127 pissn : , eissn : Original Article J Korean Orthop Assoc 2020; 55:

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1 127 pissn : , eissn : Original Article J Korean Orthop Assoc 2020; 55: 경골근위부개방절골술시개방부압력과동종쐐기골편의최대압축하중비교 윤경호 김정석 권유범 김응주 이명규 * 김상균 경희대학교의과대학정형외과학교실, * 한국공공조직은행연구개발과 Comparison of Gap Pressure in Opening Wedge High Tibial Osteotomy versus Compressive Strength of Allogenous Wedge Bone Blocks Kyoung Ho Yoon, M.D., Jung Suk Kim, M.D., Yoo Beom Kwon, M.D., Eung Ju Kim, M.D., Myeong-Kyu Lee*, and Sang-Gyun Kim, M.D. Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, *Department of Research and Development, Korea Public Tissue Bank, Seoul, Korea Purpose: The aims of this study were (1) to investigate the relationship between the characteristics of allogenic bone block and the compressive strength of an allogenic bone block measured by biomechanical experiments, and (2) to compare the maximum pressure load of allogenic bone block with the gap pressure measured at the high tibial opening osteotomy. Materials and Methods: Ten patients who provided informed consent for gap pressure measurements during opening wedge high tibial osteotomy (OWHTO) were included. The gap pressures were measured at 1 mm intervals while opening the osteotomy site from 8 mm to 14 mm. Seventeen U-shaped allogenous wedge bone blocks were made from the femur, tibia, and humerus. The height, width, cross-sectional area, and cortex thickness of the bone blocks were measured, along with the maximum compressive load just before breakage. The relationship between these characteristics and the maximum pressure load of the bone blocks was evaluated. The gap pressures measured in OWHTO were compared with the maximum pressure loads of the allogenous wedge bone blocks to evaluate the possibility of inserting allogenous wedge bone blocks into the osteotomy site without a distractor in OWHTO. Results: The OWHTO gap pressure increased with increasing osteotomy site opening. The mean gap pressure, which occurred at a 14-mm opening, was 282±93 N; the maximum pressure was 427 N. The maximum pressure load of the allografts was 13,379±6,469 N (minimum, 5,868; maximum, 29,130 N) and was correlated significantly with the cortical bone thickness (correlation coefficient=0.693, p=0.002) and cross-sectional area (correlation coefficient=0.826, p<0.001). Depending on the sterilization method, the maximum pressure loads for the bone blocks were 13,406±5,928 N for freeze-dried and 13,348±7,449 N for fresh frozen. The maximum compressive load of the allogenous wedge bone blocks was 13.7-times