inflammatory diseases were discarded. After retrieving the graft, the entire surface of the allograft was carefully swabbed, and the specimen was inoculated and cultured on blood agar for 48 hours. A bacterial culture with the entire tissue was also carried out on discarded allografts, and the rate of contamination was compared with that of used allografts. Results: Of the 334 allografts, 20 (6%) allografts were culture positive using swab method. 132 allografts were discarded. The reasons for discarding were a prior medical history in 26, no informed consent in 54 and a positive blood test in 10. The rate of contamination of the discarded allografts was 15% (20/132) using the swab method, and 19% (25/132) using entire tissue culture method. The sensitivity of the swab culture technique was only 44%. Conclusion: The low sensitivity implies that the swab method is unsuitable for detecting bacterial contamination. Unprocessed swab-culture-negative grafts may be contaminated with organisms that can cause infections. Therefore, additional antibiotic processing such as gamma-irradiation will be required.

동종동맥판 혈관내피세포의 생육성 평가에 관한 연구

임창영,홍은경 大韓胸部外科學會 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.6

Effect of platelet-rich plasma in Achilles tendon allograft in rabbits

Seok-Hong Park,Dong-Yub Kim,Won-Jae Lee,Min Jang,Seong Mok Jeong,Sae-Kwang Ku,Young-Sam Kwon,Sungho Yun The Korean Society of Veterinary Science 2024 Journal of Veterinary Science Vol.25 No.2

Background: Achilles tendon is composed of dense connective tissue and is one of the largest tendons in the body. In veterinary medicine, acute ruptures are associated with impact injury or sharp trauma. Healing of the ruptured tendon is challenging because of poor blood and nerve supply as well as the residual cell population. Platelet-rich plasma (PRP) contains numerous bioactive agents and growth factors and has been utilized to promote healing in bone, soft tissue, and tendons. Objective: The purpose of this study was to evaluate the healing effect of PRP injected into the surrounding fascia of the Achilles tendon after allograft in rabbits. Methods: Donor rabbits (n = 8) were anesthetized and 16 lateral gastrocnemius tendons were fully transected bilaterally. Transected tendons were decellularized and stored at -80℃ prior to allograft. The allograft was placed on the partially transected medial gastrocnemius tendon in the left hindlimb of 16 rabbits. The allograft PRP group (n = 8) had 0.3 mL of PRP administered in the tendon and the allograft control group (n = 8) did not receive any treatment. After 8 weeks, rabbits were euthanatized and allograft tendons were transected for macroscopic, biomechanical, and histological assessment. Results: The allograft PRP group exhibited superior macroscopic assessment scores, greater tensile strength, and a histologically enhanced healing process compared to those in the allograft control group. Conclusions: Our results suggest administration of PRP on an allograft tendon has a positive effect on the healing process in a ruptured Achilles tendon.

자가 골-슬개건-골과 동종 아킬레스 건을 이용한 전방십자인대 재건술의 임상결과 비교

최호림(Ho-Rim Choi),최상욱(Sang-Wook Choi),권세원(Sai-Won Kwon),박종석(Jong-Seok Park),이병일(Byung-Ill Lee) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.5

