• Maxillofacial Plastic and Reconstructive Surgery
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• 제20권3호
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• pp.228-231
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• 1998

This is a clinical and retrospective study of 36 patients received the autogenous particulated cancellous bone grafts from anterior iliac and proximal tibial metaphysis and we compared the clinical postoperative complications in operation sites and donor site morbidity. The results of this study indicate that, in all our patients, the proximal tibia provided an adquate volume of cancellous bone and there were no special contraindications, in choosing and using the proximal tibia as a donor site in most oral and maxillofacial cancellous bone graft surgeries. Furthermore, the proximal tibial metaphysis would appear a more easily obtainable cancellous bone source and offer a superior clinical results than anterior iliac crest in donor site morbidity.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제30권3호
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• pp.241-248
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• 2008

Tibial bone grafts provide an adequate volume of cancellous bone with cortical bone, high biologic value of bone, minimal gait disturbance and complications, and no special contraindications, and offer a superior clinical results than any other donor sites. Lateral appoach in tibial bone graft was used to gain large bone volume traditionally, but medial approach provides low morbidity associated with the tibial anatomic structure, simple and safety surgical procedure, and better comfortable to patients recently. We have undertaken clinical and retrospective studies on patients in Dept. of Oral and Maxillofacial Surgery, Inha University Hospital from April 2004 to January 2008. 50 patients have maxillofacial bony defect as resection of bening tumor, cyst enucleation, alveolar bone resorption, sinus pneumatization were received the tibial proximal autogenous particulated cancellous bone grafts. They were analyzed sex, age, diagnosis of recipient site, lesion size, dornor site, cortical bone repositioning, complications and we concluded favorable following results. 1. Medial approach for proximal tibia is safer and technically easier than lateral approach, associated with the proximal tibial anatomic structures, and short operative times. 2. Proximal tibia provides an adequate bone volume with predictability for oral and maxillofacial reconstruction. 3. Patients rarely complain of pain, swelling, discomfort and dysfunction such as gait disturbance. In conclusion, medial approach for proximal tibial graft seems to be a valuable tool for oral and maxillofacial reconstruction.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권5호
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• pp.540-543
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• 2000

The purpose of this retrospective study was to evaluate the treatment outcome of proximal tibial graft. Thirty-nine patients were grafted with proximal tibia for the repair of maxillofacial defect. Complications can be considered incidental and neglectable clinical significance. It is concluded that the proximal tibial metaphysis offers a promising alternative sources of cancellous bone for the repair of maxillofacial defect.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제20권4호
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• pp.275-278
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• 1998

Recently, the clinical applications of the autogenous cancellous bone from the proximal tibial metaphysis show satisfactory results in the repair of maxillofacial bony defect or deformity. The proximal tibia has the potential to yield viable cancellous bone with a minimum of morbidity. The purpose of this study was to investigate the regeneration of a full thickness proximal tibial bone defect with covering or uncovering of cortical bone. The follow-up periods were 4, 8, and 12 weeks. Bone defect of right side was uncovered and left side was covered with cortical bone. In the experimental group (uncovered cortical bone) at 12 weeks, the inside of defect was filled to normal marrow tissue. The cortical bone defect was united of inner, outer callus at 4, 8 weeks in both study group. At 12 weeks, the cortical bone defect was remodeled and invaded by osteoclast (giant cell) in experimental group. In the experimental specimen at 12 weeks, the regenerating tissue of bone defect was not differ from the control group.

• 대한의용생체공학회:의공학회지
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• 제34권1호
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• pp.14-23
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• 2013

In this study, biomechanical stability of the newly developed revision total knee arthroplasty (rTKA) was evaluated through strain and stress distribution analysis within the implanted proximal tibia using a three-dimensional finite element (FE) analysis. 2000N of compressive load (about 3 times body weight) was applied to the condyle surface on spacer, sharing by the medial (60%) and lateral (40%) condyles simulating a stance phase before toe-off. The results showed that PVMS within the revision total knee arthroplasty and the proximal tibia were less than yield strength considering safe factor 4.0 (rTKA: less than 10%, Cortical bone: less than 70%, Cancellous bone: less than 70%). The materials composed of them and the strain and stress distributions within the proximal tibia were generally well matched with those of a traditional revision total knee arthoplasty (Scorpio TS revision system, Stryker Corp., Michigan, USA) without the critical damage strain and stress, which may reduce the capacity for bone remodeling, leading to bone degeneration. This study may be useful to design parameter improvement of the revision total knee arthoplasty in biomechanical stability point of view beyond structural stability of revision total knee arthoplasty itself.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제39권6호
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• pp.257-262
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• 2013

