Association between oral health status and school loss in adolescents / 대한구강보건학회지

Objectives@#This study aimed to investigate the association between school loss due to dental disease and oral health status in adolescents. @*Methods@#The study participants were 881 adolescents (453 middle and 428 high school students).Data were collected through a self-administered survey and oral examination. Chi-square test and t-test were used to analyze the association between school loss due to dental disease and oral health status, and multiple logistic regression was used to analyze the factors influencing school loss. @*Results@#Dental caries was the leading cause of school loss. School loss due to dental disease was more prevalent in the group with a higher number of carious teeth than in the group without dental caries. According to bivariate analysis, school loss due to dental disease was associated with toothache, gingival bleeding, maxillofacial trauma, and caries. When controlling demographic variables, gingival bleeding, maxillofacial trauma, and dental caries were associated with school absence.Moreover, maxillofacial trauma was associated with school absence period up to 1 year. @*Conclusions@#Therefore, oral health status and school loss of adolescents are associated, and the importance of oral health in adolescents should be emphasized.

Dental caries incidence in permanent teeth of 12-year-old children in Korea / 대한구강보건학회지

Objectives@#The objective of this study was to analyze dental caries incidence in the permanent teeth of 12-year-old children. @*Methods@#This study used the raw data from the 2015 Korean children’s oral health survey. Participants of the research were 12-year-old children in their first year of middle school. A total of 27,291 people participated in the questionnaire and oral examination. Statistical analysis was performed using complex samples frequency analysis and contingency coefficient phi (φ). @*Results@#Dental caries predominately developed symmetrically with a higher tendency for left-right symmetry than for maxillary-mandibular symmetry in the mouth. The incidence of dental caries between adjacent teeth had a statistically significant correlation and was highest in the first and second premolars. @*Conclusions@#Information on symmetry in the development of dental caries and the association of dental caries incidence between adjacent teeth of 12-year-old children should be actively utilized when establishing evidence-based dental caries management plans.

Change of In-Shoe Plantar Pressure According to Types of Shoes (Flat Shoes, Running Shoes, and High Heels)

Background@#The type of footwear is one of several factors that affect foot pressure. Despite its usefulness in identifying pathology and preventing and treating foot-related diseases, the type of shoes has been investigated and compared in only a few studies. This study aimed to investigate differences in plantar pressure, induced by flat, running, and high-heeled shoes in healthy, young women. @*Methods@#A total of 27 healthy women (27 feet) with a mean age of 21.5 ± 2.03 years were included in this study. Based on demographic data, radiologic measurements, clinical scores, temporal gait parameters, and kinematic parameters of gait, we confirmed the participants had normal feet. Then, pedobarographic data were measured by dividing each foot into seven regions to compare the three types of shoes. Peak plantar pressure and pressure-time integral were calculated using the Pedar-X system. The one-way analysis of variance and the Kruskal-Wallis test with Mann Whitney U-test were used for statistical analyses. @*Results@#Regarding the 7 regions of the foot, flat shoes resulted in a significantly higher pressure than running shoes in the hallux and lesser toes and the highest pressure in the metatarsal head (MTH) 3–5 and the hindfoot. In contrast, in the MTH 1 and MTH 2 regions, the high-heeled shoes had the highest measured pressure, followed by the flat shoes. Lastly, there was no high pressure in running shoes in any region except for the midfoot compared to the other shoes. @*Conclusions@#It can be inferred from our findings that flat and high-heeled shoes can generate a considerable burden on specific parts of the foot, which will aid in choosing appropriate shoes. Also, wearing running shoes places less burden on the overall foot.

Etiology of Achilles Tendinopathy: Inflammation versus Overuse / 대한족부족관절학회지

It is widely acknowledged that Achilles tendinopathy and resultant degeneration of the Achilles tendon could be either due to vigorous physical exertion or due to inflammation of the tendon associated with systemic disease. The overuse injuries are generally multifactorial in origin and are caused by repetitive strain of the affected tendon till the tendon can no longer endure the tensile stress. Various alignment and biomechanical faults are claimed to play a causative role. Only 2% of patients complaining of Achilles tendon pain are caused by systemic disease. However, to ensure the right approach to treatment, it is necessary to rule out inflammatory tendinitis caused by systemic diseases such as rheumatoid arthritis, gout, and seronegative spondyloarthrosis.

