접합면의 차이에 따른 두개골 외판의 생존

Abstract

Onlay graft of the calvarial bone has been popularized in craniofacial surgery because absorption of the calvarial bone is less than that of the endochondral bone. But the problems with using the calvarial bone are its rigidity and difficulty in setting a precise apposition. When the outer tables of the calvarial bone are used for augmentation and reconstruction of the convex zygoma, forehead, or chin, it is better to place the cancellous surface over the convex recipient bone to get a precise apposition. Whereas, it is better to place the cortical surface over the concave nose or orbital cavity to achieve a good apposition. Therfore, our study was designed to determine the differences of bone absorption and regeneration between cancellous and cortial bone contact to facial bone, and between preserved periosteum and detached periosteum in autograft of calvarial bone in dog models. Outer tables of the calvarial bone were placed in subperiosteal pockets of the upper and lower maxilla in four different ways : Group I ; The cancellous surface was placed in contact with the bare recipient bone, and the cortical surface attached with periosteum was accordingly contacted with the elevated periosteum of the recipient bone. Group Ⅱ ; The corical surface attached with periosteum was placed in contact with the bare recipient bone and the cancellous surface was contacted with the elevated periosteum of the recipient bone, Group Ⅲ ; The arrangenent was similar to Group Ⅰ except that the periosteum of the graft was deprived. Group Ⅳ ; The arrangement was similar to Group Ⅱ except that the periosteum of the graft was deprived. Volume measurements using a caliper technique and histological study were made 20 weeks postoperatively. The volume of maintenance is as follows ; Group Ⅰ, 84.2% ; Group Ⅱ, 77.6% ; Group Ⅲ, 77.0%, and Group Ⅳ, 69.5%. The histolgical contribution of living bone was assessed by a modified point counting technique : Group Ⅰ, 86.6%, Group Ⅱ, 83.8% ; Group Ⅲ, 79.6% and Group Ⅳ, 77.6%. Greater volume maintenance and histological contribution of living bone were found when cancelllous surface rather that the cortical were placed in contact with the recipient bone and the grafts from their periosteum were preserved. We concluded that in order to expect better survival of a grafted bone, the cancellous surface of the graft should contact with the recipient bone and that the periosteum of the graft should be preserved.

저자들은 성숙견 10마리에서 골막이 붙어있는 두개골 외판과 골막을 벗겨 버린 두개골 외판을 각각 해면질골이 수혜골에 접하게 이식해 주거나 반대로 피질골면이 수혜골에 접하게 이식한 후 20주에 육안 및 광학현미경으로 관찰하여 당므과 같은 결론을 얻었다. 1) 골막이 붙은채로 이식한 군이 골막을 벗겨버리고 이식한 군보다 골생존이 많았으며 조직학적 골 생존율도 높았다. 2) 해면질골면이 수혜골에 접하게 이식한 것이 피질골면이 수혜골에 접하게 이식하는 것보다 골생존이 많았으나 조직학적 골생존율은 유의한 차이가 없었다. 이상을 종합해 보면 두개골 외판을 이식할 때 골흡수를 적게 하고 골생존을 좋게 하기 위해서는 가능한한 골막이 붙은채로 이식하는 것이 좋으며 해면질골면이 수혜골에 접하게 이식하는 것이 좋을 것으로 생각된다. 그러나 이러한 방법으로 골이식 하더라도 이식 전 용적의 13.4%가 흡수되므로 이것을 감안하여 골이식해야 할 것이다. 또 원하는 윤곽을 얻기 위해 피질골면이 수혜골에 접하게 이식해야 할 때는 해면질골면이 수혜골에 접하게 이식할 때보다 골흡수가 더 됨을 감안하여 예상보다 과교정해주는 것이 바람직할 것이다.