greater than that in OWHTO opened to 14 mm (5,868 N vs. 427 N). Conclusion: The compressive strength of allogenous wedge bone blocks was sufficiently greater than the gap pressure in OWHTO. Therefore, allogenous wedge bone blocks can be inserted safely into the osteotomy site without a distractor. Key words: knee, osteoarthritis, osteotomy, allograft, bone transplantation 서론 Received April 10, 2019 Revised May 23, 2019 Accepted June 21, 2019 Correspondence to: Sang-Gyun Kim, M.D. Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea TEL: FAX: ORCID: 경골근위부개방절골술 (opening wedge high tibial osteotomy) 은술기가비교적쉽고비골신경손상의위험이낮아무릎내 측골관절염의치료로많이시행되고있다. 1,2) 개방부의안정성이 The Journal of the Korean Orthopaedic Association Volume 55 Number Copyright 2020 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 128 Kyoung Ho Yoon, et al. 떨어지고불유합의위험이있다는단점이지적되고있으나 2-4) 최근잠금금속판 (locking plate) 이개발되면서절골부위의안정성을증가시키고임상적결과를향상시키고있다. 5-8) 또한추가적인안정성을얻기위하여잠김금속판과함께금속블록 (metal block) 을사용하기도한다. 9) 개방부에금속블록을사용하면추가적인안정성외에도금속판을고정하기전에신연장치 (distractor) 를제거함으로써얻을수있는여러가지이점이있다. 먼저, 신연장치를제거하면수술중금속판의위치를조정하는것이용이하다. 특히일반적으로신연장치를삽입하는위치인경골의후내측에금속판을쉽게삽입할수있는데여러연구에서금속판을경골의후내측에위치하면경골의후방경사에영향을덜미치고 10) 생역학적으로도우월하다는결과를보고하고있다. 11,12) 또한신연장치를제거하면금속불록의크기에따라원하는개방정도를쉽게얻을수있고특히사다리꼴형태 (trapezoidal) 의금속블록을삽입하면경골후방경사의증가를쉽게예방할수있다 (Fig. 1). 하지만금속블록은삽입되는내측피질골의골생성을방해하 고생물학적효과 (biologic effect) 가없다는단점이있다. 또한금속블록을제거하면서추가적인골소실이발생할가능성도있다. 자가장골피질골 (autologous tricortical iliac bone) 이식은이러한단점을해결할수있는좋은방법이지만공여부의부작용이발생할수있고채취할수있는크기에한계가있다. 13,14) 따라서동종쐐기골편을대안으로선택할수있다. 동종쐐기골편은골전도를통해생물학적골생성을향상시키고공여부부작용이없으며크기에상관없이사용할수있다는장점이있다. 15) 경골근위부개방절골술시신연장치없이동종쐐기골편을개방부에삽입하기위해서는동종쐐기골편의압축강도 (compressive strength) 가개방부의압력 (gap pressure) 을견딜수있어야한다. 다시말해서, 동종쐐기골편의압축강도는경골근위부개방절골술시개방부의압력에비해충분히커야한다. 하지만아직까지경골근위부개방절골술시개방부의압력과동종쐐기골편의압축강도에대한연구는없었다. 따라서이연구의목적은 (1) 동종쐐기골편의물리적성상 ( 높이, 폭, 단면적, 피질골두께 ) 과압축강도의관계를알아보고, (2) 근위부개방절골 Figure 1. Opening wedge high tibial osteotomy using a metal block. (A) Metal block was inserted after osteotomy site was opened with a distractor. (B) Metal block maintained the osteotomy gap without a distractor. The osteotomy site was opened using a trapezoidal metal block. Table 1. Demographic Data of the Enrolled Patients Patient No. Side Sex Age (yr) BMI (kg/m 2 ) BMD (T-score) Opening gap (mm) HKA ( ) MPTA ( ) mldfa ( ) JLCA ( ) 1 Left Male Left Female Left Male Right Female Left Female Right Male Left Female Right Female Left Male Right Male BMI, body mass index; BMD, bone mineral density; HKA, hip-knee-ankle axis; MPTA, medial proximal tibial angle; mldfa, mechanical lateral distal femoral angle; JLCA, joint line convergence angle.

