• 대한정형외과학회지
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• 제56권3호
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• pp.191-199
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• 2021

대퇴골두 골괴사는 젊거나 중년의 성인에서 발생하며 많은 경우에서 대퇴골두의 함몰과 관절염으로 진행된다. 이 종설에서는 이 질환의 치료에 있어 최신 지견을 기술하였다.

• 한국임상수의학회지
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• 제27권3호
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• pp.240-245
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• 2010

대퇴골 머리의 골괴사는 특발성이며 진행성 질환이다. 골괴사증 연구를 위한 다양한 동물모델이 보고되었지만, 현재까지 표준화된 동물모델은 완성되지 않았다. 본 연구에서 랫드에서 세가지 외과적인 방법으로 유발한 골괴사모델을 비교하였다. 20마리의 SD 랫드 (24주령, 숫컷)를 각 5마리씩 대조군과 세개의 실험군으로 구분하였다. 세가지 외과적인 방법으로 골괴사를 유발하였다. 원인대를 자르고, 대퇴골목의 골막을 절개 (S군), 철사를 대퇴골목에 결찰 (W군), W군과 동일한 방법으로 대퇴골목에 철사를 감은 후, 전기소락기의 끝을 철사에 접촉시켜 소락, 그리고 철사를 제거 (B군). 2주후, 랫드는 안락사하고 대퇴골 머리와 목을 채취하였다. H/E 염색, 사프라닌 O염색, TUNEL 염색을 실시하여 대퇴골 머리의 골과 연골에 골괴사 병변을 평가하였다. 모든 외과적인 방법 (S, W, B군)에서 골괴사가 2주간의 단기간에 유발되었다. 연골부분에 대한 유의적인 괴사변화는 B군에서만 관찰되었다. 철사를 통한 소락 후, 철사를 제거하는 변형된 외과적 방법은 다른 방법에 비해 더욱 효과적으로 골괴사 실험모델을 완성하였다.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1998년도 추계학술대회
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• pp.157-158
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• 1998

The purpose of this study was to test the hypothesis that even very small change of the cue direction in the treatment of the early osteonecrosis could affect the outcomes of operation. For this, the changes in stress transfer within the necrotic area of the femoral head were investigated under various directions and placements of the core utilizing finite element method. The loading of 3188N, which represents after-heel-strike, was imposed in cubic cosine pattern. All nodes on the most distal surface of the model were constrained in all directions. All materials included were assumed to have linear-elastic behavior. The result says that the critical stress, which causes collapse of the femoral head, was reduced when the core was oriented toward the posterior side of the femoral head regardless of location of the necrotic area. The same result was obtained either fibular bone grafting or cementation was adopted. As a consequence, the biomechanical study suggests that the core should be directed toward the loading point where the resultant force is applied to get more desirable treatment of the osteonecrosis of the femoral head in the early stage.

• Molecules and Cells
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• 제24권3호
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• pp.388-393
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• 2007

Osteonecrosis of the femoral head (ONFH) is a multifactorial disease to which certain individuals are more at risk. Altered lipid metabolism is one of the major risk factors for osteonecrosis, especially corticosteroid therapy and alcoholism. Peroxisome Proliferator-Activated Receptor-${\gamma}$ ($PPAR{\gamma}$) plays a crucial role in differentiation of mesenchymal cells to adipocytes, lipid homeostasis, and bone metabolism. To investigate the possible association between $PPAR{\gamma}$ gene variants and susceptibility to ONFH, we genotyped three common polymorphisms (-796A > G, +34C > G[Pro12Ala], and +82466C > T[His477His]) in 448 ONFH patients and 336 control subjects. Genotypes, allele frequencies, and haplotypes of the polymorphisms in the complete set of patients as well as in subgroups by sex or etiology were not significantly different from those in the control group. This suggests that the examined polymorphisms and haplotypes of the $PPAR{\gamma}$ gene are unlikely to be associated with susceptibility to ONFH.

