• 대한정형외과학회지
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• 제54권3호
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• pp.227-236
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• 2019

목적: 경골 외측 고평부 골절에서 추가적인 피질골 창을 내지 않고 관절경을 이용한 정복술 및 골이식술 없이 내고정한 후 이에 따른 결과를 평가해 보았다. 대상 및 방법: 2009년 3월부터 2017년 3월까지 3차원 컴퓨터 단층촬영(computed tomography, CT)에서 관절면의 함몰 및 전위가 5 mm 이상이면서 Schatzker 분류상 II형에 해당하는 경골 외측 고평부 골절에 대해 관절경을 이용하여 수술적 치료를 하고 최소 18개월 이상 추시가 가능한 27예를 대상으로 하였다. 경골 피질골에 추가적인 창을 내지 않고 전외측 연골판하방 삽입구(inframeniscal portal)를 통해 골막거상기(freer elevator)를 이용하여 감입되어 있는 골편을 정복하여 관절면의 정복을 얻은 후 골이식 없이 5.0 mm 혹은 6.5 mm 유관나사를 이용하여 내고정술을 시행하였다. 결과 판정은 임상적 결과와 방사선적 결과로 나누어 Rasmussen의 방법을 이용하여 분석하였고 유관나사 제거술을 받은 13예의 환자에 한해서 관절경을 이용하여 2차 추시를 시행하였다. 결과: 최종 추시에서 모든 예에서 골유합을 얻었고, 평균 골유합 기간은 8.7주(8-12주)였다. Rasmussen 기준에 따라 방사선적 결과는 25예(92.6%)에서 우수 또는 양호의 만족스러운 결과를 얻었고 임상적 결과는 24예(88.9%)에서 우수 또는 양호의 결과를 얻었다. 2차 추시를 시행한 환자 13예에서 섬유연골로 잘 치유됨을 확인하였고 술 후 외래 추시 중 CT 촬영한 8예에서 골결손 부위 골이식 없이 유합된 소견을 확인하였다. 결론: 경골 외측 고평부 골절에서 추가적인 피질골 창을 내지 않고 관절경을 이용한 정복 및 골이식 없이 시행한 내고정술은 관절면을 정확히 정복할 수 있는 유용한 방법이며 임상적으로 양호한 결과를 얻을 수 있는 방법으로 생각된다.

• 생명과학회지
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• 제28권10호
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• pp.1220-1232
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• 2018

본 연구는 토끼의 상악동에 Bio-Oss와 ${\beta}-TCP$를 이식한 후 골 재생 과정을 조직학적으로 비교하기 위하여 수행되었다. 12마리의 수컷 토끼를 4마리씩 3군으로 구분하였다. 토끼의 양쪽 상악동 점막을 거상한 후 한쪽은 Bio-Oss를 이식하였고, 다른 쪽은 ${\beta}-TCP$를 이식한 후 본래의 골편으로 창을 봉합하였다. 2주, 4주 및 8주 후에 토끼를 희생시키고 조직절편을 만든 후 Bio-Oss군과 ${\beta}-TCP$군의 골 재생 양상을 비교하였다. 조직계측학적 분석을 위하여 각각의 조직절편에 hematoxylin-eosin, Masson trichrome 및 tartrate-resistant acid phosphatase 염색을 하였고, proliferating cell nuclear antigen (PCNA), type I collagen 및 osteocalcin의 발현 양상을 비교하기 위하여 면역조직화학 염색을 하였다. 광학현미경 시야에서 계측프로그램을 이용하여 계측하고 분석하여 다음과 같은 결과를 얻었다. Bio-Oss군과 ${\beta}-TCP$군 모두 2주군에서 초기 골 형성이 시작되었고, 4주군에서는 각 이식재 입자의 표면에 형성된 다량의 신생골이 관찰되었으며, 8주군에서는 신생골의 골량이 더 증가되어 있었고 층판골과 골수조직도 관찰되었다. 신생골의 양은 4주군까지 두 군이 비슷하였으나, 8주군에서는 ${\beta}-TCP$군에서 유의한 증가가 계측되었다. 이식재의 양은 4주군부터 8주군까지 ${\beta}-TCP$군에서 유의하게 감소되었으며, 파골세포의 수는 4주군에서 8주군까지 ${\beta}-TCP$군에서 유의하게 증가되어 있었다. PCNA에 대한 면역반응성은 8주군에서 감소되었지만 두 군간의 유의한 변화는 없었다. Type I collagen의 발현은, 2주군에서는 ${\beta}-TCP$군에서 유의하게 증가되었지만, 8주군에서는 Bio-Oss군에서 유의한 증가가 관찰되었다. Osteocalcin에 대한 면역반응성은 8주까지 증가되었으며 두 군간의 유의한 차이는 없었다. 이러한 조직학적 결과들은 임플란트를 위한 이식재의 선택에 도움을 줄 수 있다. 이상의 결과들을 종합하면 Bio-Oss와 ${\beta}-TCP$는 모두 검증된 이식재 이지만, 토끼의 상악동 거상술에서는 ${\beta}-TCP$가 좀 더 우수한 골 재생 결과를 보였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권2호
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• pp.149-153
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• 2010