3 129 Compressive Strength of Allogenous Wedge Bone Blocks 술 시 별도의 신연장치 없이 동종 쐐기 골편을 개방부에 안전하 게 삽입이 가능한지 알아보기 위해 동종 쐐기 골편의 압축 강도 대상 및 방법 와 경골 측정된 개방부의 압력을 비교하고자 한다. 저자들은 동 1. 경골 근위부 개방 절골술 시 개방부의 압력 측정 종 쐐기 골편의 최소 압축 강도가 경골 근위부 개방 절골술 시 측 본 연구는 경희의료원 연구윤리위원회로부터 검토 및 승인을 받 정된 개방부의 최대 압력보다 충분히 클 것으로 가정하였다. 았다(KHUH ). 2018년 11월부터 2019년 2월까 지 경골 근위부 개방 절골술 시행 전 연구에 동의한 10명의 환자 의 데이터를 전향적으로 수집하였다. 연구에 참여한 환자는 남 자 5명 여자 5명이었으며 평균 나이는 59.3±9.0세, 체질량지수 는 29.2±4.8 kg/m2이었다. 환자의 평균 골밀도는 T-score -1.2 ±1.4이었고, 환자마다 교정 각도에 따라 절골부를 12 mm에 서 15 mm까지(평균 13.1±1.2 mm) 개방하였다. 수술 전 측정 한 방사선학적 하지 정렬 지표는 hip-knee-ankle axis, 7.5 ± 1.7 ; medial proximal tibial angle, 84.2 ±2.0 ; mechanical lateral distal femoral angle, 91.6 ±1.4 ; 및 joint line convergence angle, 2.7 ±1.1 로 확인되었다(Table 1). 수술은 일반적인 경골 근위부 개방 절골술의 술기에 따라 진 행하였다.1,16) 먼저 거위발건(pes anserinus)을 경골 부착부에서 박리해 천부 내측측부인대(superficial medial collateral ligament)를 확인하였다. 이후 노출된 천부 내측측부인대를 원위부 에서 골막과 함께 경골에서 분리하였다. 무릎 내측 관절면에서 약 4 cm 하방에서 비골두(무릎 외측 관절면에서 1 cm 아래)를 향해 두 개의 가이드 핀을 삽입하고 saw와 osteotome를 이용하 Figure 2. Pressure gauge components. (A) Insertion into the osteotomy site. (B) Pressure sensor. (C) Screw for adjusting the osteotomy site opening degree. (D) Instrument panel for displaying measured pressure. 여 이중 평면 절골(biplanar osteotomy)을 시행하였다. 절골의 깊이는 외측골의 hinge를 남기기 위하여 외측 피질 골에서 5-10 mm 정도가 남도록 시행하였다. 이후 절골부를 신연장치를 이용 Figure 3. Measurements of the mech anical characteristics of allogenous wedge bone blocks. (A) Height, (B) width, (C) cortex thickness, (D) cross-sectional area.

4 130 Kyoung Ho Yoon, et al. 하여 8 mm까지개방하고압력측정기 (Fig. 2) 를삽입한후에신연장치를제거하였다. 이때센서에측정된압력을기록한후압력측정기의나사를조절하여절골부개방을 14 mm까지 1 mm 씩간격으로증가시키면서압력을측정하였다. 2. 동종쐐기골편의압축강도측정한국공공조직은행에서기증받은대퇴골, 경골및상완골을이용하여 17개의동종쐐기골편을채취하였다. 동종쐐기골편은폭 mm, 높이 5-10 mm의 U자형피질골로제작되었다. 골수 (bone marrow) 와지방조직 (fat tissue) 은과산화수소와에틸알콜을이용하여제거하였다. 골편은살균을위하여 -70 C 에서동결 (fresh frozen) 하여보관하거나동결건조 (freeze-dried) 하여실온에서보관하였다. 동종쐐기골편의높이, 폭, 피질골두께는캘리퍼 (caliper) 를이용하여측정하였고골편의단면이미지를 Image J 프로그램을이용하여단면적을측정하였다 (Fig. 3). 이후만능재료측정기 (Universal Testing Machine, SGA-E-300AD; SHINGANG Ltd., Seoul, Korea) 를이용하여골편에압축력을가한뒤에골편이파괴되기직전의최대압축하중을측정하였다 (Fig. 4). 만능재료측정기의압력은 50,000 N 으로설정되었고 0.1 mm/s의속도로실험을진행하였다. 동종쐐기골편의압축강도는골편이파괴되기직전의최대압축하중으로정의하였다. 동종쐐기골편의성상 ( 높이, 폭, 단면적및피질골의두께 ) 과최대압축하중의관계를평가하였다. 3. 결과분석및통계방법통계학적분석은 IBM SPSS software for Windows ver (IBM Corp., Armonk, NY, USA) 을이용하여시행하였다. 동종쐐기골편의성상과최대압축하중과의상관관계를평가하기위 하여피어슨상관관계분석을사용하였고통계학적유의성은 p <0.05로설정하였다. 경골근위부개방절골술시별도의신연장치없이동종쐐기골편을삽입할수있는지평가하기위하여경골근위부개방절골술시측정된개방부압력의최대값과동종쐐기골편의최대압축하중의최소값을비교하였다. 결과 1. 경골근위부개방절골술시개방부의압력 경골근위부개방절골술중절골부를많이개방할수록개방부 압력이증가하여 14 mm 개방하였을때개방부의압력 ( 평균압 력 282±93 N, 최대압력 427 N) 이가장크게측정되었다 (Table 2). Table 2. Measured Gap Pressure during High Tibial Osteotomy Opening gap Gap pressure (N) Mean±SD Minimum Maximum 8 mm 72± mm 105± mm 138± mm 174± mm 210± mm 244± mm 282± SD, standard deviation. Figure 4. Instruments and methods of biomechanical study. (A) Universal testing machine (SGA-E-300AD; SHINGANG Ltd., Seoul, Korea). (B) U-shaped allogenous wedge bone block. (C) Compressive force applied to allogenous wedge bone block to measure the maximal pressure load at 0.1 mm/s.

