수직골 증대술에서 β-Tricalciumphosphate/Hydroxyapatite 골 이식재 입자 크기의 영향
Effects of different sizes of Hydroxyapatite/β-Tricalcium phosphate particles on vertical bone augmentation
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연구 목적: β-Tricalcium phosphate/Hydroxyapatite (β-TCP/HA) 입자가 혼합된 합성 골 이식재의 particle size가 토끼의 두개골에서 타이타늄 메쉬를 이용해 시행된 골유도 재생술의 결과에 미치는 영향을 평가하고자 하였다. 연구 재료 및 방법: 여섯 마리의 수컷 뉴질랜드 산 백토끼 (5 kg)를 이용하여 실험 하였다. 토끼 두개골의 정 중앙을 절개하고 전층 판막을 형성하여 박리하였다. 두개골의 네 부위에 6 mm 직경의 트레핀 바 (XTP 5406; Dentium, Seoul, Korea)로 원형의 홈을 형성한 후 blood supply를 위해 원형의 홈 안에 1 mm 직경의 라운드 바로 다섯 개의 작은 구멍을 형성하였다. 형성된 네 개의 홈 위에 표준화되어 맞춤 제작된 반구형 타이타늄 메쉬 (높이 3 mm, 직경 6 mm; Dentium, Seoul, Korea)를 위치시키고 세 개의 2 mm 길이의 티타늄 핀 (Dentium, Seoul, Korea)을 이용하여 고정하였다. 대조군은 이식재를 포함시키지 않았고 나머지 타이타늄 메쉬들은 실험군으로서 서로 다른 세 가지 크기의 이식재를 각각 담아서 고정하였다. 이식재 (Osteon(R), Dentium, Seoul, Korea)의 성분은 HA와β- TCP (β-TCP/HA)가 혼합되어 있는 합성골 이식재이며 실험군으로 사용한 이식재의 크기는 각각 small (0.3 - 0.5 mm), medium (0.5 - 1.0 mm), large (1.0 - 2.0 mm) size 였다. 8주의 치유기간 후에 토끼를 희생시킨 후 조직 표본을 제작하고 CCD 카메라 (Polaroid DMC2 digital Microscope Camera (Polaroid Corporation, Cambridge, MA 02139, USA))가 부착되어 있는 광학 현미경 (Olympus BX, Tokyo, Japan)을 이용하여 두 가지 배율 (12.5배, 40배)로 조직학적 소견을 관찰하였다. 신생 골부위와 남은 골이식재 부위의 넓이를 측정하여 타이타늄 메쉬 내부 공간에서 차지하는 면적의 비율(%)을 구하였다. 그 수치들을 Mann-Whitney U-test와 Wilcoxon signed rank-test를 이용하여 통계 분석하였다 (α= .05). 결과: 대조군과 β-TCP/HA를 이식한 나머지 세 군의 신생골 형성을 비교하면 통계적으로 유의하게 β-TCP/HA를 이식한 군에서 신생골 형성이 더 많았다 (P= .003). 서로 다른 particle size 간 비교에서는 신생골 형성에 있어서 통계적으로 유의한 차이는 없었다. 하지만 형성된 수직골 총량 (신생골과 이식골의 면적의 합)을 각 그룹 간에 비교해 보면 대조군보다 β-TCP/HA를 이식한 군이 통계적으로 더 많은 비율을 나타내었고 (P= .001), 특히 β-TCP/HA 이식 군간 비교에서는 medium size 군이 large particle size 군보다 통계적으로 더 큰 면적을 나타내었다 (P= .039). 그러나 large particle size 군과 small particle size 군 사이 그리고 medium size 군과 small particle size 군 사이에는 통계적으로 유의한 차이를 보이지 않았다 (P> .05). 결론: 티타늄 메쉬를 이용한 수직골 증대술에서 β-TCP/HA 합성골을 사용하는 경우 수직골 형성에 기여하며 특히 medium size（0.5 - 1.0 mm)의β-TCP/HA 이식재가 large size 이식재 보다 더 우수한 수직골 형성의 결과를 보였다.
Abstract
Purpose: This study was aimed to evaluate the effect of different sizes of β-TCP/ HA particles on vertical bone augmentation using titanium mesh in the cranium of rabbits. Materials and methods: Six white rabbits weighing 5 kg were used. Four circular grooves of 6mm diameter were made by trephine, and five small holes were drilled in the inner surface of each circular gooves. Different sizes of grafts (small 0.3 - 0.5 mm, medium 0.5 - 1.0, large 1.0 - 2.0 mm) were placed respectively in the experimental groups. Titanium mesh (height 3 mm, width 6 mm) was placed. After 8weeks healing period, the rabbits were euthanized, and the specimens were prepared for histological findings. New bone formation and remaining graft area were measured to calculate the ratio of areas occupying the inner space of titanium mesh. Mann-Whitney U-test and Wilcoxon signed rank-test were used for statistical analysis (α= .05). Results: The experimental groups with β-TCP/HA graft showed a significantly higher new bone formation (P = .003). Comparing different sizes of β-TCP/HA, there was no statistical difference in terms of new bone formation. The vertical bone formation (i.e. new bone and graft area) was significantly greater in β-TCP/HA groups (P = .001). In comparison between different sizes of β-TCP/HA, medium size group had significantly greater area than large particle size group (P = .039). Conclusion: The use of β-TCP/HA with titanium mesh showed a higher vertical bone formation, particularly the medium sized β-TCP/HA particles (0.5 - 1.0 mm) produced better results in vertical bone augmentation.
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