전류가 골절치유에 미치는 영향에 대한 실험적 연구

Abstract

[한글]

[영문]

Since the first indication of a piezoelectric effect in biological tissue was

reported by Martin (1941), several investigators have been concerned in many

experimental studies with its effect on bone formation. By measuring the electrical

potentials of the compressed bone, Yasuda et at. (1955) offered a suggestion that

dynamic energy could be transformed into electric energy in the formation of

callus. With the succeeding researches relating to the effect of electrical

potentials on ossification or repair of fracture, the mechanism and processes have

been widely postulated and also demonstrated(Becker, 1961; Bassett and Becker,

1962: Bassett and Pauluck, 1964; 0'Coner, 1969: Friedenberg et al., 1970, 1971).

In order to elucidate the possible problems arising from the application of

electric current in the management of fractures, this investigation was designed as

follows.

Sixty four(about 2.0 kg) albino rabbits (128 fibulae) were used in this

experimental study.

The animals were divided into 4 groups of rabbits; thus each group contained 16

rabbits. The animals were operated in sterile condition under nembutal anesthesia

(30mg per kg of body weight). An antero-lateral skin incision was made over the

knee joint and the fibula was exposed and a transverse fracture was made at the

neck of the fibula using a rotating dental disc.

We drilled a 0.2cm holes thru the fibula cortex 5mm proximal, distal, or both to

the fracture site and at the fracture site itself using a Kirschner wire for the

left side according to the experimental groups to be described. Then the electrical

implants, which consisted of a mercury cell and 150k resistors designed to deliver

a constant 4-6μa were inserted into the thigh subcutaneously. We performed an

identical surgical procedure on the right side as on the left except that the leads

were not connected to a cell, for the control study.

In group Ⅰ a cathode was inserted 5mm proximal and an anode 5mm distal to the

fracture site.

In group Ⅱ a anode was inserted into the fracture site and an anode was inserted

5mm proximal to the fracture site.

In group Ⅲ an anode was inserted into the fracture site and a cathode was

inserted 5mm proximal to the fracture site.

In group Ⅳ a cathode was inserted into the fracture sits and an anode was

anchored intramuscularly 5mm proximal to the fracture site. The operated animals

were sacrificed with intervals of 3 days, 5 days, and 1, 2, 3, 4, 5, and 7 weeks

respectively after fracture. In each case 24 hours prior to sacrifice 0.33mCi per

kg of body weight of Ca**45 (CaCl^^2 in 0.5mHCl with a specific activity

12.2mCi/mg) was injected by the intravenous route. After the sacrifice, the entire

fibula attached to the tibia was resected, X-rayed, and placed in 10% neutral

formalin solution and fixed for 24 hours. After fixation it was decalcified and

paraffineblocks were made. Multiple sections of each specimen which were cut at

five micra, were coated with Kodak NTB-3 nuclear emulsion and allowed to expose for

periods of twenty one days.

The autoradiographs were developed with Kodak D-19 developer and fixed with Kodak

fixer and stained with hematoxylin and eosin.

The autoradiographic technique was based on the method of Messier and Leblond.

The results observed in this study were mainly concentrated on the gross findings

of the fracture. radiological findings, microscopic findings, and autoradiographic

findings.

The gross findings of the fracture revealed the followings;

1) There was more fibrous union at the fracture site in the left experimental

sides than the right control sides at the 5th day except for group Ⅲ.

2) Callus appeared at the fracture site from the first week and more callus was

found in the experimental sides of groups Ⅰ and Ⅱ than in the control sides.

3) There appeared less callus formation in the experimental side of group Ⅲ than

in the control side at the 3rd week.

4) Bony union occured from the 4th week in all groups and no difference was

noticed between the experimental and control sides from the 4th week to 7th week.

The radiological findings were as follows;

1) Callus appeared from the first week and more callus was found in the

experimental sides of groups Ⅰ, Ⅱ and Ⅳ than in the control sides at the 2nd

week.

2) There was a clear evidence that more bony union occured in all experimental

sides except group Ⅲ than in the controls at the 3rd week.

3) More bony union occured at the fracture site at the 4th week than the 3rd week

in groups Ⅰ, Ⅱ and Ⅳ.

4) No difference was found between the experimental and control sides from the

5th week.

The microscopic findings were as follows;

1) In all groups there appeared callus formation and more cartilage cells

appeared in the experimental sides of groups Ⅰ, Ⅱ and Ⅳ than in the control

sides at the 1st week.

2) There were more cartilage cells at the 2nd week than the 1st week and even

calcification appeared in the experimental sides of groups Ⅰ and Ⅳ at the 2nd

week.

3) From the 3rd week trabecula appeared and more trabeculae were found in the

experimental sides of groups Ⅰ, Ⅱ and Ⅳ than in the control sides.

4) There was no remarkable difference between the experimental and control sides

except group Ⅳ where cartilage cells were found in the control side at the 4th

week.

5) No remarkable difference was found between all experimental and control sides

from the 5th week.

The autoradiographic findings were as follows;

1) The dark grain appeared from the 5th day and there were more grains in the

experimental sides of groups Ⅱ and Ⅳ than in the control sides at the 5th day.

2) More grains appeared in all experimental sides of groups except group Ⅲ than

in the control sides at the 1st week.

3) The highest incidence of grain was at the 2nd week in the groups Ⅰ and Ⅱ,

and at the 3rd week in the groups Ⅲ and Ⅳ. More grains appeared in all

experimetal sides of groups except group Ⅳ than in the control sides at the 2nd

week.

4) There was no difference between the experimental and control sides of groups

except group Ⅳ from the 3rd week.

5) There was less grain from the 4th week in all groups.

These experimental results show that;

1) There were more callus formation and bony union in the experimental sides of

groups Ⅰ, Ⅱ, and Ⅳ than in the control ones at the 1st, 2nd and 3rd week.

2) In group Ⅲ there were less callus formation and bony union in the

experimental side than the control one at the 2nd, 3rd and 4th week.

3) There was no difference between all experimental and control sides at the 5th

and 7th week.

4) The dark grain appeared from the 5th day and the frequency reached a peak at

the 2nd to 3rd week from the autoradiographic findings.

5) It was found that electric current could accelerate the callus formation and

bony union in the fracture.