KISEP Clinical Researches J Korean Neurosurg Soc 30605-610, 2001 요추부후측방유합술에서골편대체물로서황산칼슘의효과에대한연구 이승구 김충현 정진환 백광흠 김재민 오석전 = Abstract = Efficacy of Calcium Sulfate Pellets as Bone Graft Substitute in Lumbar Posterolateral Fusion Preliminary Report Seung Ku Lee, M.D., Choong Hyun Kim, M.D., Jin Hwan Cheong M.D., Koang Hum Bak, M.D., Jae Min Kim, M.D., Suck Jun Oh, M.D. Department of Neurosurgery, School of Medicine, Hanyang University, Seoul, Korea bjective Patients and Methods Results Conclusion KEY WORDS 서론 J Korean Neurosurg SocVolume 30May, 2001 605
요추부 후측방 유합술에서 골편대체물로서 황산칼슘의 효과에 대한 연구 의 이용이 증가되고 있는 추세이다10)14). 황산칼슘은 골결손부위를 보충해 주는 물질로 1982년 이 지금까지 합성 골 대체물로는 인산화칼슘 성분의 제품을 후 이용되어 왔으며 특히 장골과 상악안면골 결손부위를 보 많이 이용하여 왔다. 그러나 하이드록시아페타이트(hydro- 완하는데 아주 효과적인 물질이었다17). 황산칼슘은 골결손 xyapatite) 같은 인산화칼슘 골 대체물은 골유합을 촉진시 부위에 공간을 채워주는 물질로 작용하여 연조직이 자라는 키기도 하지만 콜라겐과 인산화칼슘 복합물이 자가골편의 것을 막아주고 혈관과 골형성세포의 성장을 도와주는 골유 골유합 능력을 감소시킬 수도 있는 것으로 알려져 있다12). 도작용이 있으며 빨리 흡수되는 동시에 신생 골의 성장을 A B C D Fig. 1. Case 9, a 52-year-old female with spinal stenosis. Posterolateral spinal fusion using autograft and OsteoSet pellets was performed with transpedicular fixation. Plain X-ray films showing the resorption of calcium sulfate pellets and bony fusion at postoperative 1 month(a), 2 months(b), 3 months(c), and 6 months(d) respectively. 606 J Korean Neurosurg Soc/ Volume 30 / May, 2001
1. 연구대상 대상및방법 2. 수술방법 3. 추적조사및결과분석 Table 1. Definition of the modified Lenke scale 19) in the posterolateral fusion of the lumbar spine Score Definition 1 Definitive evidence of contiguous bridging trabecular bone between the transverse process, without evidence of radiolucency. A solid fusion 2 Thin unilateral fusion mass, but probably solid 3 Evidence of bridging bone extending from the transverse processes but contains radiolucenciesindicating a probable non-union 4 Sparse fragments of bone between the transverse process, without evidence of fusion. A definitive nonunion Table 2. Clinical characteristics and OsteoSet pellet resorption rate in 20 cases Case Sex Fused Volume of Rate of postoperative resorption% No. Ageyrs level OsteoSet pelletml 1 months 2 months 3 months 6 months 1 F/27 L3L4L5 20 50 70 90 100 2 F/65 L3L4L5 20 60 70 90 100 3 F/53 L3L4L5 20 60 70 80 100 4 F/67 L5S1 10 50 80 90 100 5 M/64 L4L5 10 50 80 90 100 6 F/49 L4L5S1 20 60 90 90 100 7 F/58 L2L3 10 60 90 90 100 8 M/65 L4L5 10 60 80 90 100 9 F/52 L3L4L5 20 50 70 80 100 10 F/68 L5S1 10 60 80 90 100 11 M/69 L4L5 10 60 90 100 100 12 F/67 L3L4 10 60 80 90 100 13 M/63 L4L5 10 50 80 90 100 14 F/62 L1L2L3 20 60 80 90 100 15 F/68 L5S1 10 50 90 100 100 16 F/69 L2L3 10 50 80 90 100 17 M/65 L5S1 10 50 80 90 100 18 M/64 T12L1 10 60 90 90 100 19 F/70 L3L4L5 20 50 80 90 100 20 F/61 L4L5S1 20 60 80 90 100 OLF = Ossification of ligamentum flavum J Korean Neurosurg SocVolume 30May, 2001 607