• Hip & pelvis
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• 제35권3호
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• pp.147-156
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• 2023

Osteonecrosis of the femoral head (ONFH), a condition characterized by the presence of a necrotic bone lesion in the femoral head, is caused by a disruption in the blood supply. Its occurrence is more common in young and middle-aged adults and it is the main reason for performance of total hip arthroplasty in this age group. Its incidence is increasing along with increased use of glucocorticoids for management of adjuvant therapy for treatment of leukemia as well as organ transplantation and other myelogenous diseases. Current information on etiology and pathogenesis, as well as natural history, stage system, and treatments is provided in this review. A description of the Association Research Circulation Osseous (ARCO) criteria for classification of glucocorticoids-and alcohol-associated ONFH, 2019 ARCO staging system, and 2021 ARCO classification using computed tomography for the early stages of ONFH is also provided.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1996년도 추계학술대회
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• pp.349-350
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• 1996

Using FEM, we analyzed the stress changes on early osteonecrosis of femoral head as the necrotic area increases. A 3D FEM model of proximal femur was made from the CT scam data of fresh frozen adult proximal femur with the material properties from literature. The model consisted of 5994 elements and 5275 nodes. FE analyses were peformed using MSC/NASTRAN. At normal states, stress transmission is mainly along the primary compression trabeculae(PCT). Until 60% involvement of PCT with necrotic lesion, stress transmission is still along the remained PCT. When the PCT involvement is from 60% to 85%, stress transmission is along the PCT and margin of the necrotic lesion. When involvement is more than 85%, stress is mostly transferred to posterior part of femoral head.

• Archives of Reconstructive Microsurgery
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• 제13권2호
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• pp.130-135
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• 2004

Purpose : To observe the patency of anastomosis site and the findings of circulation of grafted fibula in osteonecrosis of femoral head treated with vascularized fibular graft by use of digital subtraction angiography. Materials and Methods : 17 cases of 11 patients who underwent vascularized fibula graft for osteonecrosis of femoral head. We performed digital subtraction angiography(DSA) for them at second week postoperatively in 12 cases, at sixth week in 1 case, at sixth month in 2 cases, at twelfth month in 1 case, and eighteenth month in 1 case which had been got DSA at second week before. We observe the patency of pedicle, and the circulation of grafted fibula such as periosteal and intraosseous vessels with time. Results : All cases except one which were thought failure of selective angiogram showed good passage of blood flow through anstomosed pedicle on DSA. We found the differences in appearance of circulation of grafted fibula with time. DSA at 2nd and 6th week postoperatively revealed both of periosteal and intraosseous vessels along the fibula and blood pooling at the tip of fibula. DSA at 6th month showed maintenance of periosteal and intraosseous vessels along the fibula but did not clearly reveal blood pooling at the tip of fibula. The findings of DSA at 12th and 18th month were similar each other. The periosteal vessels were not seen as the grafted fibular bone were incorporated into surrounding femoral bone but intraosseous vessels were still seen. Conclusion : It was thought that DSA could be used for evaluation of the status of pedicle including anastomsed site and vessels of grafted fibula with time. The periosteal vessels of fibula were decreased with time but intraosseous vessels were still seen until 18th month after vascularized fibula graft.

• Korean Journal of Radiology
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• 제22권12호
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• pp.2026-2033
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• 2021