Etiology of Achilles Tendinopathy: Inflammation versus Overuse / 대한족부족관절학회지

It is widely acknowledged that Achilles tendinopathy and resultant degeneration of the Achilles tendon could be either due to vigorous physical exertion or due to inflammation of the tendon associated with systemic disease. The overuse injuries are generally multifactorial in origin and are caused by repetitive strain of the affected tendon till the tendon can no longer endure the tensile stress. Various alignment and biomechanical faults are claimed to play a causative role. Only 2% of patients complaining of Achilles tendon pain are caused by systemic disease. However, to ensure the right approach to treatment, it is necessary to rule out inflammatory tendinitis caused by systemic diseases such as rheumatoid arthritis, gout, and seronegative spondyloarthrosis.

Current Trends in the Treatment of Osteochondral Lesion of the Talus:Analysis of the Korean Foot and Ankle Society (KFAS) Member Survey / 대한족부족관절학회지

Purpose@#Given the lack of definite evidence-based guidelines in clinical practice, there may be a wide variation in treatment protocols for osteochondral lesions of the talus (OLT). Based on the Korean Foot and Ankle Society (KFAS) member survey, this study aimed to report the current trends in the management of OLT. @*Materials and Methods@#A web-based questionnaire containing 30 questions was sent to all KFAS members in September 2021. The questions were mainly related to clinical experience and preferences in diagnosis, conservative, and surgical treatments for patients with OLT. Answers with a prevalence of ≥50% of respondents were considered a tendency. @*Results@#Sixty-two (11.3%) of the 550 surgeons queried responded to the survey. The responses to 9 (30.0%) of the total of 30 questions established a tendency. Answers exhibiting a tendency were as follows; additional diagnostic tools except for plain radiograph (magnetic resonance imaging), most common conservative treatment method (oral medication, rest), most important radiological factor in decision making for surgical treatment and method (size of the lesion, ankle instability, loose bodies), most important patient factors in decision making for surgical treatment and method (age, activity or occupation), infrequently requiring posterior arthroscopy (less than 3%), most common revision surgery for failed bone marrow stimulation procedure (osteochondral autograft transplantation [OAT]), not requiring additional procedure for donor site in OAT, the main reason for unsatisfactory result after OAT (persistent pain without radiological abnormality), no generalization of autologous chondrocyte implantation or chondrogenesis using stem cells. @*Conclusion@#This study presents updated information on current trends in the management of OLT in Korea. Both consensus and variations in the approach to patients with OLT were revealed through this survey. Since recent biologic efforts to regenerate cartilage have been unsuccessful, further studies to identify clinical evidence would be needed.

Prevalence of Accessory Bones and Tarsal Coalitions Based on Radiographic Findings in a Healthy, Asymptomatic Population

Background@#Accessory bones and tarsal coalitions are the most common developmental variations of the foot and ankle. However, their clinical implications are not well understood because there is no established prevalence data in the normal population and the reported prevalence varies widely. Therefore, we aimed to investigate the incidence of accessory ossicles and tarsal coalitions in a healthy, asymptomatic Korean population. @*Methods@#A total of 448 healthy, asymptomatic participants (224 men and 224 women; 896 feet) were enrolled and stratified by age and sex. To investigate the presence of accessory bones and tarsal coalitions in the foot and ankle, we obtained the weight-bearing standing radiographs (anteroposterior and lateral views) from each participant. @*Results@#Accessory ossicles were found in 49.2% of the healthy, asymptomatic Korean adults. The prevalence of accessory bones in adults was the highest with 34% for the accessory navicular, 5.8% for the os trigonum, 3.9% for the os peroneum, and 1.7% for the os subfibulare. The prevalence of tarsal coalitions in adults was 0.4% and that of symphalangism was 16% for the fourth toe and 80.6% for the fifth toe. The frequency of the accessory navicular and fifth toe symphalangism was significantly higher in women. Most of the accessory navicular and fourth and fifth toe symphalangism were bilateral, whereas the os subfibulare was mostly unilateral. @*Conclusions@#The prevalence of accessory bones and tarsal coalitions in the healthy, asymptomatic Korean population showed some variation according to age and sex.