5 131 Compressive Strength of Allogenous Wedge Bone Blocks Table 3. Biomechanical Study Results Bone block Location Sterilization Height (mm) Width (mm) Area (mm 2 ) Thickness (mm) Maximum pressure load (N) F-d-1 Femur Freeze-dried ,851 F-d-2 Femur Freeze-dried ,893 F-f-1 Femur Fresh frozen ,692 F-f-2 Femur Fresh frozen ,130 H-d-1 Humerus Freeze-dried ,938 H-d-2 Humerus Freeze-dried ,868 H-d-3 Humerus Freeze-dried ,238 H-d-4 Humerus Freeze-dried ,226 H-f-1 Humerus Fresh frozen ,740 H-f-2 Humerus Fresh frozen ,916 H-f-3 Humerus Fresh frozen ,552 T-d-1 Tibia Freeze-dried ,524 T-d-2 Tibia Freeze-dried ,349 T-d-3 Tibia Freeze-dried ,770 T-f-1 Tibia Fresh frozen ,072 T-f-2 Tibia Fresh frozen ,312 T-f-3 Tibia Fresh frozen ,377 Figure 5. Correlation between the maximum pressure load and cortex thickness (A: correlation coefficient=0.693, p=0.002) or cross-sectional area of allogenous wedge bone block (B: correlation coefficient=0.826, p<0.001). MPL, maximum pressure load. 2. 동종쐐기골편의압축강도각각의동종쐐기골편의성상과최대압축하중은 Table 3에정리되어있다. 동종쐐기골편은높이 9.1±3.5 mm, 폭 20.9± 2.2 mm, 단면적 130±36.3 mm 2, 피질골의두께 5.7±1.9 mm 로측정되었다. 동종쐐기골편의최대압축하중은평균 13,379± 6,469 N ( 최소값 5,868 N, 최대값 29,130 N) 으로측정되었으며피질골의두께 ( 상관계수 =0.693, p=0.002) 및단면적 ( 상관계수 =0.826, p<0.001) 과유의한상관관계를가지고있었다 (Fig. 5). 하지만동종쐐기골편의최대압축하중은골편의높이또는폭과는유의한상관관계를보이지않았다. 살균방법에따라동결건조골편의압축강도는평균 13,406 ±5,928 N ( 최소값 5,868 N, 최대값 25,893 N), 동결골편의압축강도는평균 13,348±7,449N ( 최소값 5,916 N, 최대값 29,130 N) 으로측정되었다.

