장관골의 골막부분손상이 골성장에 미치는 실험적 연구

Abstract

[한글]

장관골의 성장은 골단판에서 이루어지고 골단판에 가해지는 압력의 변화에 따라 골성장이 영향받는다는 것은 잘 알려진 사실이다. 그후 골막박리가 골성장을 촉진한다는 보고가 있었으며, 최근에는 소아 경골근위부 골절시 오는 외반변형의 원인에 관하여 골막의 골단판에 대한 영향으로 발생한다는 보고가 있었다.

이에 저자는 장관골 골막의 부분손상이 골성장에 미치는 영향을 연구하기 위하여 유약가토의 경골근위부에 여러 유형의 골막손상을 가한 실험을 통하여 다음과 같은 결론을 얻었다.

1. 경골 근위부 내측골막 손상시 수술후 2주이후 대조군에 대한 실험군의 골단판-골간각 차이가 현저하였으나, 외측골막 절개시에는 그 차이가 거의 없었다.

2. 경골 내측골막 손상시 좌우 경골의 골단판-골간각의 차이는 수술후 4주를 전후하여 가장 현저하였으며 그후 점차 감소하는 경향을 나타내었다.

3. 경골 내측골막 절개시 거위발모양근 상부를 절개한 군, 하부를 절개한 군 및 근육절개를 포함하여 절개한 군을 서로 비교하면 근육절개를 포함한 군에서 좌우 골단판-골간각의 차이가 조기에 감소하기 시작하여 수술후 12주에는 그 차가 거의 없었다.

4. 거위발로얄근 상부의 경골 내측골막의 절개와 절제를 비교시 좌우 골단판-골간각의 차이는 현저하지는 않지만 절제군에서 절개군에 비하여 더 큰 것을 관찰하였다.

5. 경골 근위부 내측골막 절개와 함께 부분골절시킨 경우 타군에 비하여 좌우 골단판-골간각의 차이가 특히 수술후 4주와 6주에 현저하게 큰 것을 관찰하였다.

6. 좌우측 경골의 근위 및 원위부 골단판에 대한 좌우 내외측 사이에 골단판의 두께, 세포배열 및 성숙도에 조직학적 차이는 없었다.

이상의 결과를 미루어 보아 골막은 부착된 근육과 더불어 골단판 사이에서 내재적인 생역학적 균형을 이루고 있으며 골막손상은 이 군형을 파괴시켜 골성장의 변화를 초래하고 골막의 재결합으로 새로운 생역학적 균형을 형성하면서 골성장에 영향을 미치는 것으로

생각되며, 골성장의 촉진은 골단판의 형태학직 변화없이 골형성과정의 속도가 증가되어 일어나는 것으로 사료된다.

Experimental Study on Bone Growth Process after Partial Periosteal Injury of the

Long Bone

Churl Soo Joo

Department of Medical Science The Graduate School, Yonsei University

(Directed by Prof. Byeong Mun Park, M.D.)

It has long been known that the longitudinal growth of long bones occurs in

epiphyseal plates, and pressures parallel to the axis of epiphyseal growth affect

the rate of such growth. And many published articles showed that circumferential

stripping of the periosteum increased the rate of growth of long bones by

increasing the activity of the epiphyseal plates. Rescently some authors reported

that genu valium deformity in a child after a fracture of the uppermetaphysis of

the tibia resulted from the biomechanical disturbance of the periosteum inducing

asymmetrical growth at both ends of the bone. So an experimental study was done in

order to observe the patterns of bone growth and the changes of the growth plates

after periosteal division and other injuries about the upper tibia of immature

rabbit. The results were as follows :

1. Hemicircumferential injuries of the medial periosteum all stimulated the

growth plates on the same side, induced angular deformities, and resulted in

increase of P.S angles, on the other hand, hemicircumferential division of the

lateral periosteum had no effet on growth.

2. In hemicircumferential injuries of the medial periosteum, P-S angle difference

was most increased post-operative 4 weeks and then decreased slowly.

3. Comparing with hemicircumferential division of the medial periosteum above and

below pes anserinus, hemicircumferential division of the medial periosteum through

pes anserinus revealed that P-S angle difference between experimental and control

legs decreased early and was only 0.8±2.1 at post-operative 12 weeks.

4. In hemicircumferential resection of the medial periosteum, P-S angle

differenoe was more increased than any other hemicircumferential division of the

medial periosteum.

5. In hemicircumferential division of the medial perioateum with partial

fracture, P-S angle difference was more increased than any others especially during

post-operative period of 4∼6 weeks.

6. The medial and lateral sides of proximal and distal epiphyseal plates on both

tibias did not show any differences and abnormal features including the width of

growth plate, cellular orientation, and maturation.

In summary, it is proposed that an intrinsic biomechanical eauillibrium for bone

growth between the plates and the periosteum with attached muscles exists in a

growing long bone, division of the periosteum disturbs the biomechanical

equillibrium, that is, releases its inherent tension and allows the rate of growth

to increase, and reunion of periosteum establishes a new biomechanical equillibrium

at the site of division as a result of which the relative growth rates of the

epiphyseal plates of the bone are permanently altered, also that bone growth

acceleration results from increase of the rate of ossification process without any

morphological changes of the epiphyseal plates.

[영문]

It has long been known that the longitudinal growth of long bones occurs in epiphyseal plates, and pressures parallel to the axis of epiphyseal growth affect the rate of such growth. And many published articles showed that circumferential stripping of the periosteum increased the rate of growth of long bones by

increasing the activity of the epiphyseal plates. Rescently some authors reported that genu valium deformity in a child after a fracture of the uppermetaphysis of the tibia resulted from the biomechanical disturbance of the periosteum inducing asymmetrical growth at both ends of the bone. So an experimental study was done in order to observe the patterns of bone growth and the changes of the growth plates after periosteal division and other injuries about the upper tibia of immature rabbit. The results were as follows :

1. Hemicircumferential injuries of the medial periosteum all stimulated the growth plates on the same side, induced angular deformities, and resulted in increase of P.S angles, on the other hand, hemicircumferential division of the lateral periosteum had no effet on growth.

2. In hemicircumferential injuries of the medial periosteum, P-S angle difference was most increased post-operative 4 weeks and then decreased slowly.

3. Comparing with hemicircumferential division of the medial periosteum above and below pes anserinus, hemicircumferential division of the medial periosteum through pes anserinus revealed that P-S angle difference between experimental and control

legs decreased early and was only 0.8±2.1 at post-operative 12 weeks.

4. In hemicircumferential resection of the medial periosteum, P-S angle differenoe was more increased than any other hemicircumferential division of the medial periosteum.

5. In hemicircumferential division of the medial perioateum with partial fracture, P-S angle difference was more increased than any others especially during post-operative period of 4∼6 weeks.

6. The medial and lateral sides of proximal and distal epiphyseal plates on both tibias did not show any differences and abnormal features including the width of growth plate, cellular orientation, and maturation.

In summary, it is proposed that an intrinsic biomechanical eauillibrium for bone growth between the plates and the periosteum with attached muscles exists in a growing long bone, division of the periosteum disturbs the biomechanical

equillibrium, that is, releases its inherent tension and allows the rate of growth to increase, and reunion of periosteum establishes a new biomechanical equillibrium at the site of division as a result of which the relative growth rates of the

epiphyseal plates of the bone are permanently altered, also that bone growth acceleration results from increase of the rate of ossification process without any morphological changes of the epiphyseal plates.