Natural History of Osteochondral Lesion of the Talus / 대한족부족관절학회지

Many articles on operative treatment strategies for osteochondral lesions of the talus (OLT) have been published. On the other hand, there are only a few reports on the conservative treatment of OLT. Understanding the natural history of OLT is essential to establishing the correct treatment. Conservative treatment might lead to comparable clinical outcomes compared to the current options of the operative treatment in isolated OLT lesions. OLT lesions can be divided into two (or possibly three) types. Hence, the prognosis and outcome of certain operative treatments should be evaluated further. The prognosis of OLT combined with instability or malalignment appears poorer than that of isolated OLT lesions. Therefore, concomitant pathologies should be evaluated together when treating patients with OLT.

Validation of Electronic Foot Function Index in Patients with Foot and Ankle Disease: A Randomized, Prospective Multicenter Study / 대한족부족관절학회지

PURPOSE: To evaluate the efficiency of the electronic foot function index (eFFI) through a prospective, random based, multi-institutional study. MATERIALS AND METHODS: The study included 227 patients ranging in age from 20 to 79 years, visited for surgery in different 15 institutes, and agreed to volunteer. The patients were assigned randomly into a paper-based evaluated group (n=113) and tablet-based evaluated group (n=114). The evaluation was done on the day of hospital admission and the method was changed on the second day of surgery and re-evaluated. PADAS 2.0 (https://www.proscore.kr) was used as an electronic evaluation program. RESULTS: There were no differences in age and sex in both groups. The intraclass correlation coefficient (ICC) evaluation revealed an eFFI ICC of 0.924, showing that both results were similar. The evaluation time was shorter in the tablet-based group than the paper-based group (paper vs tablet, 3.7±3.8 vs 2.3±1.3 minutes). Thirty-nine patients (17.2%) preferred to use paper and 131 patients (57.7%) preferred the tablet. Fifty-seven patients (25.1%) found both ways to be acceptable. CONCLUSION: eFFI through tablet devices appears to be more constant than the paper-based program. In addition, it required a shorter amount of time and the patients tended to prefer the tablet-based program. Overall, tablet and cloud system can be beneficial to a clinical study.

Repeatability of a Multi-segment Foot Model with a 15-Marker Set in Normal Children

BACKGROUND: The use of three-dimensional multi-segment foot models (3D MFMs) is increasing since they have superior ability to illustrate the effect of foot and ankle pathologies on intersegmental motion of the foot compared to single-segment foot model gait analysis. However, validation of the repeatability of the 3D MFMs is important for their clinical use. Although many MFMs have been validated in normal adults, research on MFM repeatability in children is lacking. The purpose of this study is to validate the intrasession, intersession, and interrater repeatability of an MFM with a 15-marker set (DuPont foot model) in healthy children. METHODS: The study included 20 feet of 20 healthy children (10 boys and 10 girls). We divided the participants into two groups of 10 each. One group was tested by the same operator in each test (intersession analysis), while the other group was tested by a different operator in each test (interrater analysis). The multiple correlation coefficient (CMC) and intraclass correlation coefficient (ICC) were calculated to assess repeatability. The difference between the two sessions of each group was assessed at each time point of gait cycle. RESULTS: The intrasession CMC and ICC values of all parameters showed excellent or very good repeatability. The intersession CMC of many parameters showed good or better repeatability. Interrater CMC and ICC values were generally lower for all parameters than intrasession and intersession. The mean gaps of all parameters were generally similar to those of the previous study. CONCLUSIONS: We demonstrated that 3D MFM using a 15-marker set had high intrasession, intersession, and interrater repeatability in the assessment of foot motion in healthy children but recommend some caution in interpreting the hindfoot parameters.

Platelet-Derived Growth Factor Receptor-Positive Pericytic Cells of White Adipose Tissue from Critical Limb Ischemia Patients Display Mesenchymal Stem Cell-Like Properties