608 1. 임상적특징 결 Average percentage of resorption% 100 80 60 40 20 0 Table 3. Average modified Lenke scale scores in 20 cases with using OsteoSet pellets lumbar posterolateral fusion Postoperative intervalsmonths 과 1 2 3 6 Postoperative intervalsmonths Fig. 2. Average percentage of OsteoSet pellets resorption in 20 cases with posterolateral spinal fusion. Average modified Lenke scale score 4 3 2 1 0 Average modified Lenke scale score 1 3.8 2 2.8 3 2.4 6 1.8 1 2 3 6 Postoperative intervalsmonths Fig. 3. Average scores of modified Lenke scale in 20 cases with posterolateral fusion using OsteoSet pellets. 2. 황산칼슘 pellet 의흡수정도 3. 골유합정도 고 찰 J Korean Neurosurg SocVolume 30May, 2001
결 론 J Korean Neurosurg SocVolume 30May, 2001 609
References 1) Anson D:Calcium sulfate:a 4-year observation of its use as a resorbable barrier in guided tissue regeneration of periodontal defects. Compend Contin Educ Dent 17(9):895-899, 1996 2) Bahn SL:Plaster:a bone substitute. Oral Surg Oral Med Oral Pathol 21(5):672-681, 1966 3) Beeson WH:Plaster of paris as an alloplastic implant in the frontal sinus. Arch Otolaryngol 107(11):664-669, 1981 4) Berrey BH Jr, Lord CF, Gebhardt MC, Mankin HJ:Fractures of allografts. Frequency, treatment, and end-results. J Bone Joint Surg Am 72(6):825-833, 1990 5) Bonfiglio M, Jeter WS:Immunological responses to bone. Clin Orthop 87:19-27, 1972 6) Bowyer GW, Cumberland N:Antibiotic release from impregnated pellets and beads. J Trauma 36(3):331-335, 1994 7) Bridwell KH, Sedgewick TA, O Brien MF, Lenke LG, Baldus C:The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6(6):461-472, 1993 8) Bucholz RW, Carlton A, Holmes RE:Hydroxyapatite and tricalcium phosphate bone graft substitutes. Orthop Clin North Am 18(2):323-334, 1987 9) Coetzee AS:Regeneration of bone in the presence of calcium sulfate. Arch Otolaryngol 106(7):405-409, 1980 10) Conner HD:Bone grafting with a calcium sulfate barrier after root amputation. Compend Contin Educ Dent 17(1):42-46, 1996 11) Jarcho M:Calcium phosphate ceramics as hard tissue prosthetics. Clin Orthop 157:259-278, 1981 12) Lane JM, Bostrom MP:Bone grafting and new composite biosynthetic graft materials. Instr Course Lect 47:525-534, 1998 13) Mackey D, Varlet A, Debeaumont D:Antibiotic loaded plaster of Paris pellets:an in vitro study of a possible method of local antibiotic theraphy in bone infection. Clin Orthop 167:263-268, 1982 14) Passuti N, Daculsi G, Rogez JM, Martin S, Bainvel JV:Macroporous calcium phosphate ceramic performance in human spine fusion. Clin Orthop 248:169-176, 1989 15) Peltier LF, Jones RH:Treatment of unicameral bone cysts by currettage and packing with plaster-of-paris pellets. J Bone Joint Surg Am 60(6):820-822, 1978 16) Sidqui M, Collin P, Vitte C, Forest N:Osteoblast adherence and resorption activity of isolated osteoclasts on calcium sulfate hemihydrate. Biomaterials 16(17):1327-1332, 1995 17) Snyders RV Jr, Eppley BL, Krukowski M, Delfino JJ:Enhancement of repair in experimental calvarial bone defects using calcium sulfate and dextran beads. J Oral Maxillofac Surg 51(5):517-524, 1993 18) Yamazaki Y, Oida S, Akimoto Y, Shioda S:Response of the mouse femoral muscle to an implant of a composite of bone morphogenic protein and plaster of Paris. Clin Orthop 234: 240-249, 1988 610 J Korean Neurosurg SocVolume 30May, 2001