목적: 전방 십자 인대 손상에 대한 자가 골-슬개건-골과 신선 동결 동종 아킬레스 건을 이용한 관절경적 재건술의 임상 결과를 비교하고자 한다. 대상 및 방법: 2002년 3월부터 2006년 12월까지 동종 아킬레스 건과 자가 골-슬개건-골을 이용하여 전방 십자 인대 재건술을 시행 받은 61명의 환자를 대상으로 하였다. 자가 골-슬개건-골 군은 29예, 동종 아킬레스 건군은 32예였다. 수술 시 환자의 평균 나이는 자가 골-슬개건 골 군 30.4세, 동종 아킬레스 건 군 32.5세였으며, 평균 추시 기간은 자가 골-슬개건-골 군 18.2개월, 동종 아킬레스 건 군 25.7개월이었다. 수술 전과 최종 추시 시점에서 이학적 검사와, KT-2000 관절측정기, 전방 전위 스트레스 방사선 사진을 이용하여 양 군을 비교하였고, IKDC 평가와 Lysholm 점수를 시행하였다. 결과: 수술 전과 최종 추시에서 KT-2000 관절측정기로 평가한 환측과 건측의 전방 전위 정도 차이는 자가골-슬개건-골 군은 평균 6.4 ㎜±3.0에서 3.2 ㎜±1.9로, 동종 아킬레스 건 군은 7.6 ㎜±3.1에서 2.9㎜±2.0로, 두 군 모두 통계학적으로 유의하게 향상되었으며(p<0.001), 향상 정도는 동종 아킬레스 건에서 유의하게 높았다(p=0.045). 전방 전위 스트레스 방사선 사진에서는 자가 골-슬개건-골 군이 평균 5.3㎜±2.5에서 2.0 ㎜±2.1로, 동종 아킬레스 건 군은 평균 6.0㎜±3.4에서 2.2 ㎜±2.1로, 두 군에서 통계학적으로 유의하게 호전되었으며(p<0.001), 두 군 간 차이는 없었다. 최종 추시 IKDC 평가에서 자가 골-슬개건-골 군은 26예(89.7%)가 정상 또는 거의 정상이었으며, 동종 아킬레스 건 군은 28예(87.5%)가 정상 또는 거의 정상을 보였다. Lysholm 슬관절 점수는 자가 골-슬개건-골 군은 69.9점에서 90.2점으로, 동종 아킬레스 건 군은 64.4점 에서 91.4점으로 향상되었다(p<0.001). 결론: 전방십자인대 재건수술에서 자가 골-슬개건-골과 동종아킬레스건 모두 이식물에 따른 양군간 임상적 차이 없이 양호한 결과를 얻어, 자가 골 슬개건-골과 동종 아킬레스 건 모두 전방십자인대 재건을 위한 적절한 이식물로 고려될 수 있을 것으로 생각된다. Purpose: To compare clinical outcomes after arthroscopic ACL reconstruction using bone-patellar tendon-bone autograft and using fresh-frozen Achilles tendon allograft. Materials and Methods: We enrolled 61 patients who underwent anterior cruciate ligament reconstruction by means of bone-patellar tendon-bone autograft or Achilles tendon allograft between March, 2002 and December, 2006. The bone-patellar tendon-bone group included 29 patients (mean age 30.4 years), and the Achilles tendon allograft group included 32 patients (mean age 32.5 years). The mean follow-up was 18.2 months and 25.7 months in each group, respectively. Preoperative and last follow-up clinical results were evaluated through physical examination, KT-2000 arthrometer, stress roentgenogram, IKDC knee rating system, and Lysholm knee score. Results: The mean side-to-side difference in anterior translation, as measured by KT-2000 arthrometer, was significantly improved from 6.4 ㎜±3.0 to 3.2 ㎜±1.9 in the bone-patellar tendon-bone group, and from 7.6 ㎜±3.1 to 2.9 ㎜±2.0 in the Achilles tendon allograft group (p < 0.001). The Achilles tendon allograft group improved more significantly than did the bone-patellar tendon-bone group (p=0.045). The mean side-to-side difference on stress roentgenogram was significantly improved from 5.3 ㎜±2.5 to 2.0 ㎜±2.1 in the bone-patellar tendon-bone group, and from 6.0 ㎜±3.4 to 2.2 ㎜±2.1 in the Achilles tendon allograft group (p < 0.001). There was no significant difference between the two groups. According to the IKDC knee rating system at last follow-up, 26 (89.7%) patients in the bone-patellar tendon-bone group and 28 (87.5%) patients in the Achilles allograft group were normal or nearly normal. The mean Lysholm knee score significantly improved from 69.9 to 90.2 in the bone-patellar tendon-bone group, and from 64.4 to 91.4 in the Achilles tendon allograft group (p < 0.001). Conclusion: Both bone-patellar tendon-bone and Achilles tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both bone-patellar tendon-bone autograft and Achilles tendon allograft be considered as graft substitutes for anterior cruciate ligament reconstruction.

신이식 후 면역반응의 이해 - 1부. 이식 거부 반응의 기전 -

강희경,Kang, Hee-Gyung 대한소아신장학회 2008 Childhood kidney diseases Vol.12 No.1

Kidney allograft transplantation is the most effective method of renal replacement for end stage renal disease patients. Still, it is another kind of 'disease', requiring immunosuppression to keep the allograft from rejection(allograft immune reaction). Immune system of the allograft recipient recognizes the graft as a 'pathogen (foreign or danger)', and the allograft-recognizing commanderin-chief of adaptive immune system, T cell, recruits all the components of immune system for attacking the graft. Proper activation and proliferation of T cell require signals from recognizing proper epitope(processed antigen by antigen presenting cell) via T cell receptor, costimulatory stimuli, and cytokines(IL-2). Thus, most of the immunosuppressive agents suppress the process of T cell activation and proliferation.