The purpose of this retrospective study was to evaluate relapse, comparing large and small maxillary advancements with four-plate rigid fixation and without bone grafting. All patients had skeletal class III malocclusion, and underwent bimaxillary surgery. Standardized cephalometric analysis by one examiner was performed on serial radiographs of 14 patients immediately before surgery, and within 1 week and at least 6 months postoperatively (mean 10 months). The group was divided into two subsets to determine whether the magnitude of relapse. In group 1 ($\leq$ 5 mm, n = 8), the average advancement was $4.0{\pm}0.9\;mm$, with a mean relapse of $0.1{\pm}0.5\;mm$. In group 2 (6-8 mm, n = 4), the average advancement was $6.8{\pm}0.9\;mm$, with a mean relapse of $0.7{\pm}0.4\;mm$. There was no statistical difference in the measured relapse among the groups. Maxillary advancement with a 1-piece Le Fort I osteotomy is a relatively stable procedure.

• Journal of Periodontal and Implant Science
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• 제29권2호
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• pp.355-373
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• 1999

Many researches have been reported that collagen as cellular stroma, matrix of grafting materials, mediator of agents for the purpose of promoting healing process invivo, but the responses in vivo were seen various. The goal of this experiment is to assess the effect of collagen on bony healing, through histological evaluation of implanted collagen on the calvarial defect in rats. 2-month-old Sprague-Dawley, 24 rats were used and 12 rats assigned to each group of control and test. Defect of 5mm in diameter was made on the calvarial bone with trephine bur. Following thorough saline rinse, defect of control group was left in empty and that of experimental group was filled with fibrillar collagen($COLLATAPE^{(R)}$, COLLA-TEC. INC. U.S.A.) soaked in saline. 3 rats in each group were sacrificed at 3, 7, 14, 21 days after operation respectively, and the tissue blocks were prepared for light microscope with H-E for evaluation of overall healing, with TRAP(tartrate resistant acid phosphatase) for evaluation of osteoclastic activity and with immunohistochemical staining for macrophages. The results were as follows : 1. In the control group, inflammatory responses were disappeared at day 14, but, in the experimental group inflammatory infiltrates were reduced at day 21. Thus, the experimental group showed more severe soft tissue inflammation than control group. 2. Both control and experimental group showed slight appositional growth at day 7 and gradual bony growth to 21th day. But, complete bony healing of the defect was not shown. There was no significant difference in bony healing between control and experimental group 3. Specific response of macrophages for implanted collagen was observed at day 14 in the experimental group. In conclusion, although fibrillar collagen caused inflammation of soft tissue during initial healing period, inflammatory responses by fibrillar collagen didn't inhibit bony regeneration and implanted collagen was biodegradaded by macrophages. Thus, we expect that fibrillar collagen can be used for useful mediator of graft materials or growth factors.