Objective: The aim of this study was to compare the diagnostic performances of digital tomosynthesis (DTS) and conventional radiography in detecting osteonecrosis of the femoral head (ONFH) using computed tomography (CT), as the reference standard and evaluate the diagnostic reproducibility of DTS. Materials and Methods: Forty-five patients (24 male and 21 female; age range, 25-77 years) with clinically suspected ONFH underwent anteroposterior radiography, DTS, and CT. Two musculoskeletal radiologists independently evaluated the presence and type of ONFH. The diagnostic performance of radiography and DTS in detecting the presence of ONFH and determining the types of ONFH were evaluated. The interobserver and intraobserver reliabilities of each imaging modality were analyzed using Cohen's kappa. Results: DTS had higher sensitivity (89.4%-100% vs. 74.5%-76.6%) and specificity (97.3%-100% vs. 78.4%-83.8%) for ONFH detection than radiography. DTS showed higher performance than radiography in identifying the subtypes of ONFH with statistical significance in one reader (type 1, 100% vs. 30.8%, p = 0.004; type II, 97.1% vs. 73.5%, p = 0.008). The interobserver agreement was excellent for DTS and moderate for radiography (kappa of 0.86 vs. 0.57, respectively). The intraobserver agreement for DTS was higher than that of radiography (kappa of 0.96 vs. 0.69, respectively). Conclusion: DTS showed higher diagnostic performance and reproducibility than radiography in detecting ONFH. DTS may be used as a first-line diagnostic modality instead of radiography for patients suspected of having ONFH.

• Molecules and Cells
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• 제26권5호
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• pp.490-495
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• 2008

Thrombophilia and hypofibrinolysis have been implicated in the pathogenesis of osteonecrosis of the femoral head (ONFH). Tissue factor pathway inhibitor (TFPI), a multivalent protease inhibitor, is an important regulator of the tissue factor-mediated blood coagulation pathway. Mutations of the TFPI gene can increase the risk of thrombin generation and venous thrombosis. The aim of this study was to evaluate the association of TFPI gene polymorphisms with ONFH. All exons and their boundaries of the TFPI gene, including the -1,500 bp promoter region, were directly sequenced in 24 Korean individuals and four sequence variants were identified. These four polymorphisms [-51096 G > A (C-399T), -50984A > G (T-287C), + 24999A > G (Int7 -33T > C), + 37339T > A] were genotyped in 474 ONFH patients and 349 control subjects. The association of genotyped SNPs with ONFH was not found in the present study. The haplotype AAAT of TFPI was significantly associated with total, alcohol-induced, and idiopathic ONFH (p = 0.003, 0.021, and 0.007, respectively), and the haplotype GAAT was significantly associated with total and alcohol ONFH (p = 0.022 and 0.009, respectively). In addition, a new SNP + 37339 T > A in the 3'-UTR of the TFPI gene, was found in the Korean population. To date, this study is the first to show that haplotypes of the TFPI gene are associated with an increased susceptibility for ONFH. The results suggest that genetic variations in TFPI may play an important role in the pathogenesis and risk factors of ONFH.

• Journal of Yeungnam Medical Science
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• 제11권2호
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• pp.284-292
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• 1994

1992년 12월부터 1994년 6월까지 영남대학교 의과대학 부속병원 정형외과에 내원한 대퇴골두무혈성 괴사 환자 28명, 31 고관절에 대해 시행한 경전자간 회전 절골술의 결과는 다음과 같다. 1. 대상 환자는 한명을 제외하고는 모두 남자였으며, 평균 연령은 44.3세로 삼, 사십대가 대부분이었다. 2. 무혈성 괴사의 원인은 과다한 음주에 의한 것이 18례로 가장 많았고, 괴사의 정도는 Ficat와 Arlet의 분류에 의하면 II a가 16례로 가장 많았다. 3. 절골술 후 고정 방법으로는 screw가 15례, DHS가 16례였고, 고정 방법에 따른 대퇴경간각의 변화로는, screw를 사용한 경우는 술전에 비해 내반고 되는 경향을 보였고, DHS를 사용한 경우는 외반고 되는 경향을 보였다. 4. 술전 대퇴골두 측면 방사선 사진에서 측정한 대퇴골두 전체 관절면에 대한 건전한 관절면의 비는 1/3이하가 8례, 1/3 이상이 23례(74%)이었다. 5. 술후 고관절의 전후면 방사선 사진에서 측정한 비구의 체중 부하면에 대한 전위된 건전한 대퇴골두의 관절면 비는 36% 이상이 24례(78%), 21-35%가 6례, 20% 이하가 1례였다.