초냉동 보관된 백서의 동종 기관 이식편의 대망 내 이식에 따른 조직 생육성 및 혈관 형성

김용희,박승일,김동관,김규래 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.8

Background: Using the neovascularizing properties of the omentum, we studied the viability and vascularity of the cryopreserved rat tracheal allografts with omental implantation. Material and Method: The cryopreserved tracheal allografts of eight-week old male Sprague Dawley rats were implanted into the omentum. The rats were divided into the four groups according to the duration of cryopreservation and of omental implantation. We examined the tracheal allografts histologically for viability of cartilages, inflammation and fibrosis of smooth muscle and connective tissue, and degree of vascularity. Result: The degree of inflammation in the smooth muscle and the connective tissue of the tracheal allografts was not statistically related to neither the duration of cryopreservation or of omental implantation. The tracheal cartilages of the tracheal allografts were found to be severely calcified in all cases. Significant difference in vascularity was found between the groups I and II (p<0.05). And a sufficient vascularity in the intercartilaginous space was observed in the midportion of the the tracheal allografts as well as both ends. Conclusion: In conclusion, the omental implantation for 2 weeks could establish a sufficient vascularity in the intercartilaginous spaces for maintaining the viability of the tracheal allografts. This study might provide a possibility of the sequential tracheal allotransplantation after omental implantation. 배경: 대망의 가장 중요한 성질 중 하나인 혈관 형성 촉진 기능을 이용하여 초냉동 보관된 기관 이식편의 대망 내 이식이 기관 이식편의 생육성이나 혈관 형성에 미치는 영향을 연구하고자 한다. 대상 및 방법: 8주령의 Sprague Dawley rat 수컷의 초냉동 보관된 기관 이식편을 백서의 복강 내 대망에 이식하였다. 연구군은 냉동 보관기간과 대망 내 이식기간에 따라 4개의 군으로 분류하였다(n=52). 이식된 기관 이식편을 획득하여 기관 평활근 및 주변 결합 조직의 섬유화 및 염증 정도, 기관 연골의 석회화 정도, 기관 내 상피세포의 변화 및 연골간 간격에서의 혈관 형성 정도 등을 검사하였다. 결과: 기관 평활근의 염증 정도는 냉동 보관기간이나 대망 내 이식기간에 따라 유의한 차이를 보이지 않았고, 기관 연골의 석회화 정도는 냉동 보관기간과 상관없이 대부분 심하게 진행되어 있었다. 혈관 형성은 기관 이식편의 양 끝뿐만 아니라 중간 부위에서도 충분히 이루어져 있었다. 결론: 초냉동 보관된 백서의 장분절 기관 이식편을 2주간 대망 내 이식을 시행한 결과 기관 이식편의 조직 생육성이 적절히 유지되면서 새로운 혈관이 형성되었다. 향후 동종 기관 이식 시 초냉동 보관된 기관 이식편을 대망 내 이식하여 새로운 혈관이 형성된 후 단계적으로 기관 이식을 시행하는 데 도움이 될 수 있다고 생각한다.

동종피부를 이용한 광범위 화상의 치료

송종훈(Jong Hoon Song),김도헌(Do Hern Kim),허준(Jun Hur),전욱(Wook Chun),김종현(Jong Hyun Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.1

Purpose: The most common cause of death in massive burn patients is burn wound sepsis. Therefore we have been using allograft skin for preventing burn wound sepsis. Methods: Included in this study were 71 subjects who had sustained extensive burns from December 2003 through February 2006. 1. Early selective Escharectomy was performed for full thickness burn areas. 2. Allograft skins were grafted on excision area. 3. An autograft was performed for areas with a formation of granulation tissue after the allograft skin had come away. 4. A modified sandwich grafting technique (1:4∼6 meshed autograft with Cultured Epithelial Autografts) was performed in large sized burns. 5. Acellular dermal substitute was concurrently used to prevent burn scar contraction on joint areas. Results: Seventy one subjects were included (Fresh allograft: 9 cases, Cryo-preserved allograft: 42 cases, Glycerol preserved allograft: 20 cases). The average burn area was 41.8 (20∼92) %TBSA (Total Body Surface Area). The mean area of the allograft skin used was 26.9 (8∼70) %TBSA. The grafted allograft skins usually came away 3 weeks later. Four cases of initial take failure were occurred. All of these cases were pediatric patients using cadaver skin. Nine patients were dead from heart failure, severe inhalation, respiratory failure, pneumonia in old age, renal failure etc. There was no definite wound sepsis. Cultured Epithelial Autografts (CEAs) were used in fourteen cases. In twentyfive cases, acellular dermal substitute was simultaneously used. Conclusion: Early selective escharectomy, allograft skin coverage, acellular dermal substitutes and wide meshed autograft with CEA application would be immensely helpful techniques in patients with extensive burns.