• Archives of Plastic Surgery
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• 제45권6호
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• pp.564-571
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• 2018

Background Chronic wounds occur due to failure of the normal healing process, associated with a lack of deposition of cellular components and a suitable microenvironment such as the extracellular matrix (ECM). Acellular dermal matrix (ADM) is viewed as an ECM substitute, and a paste-type ADM has recently been introduced. We hypothesized that CGPaste, an injectable paste-type ADM, could serve as a scaffold and promote wound healing. Methods We retrospectively studied seven patients in whom CGPaste was applied between 2017 and 2018, who had pressure ulcers, necrotizing fasciitis, diabetic foot ulcers, traumatic defects, and osteomyelitis. The goal of applying CGPaste was to achieve complete wound healing with re-epithelialization or growth of granulation tissue, depending upon the wound bed status. CGPaste was injected based on the wound size along with the application of a dressing. Results Four of the seven patients showed granulation tissue on their wound bed, while the other three patients had a bony wound bed. The mean wound area was $453.57mm^2$ and the depth was 10.71 mm. Wound healing occurred in five of the seven patients (71.43%). The mean duration of complete healing was 2.4 weeks. Two patients showed failure due to paste absorption (29.57%); these patients had wound beds comprising bone with relatively large and deep wounds ($40{\times}30$ and $30{\times}20mm^2$ in area and 15 and 10 mm in depth). Conclusions CGPaste is an effective option for coverage of small and deep chronic wounds for which a flap operation or skin grafting is unfeasible.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권6호
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• pp.565-580
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• 2000

This study was designed to evaluate the influence of cultured epidermal tissue graft and the administration of transforming growth factor(TGF)-${\beta}_3$ on maxillary growth in surgically created palatal defects. A total of 155 rats were divided into 2 groups according to surgical timing : postnatal 2 weeks(n=95), 4 weeks(n=40) and control(unoperated) group(n=20). The postnatal 2-week surgical group was subdivided into 3 groups according to repair methods: conventional surgery(Von Langenbeck technique)group(n=23); cultured tissue graft group(n=25); and full thickness skin graft group(n=25). Additionally, recombinant human TGF-${\beta}_3$ was administered(30ng or 150ng) on collagen matrix in surgically created palatal defects during surgery(9 conventional surgeries, 9 cultured tissue grafts) in 2-week-old rats. The results showed that all types of surgical treatment decreased maxillary growth compared with the control(unoperated) group(p<0.0001). On the other hand, the tissue graft group, whether cultured tissue or grafted skin, contributed to increased maxillary growth(p<0.0001).And exogenous TGF-${\beta}_3$ might play a role in connective tissue proliferation and new bone generation during wound healing on palatal defects. Our results suggest that grafting cultured epidermis with collagen matrix decreases the scar tension on maxillary growth more than conventional palatal surgery does. Therefore, exogenous TGF-${\beta}_3$ may contribute to accelerate wound healing on palatal defects.

• 대한치과교정학회지
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• 제48권2호
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• pp.113-124
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• 2018

The purpose of this case report was to introduce the concept of orthodontic and orthopedic treatment for a growing patient with Tessier number 0 cleft. A 5-year-old boy patient with Tessier number 0 cleft presented congenitally missing maxillary central incisors (MXCI), a bony defect at the premaxilla, a constricted maxillary arch, an anterior openbite, and maxillary hypoplasia. His treatment was divided into three stages: management of the bony defect at the premaxilla and the congenitally missing MXCIs using a fan-type expansion plate, iliac bone grafting, and eruption guidance of the maxillary lateral incisors into the graft area for substitution of MXCIs; management of the maxillary hypoplasia using sequential facemask therapy with conventional and skeletal anchorage; and management of the remaining occlusal problems using fixed orthodontic treatment. The total treatment duration was 15 years and 10 months. Class I canine and Class II molar relationships and normal overbite and overjet were achieved at the end of treatment. Although the long-term use of facemask therapy resulted in significant protraction of the retrusive maxilla, the patient exhibited Class III profile because of continued mandibular growth. However, the treatment result was well maintained after 2 years of retention. The findings from this case suggest that interdisciplinary and customized approaches are mandatory for successful management of maxillary hypoplasia, bony defect, and dental problems in Tessier number 0 cleft. Moreover, considering the potential of orthognathic surgery or distraction osteogenesis, meticulous monitoring of mandibular growth until growth completion is important.

