Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Comparison of the Bone Union Rates Using a Local Autobone and Bone Graft Substitute Mixed Graft in Lumbar Posterolateral Fusion

요추부 후측방 유합술 시 국소 자가골 및 골 이식 대체재 혼합 이식에 의한 골유합률의 비교

  • Received : 2018.05.31
  • Accepted : 2019.04.25
  • Published : 2020.04.30
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Abstract

Purpose: To assess the effectiveness of mixed grafts in lumbar posterolateral fusion (PLF) by comparing the bone union rates of an autobone with a bone substitute mixed graft. Materials and Methods: The patients were followed-up for at least two years after PLF and divided into four groups according to the mixed graft retrospectively. Group I was 48 cases using a femoral head allobone. Group II was 38 cases using β-tricalcium phosphate. Group III was 92 cases using biphasic calcium phosphate. Group IV was 38 cases using biphasic calcium phosphate and autologous bone marrow. Union was evaluated by the work up simple radiographs after two years from PLF. Union was defined if the radiographs demonstrated a bilateral continuity in the fusion mass between the cephalad and caudal transverse processes with less than 2° of angular motion and no translation between the vertebrae at the level of fusion on the lateral flexion-extension radiographs. Results: According to simple radiographs after two years from PLF, the rate of union was highest in Group IV using local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft. Conclusion: Biphasic calcium phosphate is an osteoconductive bone substitute that increases the bio-absorbability and mechanical strength. Autologous bone marrow has osteoinductive and osteogenic properties. These features can increase the rate of bone union. Therefore, a local autobone, biphasic calcium phosphate and autologous bone marrow mixed graft can be considered an effective bone graft substitute for lumbar PLF instead of an autobone graft.

목적: 요추부 후측방 유합술 시 자가골과 혼합 이식하는 골대체재의 종류에 따른 골유합률을 비교하여 효과적인 혼합 이식 재료를 제시하고자 한다. 대상 및 방법: 본 연구는 후측방 유합술 시행 후 최소 2년 추시한 환자들을 대상으로 후향적으로 시행하였으며 유합술 시 국소 자가골에 혼합하여 사용한 이식 재료에 따라 네 군으로 분류하였다. I군은 대퇴 골두 동종골을 사용한 48예, II군은 β-tricalcium phosphate를 사용한 38예, III군은 이상인산칼슘을 사용한 92예, IV군은 이상인산칼슘 및 자가 골수를 사용한 38예를 대상으로 하였다. 술 후 2년째 단순 방사선 검사를 추시하여 유합 여부와 임상결과로 판단하였으며, 단순 방사선 소견상 양측 상하 횡돌기간에 뚜렷하게 형성된 골괴와 함께 굴신 방사선 소견상 각 운동 범위가 2도 미만이면서 전위 소견이 보이지 않을 때 유합으로 정의하였다. 결과: 술 후 2년째 단순 방사선을 추시한 결과 이상인산칼슘 및 자가골수를 국소 자가골과 혼합 이식한 IV군에서 가장 높은 유합률을 나타냈다. 결론: 생체흡수성이 높아지고 기계적 강도가 보완된 골전도성 대체재인 이상인산칼슘과 골유도 및 골형성이 가능한 자가 골수의 물질적 특성이 골유합률을 높일 수 있을 것이다. 따라서 요추부 후측방 유합술 시 이상인산칼슘, 자가 골수 및 국소 자가골의 혼합 이식이 자가골 이식을 효과적으로 대체할 수 있는 방법으로 사용될 수 있으리라 생각된다.

Keywords

References

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