Objectives: Oral and maxillofacial defects often require bone grafts to restore missing tissues. Well-recognized donor sites include the anterior and posterior iliac crest, rib, and intercalvarial diploic bone. The proximal tibia has also been explored as an alternative donor site. The use of the tibia for bone graft has many benefits, such as procedural ease, adequate volume of cancellous and cortical bone, and minimal complications. Although patients rarely complain of pain, swelling, discomfort, or dysfunction, such as gait disturbance, both patients and surgeons should pay close attention to such after effects due to the possibility of tibial fracture. The purpose of this study is to analyze tibial fractures that occurring after osteotomy for a medioproximal tibial graft. Materials and Methods: An analysis was intended for patients who underwent medioproximal tibial graft between March 2004 and December 2011 in Inha University Hospital. A total of 105 subjects, 30 females and 75 males, ranged in age from 17 to 78 years. We investigated the age, weight, circumstance, and graft timing in relation to tibial fracture. Results: Tibial fractures occurred in four of 105 patients. There were no significant differences in graft region, shape, or scale between the fractured and non-fractured patients. Conclusion: Patients who undergo tibial grafts must be careful of excessive external force after the operation.

• Archives of Reconstructive Microsurgery
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• 제15권1호
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• pp.17-25
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• 2006

Twelve cases in eleven patients with segmental bone defects were treated with contralateral fibula free flap and ipsilateral island fibula flap in an antegrade, retrograde or bidirectional flow fashion. Five cases were managed with free flaps and seven were with ipsilateral fibula island transfer. Among seven cases, antegrade fashion was three, retrograde was three, and bidirectional was one. All patients were related with open tibial fractures and its sequelae except one who had open foot bone fracture. According to Gustilo's classification, ten patients were type IIIb and one was type IIIc. Basically, antegrade-flow flaps based on the peroneal vessels as in the conventional free flap were used for the proximal or middle one-third tibial defects. On the contrary, retrograde-flow flaps based on the communicating branch between the peroneal and posterior tibial vessels were used for the middle or distal one-third of the tibia. Bidirection-flow flap based on intact peroneal vessels were used for the middle portion of the tibia. The patients who have undergone ipsilateral fibula island flap had one of the following problems: a previously failed free flap, below-knee amputation of the opposite leg because of open tibial fracture, refusal to use the contralateral sound leg, or poor general condition to stand a lengthy operation. Six of the patients who have got ipsilateral fibula island flap also had an associated fibula fracture on the same leg, which was ultimately used as one of the osteotomy sites. The follow-up period was from 1 to 10 years. Two cases of free flap were failed: one patient had below-knee amputation and the other patient had ipsilateral fibula transfer. Other cases were successful and excellent hypertophy of the transferred fibula was achieved. Time to bone union ranged from 4 to 11 months. Time to full weight bearing was from 5 to 13 months after surgery. All of the transferred fibulas showed hypertrophy after weight bearing. In one case, stress fracture was developed during ambulation, which was healed conservatively. Nonunion occurred in two cases, which were treated with a long leg cast and cancellous bone graft, respectively. Length discrepancy of the legs was noted. The limb was shorter by an average 0.5 cm in three cases, longer by 1.1 cm in one case. In the case of island fibula transfer, limited arc of rotation was not a problem. Other disabling complications were not seen. We believe that these diverse modalities using a vascularized fibula will make us more comfortable to handle major bone defects.

• Journal of Oral Medicine and Pain
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• 제32권1호
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• pp.35-43
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• 2007

본 연구는 숙지황과 가시오가피 복합추출물 (OPB)이 난소절제 흰쥐의 골밀도 및 골대사 변화에 미치는 영향을 관찰하기 위하여 수행하였다. 13주된 20마리의 Sprague-Dawley 암컷 흰쥐를 대조군과 실험군으로 나누었고, OPB의 골밀도 및 골대사 변화에 대한 효과를 관찰하기 위하여 난소절제 후 3일 후부터 OPB를 100 mg/kg씩 8주 동안 경구투여 하였다. pQCT 방식으로 골밀도, 골함유량, 골강도를 측정하였고, 혈청 중 CTx (C-telopeptide of type I collagen)의 변화를 관찰하였다. 난소절제 후 대조군의 골밀도는 $-29.8{\pm}3.0%$로 현저히 감소하였으며, 이러한 감소는 OPB의 투여에 의해 $-21.4{\pm}2.3%$로 억제되었다. 골강도의 변화에서는 anti-fracture 값과 anti-twisting 값이 대조군에 비해 OPB 처리군에서 유의성 있는 차이를 나타냈다. 또한 혈청 중 골흡수 지표인 CTx 농도는 대조군에 비해 OPB 처리군에서 낮게 나타났다. 이상의 결과로 숙지황과 가시오가피의 복합 추출물인 OPB가 난소를 절제한 흰쥐에서 골 소실을 억제하므로 임상에서 난소절제 후 또는 폐경 후 골다공증의 개선제로 이용될 수 있으리라 여겨진다.