내부 골 신연기에 의한 이동 골 절편 신연술의 두개골 결손 재건에서의 유용성

Abstract

[한글]골 신연술 특히 골 절편 신연술은 골 결손을 재건하기 위해서 임상적으로 그 필요성이 날로 커지고 있다. 그러나 그에 대한 기초적인 연구는 아직 미진한 상태이다. 기존에 발표된 동물실험 결과는 한 개체 내에서 대조군을 정하지 않아 골 생성 정도를 비교한 결과의 신뢰성을 확보하지 못하였다. 본 연구에서는 내부 신연 장치와 이동 골 절편을 이용해 두개골 결손을 재건하여 골 절편 신연술의 유용성을 검증해보고자 하였다.6마리의 개를 마취 후 두개골 양측에 35×15mm의 골 결손을 만들었다. 한 쪽에는 7×15mm의 이동 골 절편과 내부 신연 장치를 장착하고, 다른 쪽은 골 절편 신연 장치 없이 대조군으로 이용하였다. 수술 후 5일부터 하루에 1mm씩 28일간 골 절편을 신연하고, 3개월의 경화 기간 후 3차원 컴퓨터 단층 촬영을 하여 남아있는 골 결손 정도를 평가하였다.

[영문]The necessity of distraction osteogenesis, particularly transport disc distraction osteogenesis (TDDO) for the reconstruction of bone defect has greatly increased. The basic research in TDDO, however, is still insufficient. According to previous reports, the comparisons of bone regeneration results were not valid, because those studies lacked control groups in the same animals. To overcome these facts, our department performed a TDDO study with an external distractor. But, at that time, the bone regeneration effect of TDDO was not distinguishable from the control group owing to instability of the external distractor device. In this report, we intended to verify the effect of TDDO in the reconstruction of skull defects with an internal distractor.

Six female dogs were operated on and were given a 35×15mm bilateral skull defect. In the study group, TDDO with internal distractors (with transport disc, 7×15mm sized) were installed. On the other side, the control group, the bone defects were left to heal naturally. The distraction was performed from the postoperative fifth day at a rate of 1mm/day for 28 days. Then, after 3 months of a consolidation period, the remained boned defects were measured by a 3-dimensional computed tomography. The solidity of the new bone was compared with the bone tissue of the normal skull bone.

In the study group, the new bone formation was estimated to be 62.3%(±25.1) of defect area and in the control group, it was 44.8%(±27.3). The difference between the two groups was significant (P=0.04). The solidity of the newly generated bone by TDDO was not different from the normal skull bone.

With these results, we can conclude that TDDO promotes new bone formation and it is useful to the reconstruction of a calvarial defect.