6 132 Kyoung Ho Yoon, et al. 3. 경골근위부개방절골술시개방부의압력과동종쐐기골편의압축강도비교동종쐐기골편의최대압축하중최소값은경골근위부를 14 mm 까지개방하였을때측정된개방부의최대압력에비해 13.7배높았다 (5,868 N vs. 427 N). 따라서본연구의동종쐐기골편의최소압축강도는경골근위부절골술시개방부에서측정된최대압력보다충분히큰것으로확인되었다. 고찰 본연구를통해동종쐐기골편의압축강도가경골근위부개방절골술에서절골부를 14 mm까지개방하면서측정한압력보다충분히큰것을확인되었다. 수술중절골부를 14 mm 개방하였을때개방부의압력은평균 282±93 N이었으며최대 427 N으로측정되었다. 하지만생역학실험결과, 동종쐐기골편의압축강도는동결건조골편이 5,868 N 이상, 동결골편이 5,916 N 이상의압축강도를갖는것으로확인되었기때문에결과적으로경골근위부개방절골술중별도의신연장치없이동종쐐기골편을개방부에안전하게삽입가능한것으로판단된다. 경골근위부개방절골술중별도의신연장치없이동종쐐기골편을이용하여절골부의개방을유지하는것은금속판의위치를쉽고자유롭게결정할수있다는장점이있다. 특히금속판을경골의후내측에위치하면개방부의생역학적안정성및후방경사의조절에도움을준다는연구결과가보고되고있다. Rubino 등 10) 은사체연구에서후방에삽입된금속판은경골의후방경사에영향을덜미치고금속판을전방또는중간에삽입하면경골의후방경사를증가시킨다고하였다. Takeuchi 등 11) 은근위경골개방절골술에서금속판위치의영향을조사하였고후내측에위치한금속판이전내측에위치한금속판보다생학적으로우월하다는것을증명하였다. Martinez de Albrnoz 등 12) 도금속판이후방에위치했을때전방또는중간에위치하였을때보다생역학적안정성이높다고하였다. 동종골의압축강도에대한이전연구는대부분동종골의살균방법에따른압축강도의차이를연구한것이었다. Pelker 등 17,18) 이동결또는동결건조한동종골의생역학적특성을확인한결과에따르면두살균방법모두동종골의압축강도에는영향을주지않는다고하였다. 하지만본연구는살균방법뿐아니라동종쐐기골편의크기, 폭, 단면적, 피질골두께와같은물리적특성과압축강도와의상관관계를연구하였으며결과적으로동종쐐기골편의압축강도가피질골의두께및단면적과유의한상관관계가있음을보여주었다. 이러한결과는향후경골근위부개방절골술을위한동종쐐기골편을제작할때도움이될수있다. 따라서가능하다면두꺼운피질과넓은단면적을갖는동종쐐기골편을제작하여사용하는것이좋을것으로생각된다. 본연구에서는다양한부위에서채취한다양한크기의동종쐐기골편을사용하였기때문에살균방법에따른동종쐐기골편의압축강도를비교하는것이어려웠다. 그러나두가지방법으로된골편이유사한압축강도를보였으며 ( 동결건조 : 13,406± 5,928 N, 동결 : 13,348±7,449 N) 보관방법에상관없이경골근위부개방절골술의개방부압력에비해충분히강한것으로확인되었다. 따라서경골근위부개방절골술의동종쐐기골편은두가지방법으로모두살균될수있지만보관상의이점때문에동결건조방법을사용하는것이편리할것으로생각된다. 이연구의강점은경골근위부개방절골술에서절골부위의개방부압력을처음으로측정하였으며동종골의성상 ( 높이, 너비, 단면적, 피질골두께등 ) 과동종골의압축강도와의관계에대해연구했다는점이다. 이러한연구데이터는향후다른내고정물이나골대체제의개발과같은연구에참고자료로사용될수있을것이다. 또한본연구의생역학실험을통해다양한동종쐐기골편이모두절골부위개방부압력에비해충분한압축강도를갖고있는것으로확인되었다. 따라서경골근위부개방절골술시다양한부위에서채취한동종쐐기골편을크기나살균방법에관계없이사용할수있을것으로판단된다. 이연구에는몇가지한계점이있다. 첫째, 경골근위부개방절골술시개방부압력을측정한환자의수가많지않는점이다. 이연구는 10명의소수의환자를대상으로한예비연구 (preliminary study) 이기때문에본연구의결과가경골근위부개방절골술의개방부압력을대표한다고할수는없다. 둘째, 경골근위부개방절골술의개방부압력은최대 14 mm까지만측정해그이상개방하였을때의개방부압력에대한결과는알수없다는점이다. 또한천부내측측부인대을절단하거나단평면절골 (uniplanar osteotomy) 과같은다른절골법을사용하였을때에는개방부압력이달라질수있다. 셋째, 잠금금속판을이용한경골근위부개방절골술의안정성을위해동종쐐기골편의압축강도가절대적으로필요한것은아니라는점이다. 하지만본연구의목적은경골근위부개방절골술중에동종쐐기골편을신연장치없이도안전하게삽입할수있는지알아보기위함이며앞서언급한대로신연장치없이동종쐐기골편을삽입하는것은수술중여러가지이점이있을것으로생각된다. 또한동종쐐기골편의압축강도가수술후개방부위의생역학적안정성에절대적인것은아니더라도추가적인안정성을제공할수는있을것이다. 마지막으로채취부위, 크기및살균방법이통일되지않은골편을사용하였다는점이다. 그러나이것은위에서언급한것처럼본연구의강점으로도볼수있다. 결론 동종쐐기골편의최소압축강도는경골근위부개방절골술시