• 대한족부족관절학회지
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• 제10권2호
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• pp.150-155
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• 2006

Purpose: The purpose of this study is to assess the results of the autologous osteochondral grafting harvested from medial side of talus for relatively large osteochondral lesion of the medial talar dome. Materials and Methods: From October 2004 to September 2005, 12 patients with osteochondral lesion measured more than 10 mm in axial MRI who were followed up more than 1 year after operation were analyzed. We evaluated postoperative symptoms by Mann and Reynolds scale, morbidity of donor site, and compared the range of both ankle motion. We also evaluated the union at the medial malleolar osteotomy site, trabecular connection between the grafted osteochondral mass and talus, irregularity of the articular surface in lesion. Results: Clinical results were rated as excellent in 4, good in 7, fair in 1. The mean angle of the total range of motion in affected ankle was decreased by 3 degrees compared to that in unaffected ankle. We did not observe abnormal findings at donor site. The osteotomized bone was united at mean 9 weeks (range, 8-12 weeks). We observed trabecular connection between grafted osteochondral mass and talus at mean 14 weeks (range, 12-16 weeks). We also observed irregular articular surface in osteochondral lesions in 6, smooth articular surface in 6. Conclusion: The local autologous osteochondral graft for relatively large osteochondral lesion of the medial talar dome is useful operative method with advantages of wide operative field, low morbidity of donor site, and high satisfaction rate.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1998년도 추계학술대회
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• pp.157-158
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• 1998

The purpose of this study was to test the hypothesis that even very small change of the cue direction in the treatment of the early osteonecrosis could affect the outcomes of operation. For this, the changes in stress transfer within the necrotic area of the femoral head were investigated under various directions and placements of the core utilizing finite element method. The loading of 3188N, which represents after-heel-strike, was imposed in cubic cosine pattern. All nodes on the most distal surface of the model were constrained in all directions. All materials included were assumed to have linear-elastic behavior. The result says that the critical stress, which causes collapse of the femoral head, was reduced when the core was oriented toward the posterior side of the femoral head regardless of location of the necrotic area. The same result was obtained either fibular bone grafting or cementation was adopted. As a consequence, the biomechanical study suggests that the core should be directed toward the loading point where the resultant force is applied to get more desirable treatment of the osteonecrosis of the femoral head in the early stage.

• Archives of Plastic Surgery
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• 제38권2호
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• pp.194-198
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• 2011

Purpose: Heterotopic calcification is the abnormal deposition of calcium salts in tissues other than bone and enamel, and it occurs in the form of dystrophic calcification or metastatic calcification. This deposition can occur under many conditions, but in some rare cases, it may develop in burns and nonhealed scars. It is difficult to treat the combination of heterotopic calcification and ulceration in scar tissues by using conservative therapy and to determine the margin of excision in such cases. Our study proposes the use of intraoperative C-arm-guided mapping of lesions with heterotopic calcification, and adequate excision of ulcers in chronic scars where heterotopic calcification is also observed. Methods: This study included 2 patients and was conducted from January 2010 to July 2010. The first patient was a 63-year-old woman who presented with atypical calcium deposits and chronic ulceration in the lower one-third region of the right leg. The second patient was a 38-year-old man who presented with a nonhealing ulcer that had developed on the right leg 3 months earlier he had a history of 40% scalding burns on the entire body. Surgery is the most reliable method for treating heterotopic calcification therefore, both patients were treated using intraoperative C-arm-guided marginal mapping of heterotopic calcification, followed by release of contracture, and eventually split-thickness skin grafting. Results: Plain radiographs of the leg showed spotty radiopaque areas in the hard part of the scar well superficial to the underlying bones. Histopathological analysis revealed multiple foci of calcified deposits, increased fibrosis, and inflammation in the scar tissue. Surgery-related complications were not observed. Conclusion: C-arm guided excision of calcified scars and the release of contracture can cure nonhealing ulcers and may therefore prevent recalcification.