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骨移植에 關한 實驗的硏究

Experimental Study on Bone Transplantation

최신의학 1963년 6권 12호 p.19 ~ 34
유명하,
소속 상세정보
유명하 (  ) - 제18육군병원 정형외과

Abstract


There are four different types of bone grafts: autogenous; homogenous; heterogenous; and alloplastic. However, it has been proved by experimental and clinical_ studies that only autogenous and homogenous bone grafts are effective.
There is no doubt that the patient´s own bones are superior for a grafts as compared with other bone from another source. However, in cases requiring large amounts of bone or large gaps to be bridged, autogenous bone graft has some disadvantages. The operation of taking autogenous bone creates an additional burden to the patient and prolongs the operation. Therefore, this method is unsuitable in elderly or poor risk patients. Additional disadvantages include postoperative pain, scar over the donor site and weakening of donor area especially when the grafts was taken from the tibia. Patients with systemic disease are also unsuitable for autogenous bone graft. For these reasons, many clinician prefer to use homogenous bone rather than autogenous bone if it is available.
The purpose of this study was to determine the best method of preserved homogenous bone grafting which would give results comparable with autogenous grafting.
Under aseptic conditions, the bones was cut into the disired size and shape, and placed into sterile jars. Three different methods were used to preserve the bone: deep freeze with no solution at -20C; preserved in merthiolate solution at 2-5C; and preserved in saline solution at 2-5c. Merthiolate and saline solutions were changed every three weeks, and cultures were taken at regular intervals.
i\ inty-five healthy adult rabbits(average weight of 2.0kg) were used in this experiment. Under sterile conditions, the mid-shaft of the tibia was exposed 2.0 to 3.Ocm. elliptical incision over the lower leg. A transverse fracture was made by the use of a Gigli saw and both ends were displaced. The wound was closed in layers. Two weeks later, an open reduction and fixation with an intramedullary K-wire was performed. The bone grafting was done around and in between fracture site, and the wound was closed and the leg was immobilized with a splint. Before the preserved bones were used in the surgical repair it was kept at room temperature for a short while and soaked in penicillin solution.
Experimental animals were divided into 5 groups. Control (fracture only), autogenous grafts, and homogenous grafts using three different method of preservation. At intervals of four weeks, six weeks and eight weeks from the time of bone grafting the tibia was excised and observed macroscopically. Paraffin preparations were made and stained with hematoxylin-eosin and examined microscopically. 1´. _-ray examination were performed at two weeks intervals. Serum levels of Ca, P and alkaline phosphatase were also determined at two weeks intervals.
Paraffin preparations were obtained in 60 out of 95 experimental animals. As expected the best results were obtained with autogenous bone grafts. In the homogenous group, deep freezing gave the best results with merthiolate preserving and saline preserving in that order giving poorer results. With saline or
merthiolate preserved bone the sooner the bone was used the better results. However. with the. deep freeze preserved bone, no time relationship was noted.
By the end of eight weeks, no cellular inflammatory response was noted. Marked osteoblastic activity and osteoid proliferation were observed with autogenous bone and homogenous bone grafts in the deep freezing preserved or merthiolate preserved specimens. X-ray showed firm bony union with restoration of a normal trabeculation pattern. The blood serum level of Ca, P and alkaline phosphatase among the various groups were almost within the normal limits for rabbits. .
In summary, autogenous bone gives the most satisfactory result in bone grafting procedures. However, in cases autogenous bone graft is not suitable, homogenous bone must be substituted. The homogenous bone can best be preserved by a deep freeze method.

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