7 133 Compressive Strength of Allogenous Wedge Bone Blocks 측정된개방부의최대압력보다충분히큰것으로확인되었다. 따라서경골근위부개방절골술중별도의신연장치없이동종쐐기골편을개방부에안전하게삽입이가능한것으로판단된다. CONFLICTS OF INTEREST The authors have nothing to disclose. ORCID Kyoung Ho Yoon, Jung Suk Kim, Yoo Beom Kwon, Eung Ju Kim, Myeong-Kyu Lee, Sang-Gyun Kim, REFERENCES 1. Lee DC, Byun SJ. High tibial osteotomy. Knee Surg Relat Res. 2012;24: Sabzevari S, Ebrahimpour A, Roudi MK, Kachooei AR. High tibial osteotomy: a systematic review and current concept. Arch Bone Jt Surg. 2016;4: Ruzbarsky JJ, Dare DM, Marx RG. Closing verses opening wedge high tibial osteotomy: an evidence-based review. HSS J. 2015;11: Sun H, Zhou L, Li F, Duan J. Comparison between closing-wedge and opening-wedge high tibial osteotomy in patients with medial knee osteoarthritis: a systematic review and meta-analysis. J Knee Surg. 2017;30: Agneskirchner JD, Freiling D, Hurschler C, Lobenhoffer P. Primary stability of four different implants for opening wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2006;14: Brosset T, Pasquier G, Migaud H, Gougeon F. Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix TM ) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases. Orthop Traumatol Surg Res. 2011;97: Raja Izaham RM, Abdul Kadir MR, Abdul Rashid AH, Hossain MG, Kamarul T. Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy. Injury. 2012;43: Stoffel K, Stachowiak G, Kuster M. Open wedge high tibial osteotomy: biomechanical investigation of the modified Arthrex Osteotomy Plate (Puddu Plate) and the TomoFix Plate. Clin Biomech (Bristol, Avon). 2004;19: Han SB, Bae JH, Lee SJ, et al. Biomechanical properties of a new anatomical locking metal block plate for opening wedge high tibial osteotomy: uniplane osteotomy. Knee Surg Relat Res. 2014;26: Rubino LJ, Schoderbek RJ, Golish SR, Baumfeld J, Miller MD. The effect of plate position and size on tibial slope in high tibial osteotomy: a cadaveric study. J Knee Surg. 2008;21: Takeuchi R, Woon-Hwa J, Ishikawa H, et al. Primary stability of different plate positions and the role of bone substitute in open wedge high tibial osteotomy. Knee. 2017;24: Martinez de Albornoz P, Leyes M, Forriol F, Del Buono A, Maffulli N. Opening wedge high tibial osteotomy: plate position and biomechanics of the medial tibial plateau. Knee Surg Sports Traumatol Arthrosc. 2014;22: Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996;329: Chae DJ, Shetty GM, Wang KH, Montalban AS Jr, Kim JI, Nha KW. Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation. Knee. 2011;18: Finkemeier CG. Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am. 2002;84: Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2003;11: Pelker RR, Friedlaender GE, Markham TC. Biomechanical properties of bone allografts. Clin Orthop Relat Res. 1983;174: Pelker RR, Friedlaender GE, Markham TC, Panjabi MM, Moen CJ. Effects of freezing and freeze-drying on the biomechanical properties of rat bone. J Orthop Res. 1984;1:

8 134 pissn : , eissn : Original Article J Korean Orthop Assoc 2020; 55: 경골근위부개방절골술시개방부압력과동종쐐기골편의최대압축하중의비교 윤경호 김정석 권유범 김응주 이명규 * 김상균 경희대학교의과대학정형외과학교실, * 한국공공조직은행연구개발과 목적 : 이연구의목적은동종쐐기골편의성상과최대압축하중과의관계를알아보고동종쐐기골편의최대압축하중과경골근 위부개방절골술시측정된개방부의압력을비교하는것이다. 대상및방법 : 경골근위부개방절골술을시행하기전연구에동의한 10 명의환자가본연구에포함되었다. 수술중절골부위를 8 mm 에서 14 mm 까지개방시키면서 1 mm 간격으로개방부의압력을측정하였다. 대퇴골, 경골및상완골에서 U 자형동종쐐 기골편을채취하여골편의높이, 폭, 단면적및피질골의두께를측정한뒤에골편이파괴되기직전의최대압축하중을측정해골 편의성상과최대압축하중과의관계를평가하였다. 경골근위부개방절골술시별도의신연장치없이개방부에동종쐐기골편을 삽입할수있는지평가하기위해경골근위부개방절골술시측정된개방부압력과동종쐐기골편의최대압축하중을비교하였 다. 결과 : 경골근위부개방절골술중절골부를많이개방할수록개방부압력이증가해 14 mm 개방하였을때개방부의압력 ( 평균 282±93 N, 최대 427 N) 이가장크게측정되었다. 동종쐐기골편의최대압축하중은평균 13,379±6,469 N ( 최소값 5,868 N, 최대값 29,130 N) 으로측정되었으며피질골의두께 ( 상관계수 =0.693, p=0.002) 및단면적 ( 상관계수 =0.826, p<0.001) 과유의한상관관계를가지고있었다. 살균방법에따라동결건조 (freeze-dried) 골편은평균 13,406±5,928 N ( 최소값 5,868 N, 최대값 25,893 N), 동결 (fresh frozen) 골편은평균 13,348±7,449 N ( 최소값 5,916 N, 최대값 29,130 N) 으로측정되었다. 동종쐐기골 편의최대압축하중최소값은경골근위부를 14 mm 까지개방하였을때측정된개방부의최대압력에비해 13.7 배높았다 (5,868 N vs. 427 N). 결론 : 동종쐐기골편의최소압축강도는경골근위부개방절골술시측정된개방부의최대압력보다충분히큰것으로확인되 었다. 따라서경골근위부개방절골술중별도의신연장치없이동종쐐기골편을개방부에안전하게삽입가능한것으로판단된 다. 색인단어 : 무릎, 골관절염, 절골술, 동종골, 골이식 접수일 2019 년 4 월 10 일수정일 2019 년 5 월 23 일게재확정일 2019 년 6 월 21 일책임저자김상균 02447, 서울시동대문구경희대로 23, 경희대학교의과대학정형외과학교실 TEL , FAX , ORCID 대한정형외과학회지 : 제 55 권제 2 호 2020 Copyright 2020 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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