BACKGROUND: The pericytes in the blood vessel wall have recently been identified to be important in regulating vascular formation, stabilization, remodeling, and function. We isolated and identified pericyte-like platelet-derived growth factor receptor beta-positive (PDGFRβ+) cells from the stromal vascular fraction (SVF) of adipose tissue from critical limb ischemia (CLI) patients and investigated their potential as a reliable source of stem cells for cell-based therapy. METHODS: De-identified subcutaneous fat tissues were harvested after amputation in CLI patients. Freshly isolated SVF cells and culture-expanded adipose-derived stem cells (ADSCs) were quantified using flow cytometry. A matrigel tube formation assay and multi-lineage differentiation were performed to assess pericytic and mesenchymal stem cell (MSC)-like characteristics of PDGFRβ+ ADSCs. RESULTS: PDGFRβ+ cells were located in the pericytic area of various sizes of blood vessels and coexpressed mesenchymal stem cell markers. PDGFRβ+ cells in freshly isolated SVF cells expressed a higher level of stem cell markers (CD34 and CXCR4) and mesenchymal markers (CD13, CD44, CD54, and CD90) than PDGFRβ– cells. In vitro expansion of PDGFRβ+ cells resulted in enrichment of the perivascular mesenchymal stem-like (PDGFRβ+/CD90+/CD45–/CD31–) cell fractions. The Matrigel tube formation assay revealed that PDGFRβ+ cells were located in the peritubular area. CONCLUSIONS: PDGFRβ+ ADSCs cells demonstrated a good multilineage differentiation potential. Pericyte-like PDGFRβ+ cells from the SVF of adipose tissue from CLI patients had MSC-like characteristics and could be amplified by in vitro culture with preservation of their cell characteristics. We believe PDGFRβ+ cells in the SVF of adipose tissue can be used as a reliable source of stem cells even in CLI patients.

Demineralized Bone Matrix Injection in Consolidation Phase Enhances Bone Regeneration in Distraction Osteogenesis via Endochondral Bone Formation

BACKGROUND: Distraction osteogenesis (DO) is a promising tool for bone and tissue regeneration. However, prolonged healing time remains a major problem. Various materials including cells, cytokines, and growth factors have been used in an attempt to enhance bone formation. We examined the effect of percutaneous injection of demineralized bone matrix (DBM) during the consolidation phase on bone regeneration after distraction. METHODS: The immature rabbit tibial DO model (20 mm length-gain) was used. Twenty-eight animals received DBM 100 mg percutaneously at the end of distraction. Another 22 animals were left without further procedure (control). Plain radiographs were taken every week. Postmortem bone dual-energy X-ray absorptiometry and micro-computed tomography (micro-CT) studies were performed at the third and sixth weeks of the consolidation period and histological analysis was performed. RESULTS: The regenerate bone mineral density was higher in the DBM group when compared with that in the saline injection control group at the third week postdistraction. Quantitative analysis using micro-CT revealed larger trabecular bone volume, higher trabecular number, and less trabecular separation in the DBM group than in the saline injection control group. Cross-sectional area and cortical thickness at the sixth week postdistraction, assessed using micro-CT, were greater in the regenerates of the DBM group compared with the control group. Histological evaluation revealed higher trabecular bone volume and trabecular number in the regenerate of the DBM group. New bone formation was apparently enhanced, via endochondral ossification, at the site and in the vicinity of the injected DBM. DBM was absorbed slowly, but it remained until the sixth postoperative week after injection. CONCLUSIONS: DBM administration into the distraction gap at the end of the distraction period resulted in a significantly greater regenerate bone area, trabecular number, and cortical thickness in the rabbit tibial DO model. These data suggest that percutaneous DBM administration at the end of the distraction period or in the early consolidation period may stimulate regenerate bone formation and consolidation in a clinical situation with delayed bone healing during DO.

Osteoporotic Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research

Osteoporotic fractures are one of the most common causes of disability and a major contributor to medical care costs worldwide. Prior osteoporotic fracture at any site is one of the strongest risk factors for a new fracture, which occurs very soon after the first fracture. Bone mineral density (BMD) scan, a conventional diagnostic tool for osteoporosis, has clear limitations in diagnosing osteoporotic fractures and identifying the risk of subsequent fractures. Therefore, early and accurate diagnosis of osteoporotic fractures using the clinical definition which is applicable practically and independent of BMD, is essential for preventing subsequent fractures and reducing the socioeconomic burden of these fractures. Fractures caused by low-level trauma equivalent to a fall from a standing height or less at major (hip, spine, distal radius, and proximal humerus) or minor (pelvis, sacrum, ribs, distal femur and humerus, and ankle) sites in adults over age 50, should be first regarded as osteoporotic. In addition, if osteoporotic fractures are strongly suspected on history and physical examination even though there are no positive findings on conventional X-rays, more advanced imaging techniques such as computed tomography, bone scan, and magnetic resonance imaging are necessary as soon as possible.

Change of Radiologic Index of Foot according to Radiation Projection Angle: A Study Using Phantom Foot / 대한족부족관절학회지

PURPOSE: The purpose of this study is to analyze the measurement differences of simple radiographs according to radiation projection angle using a phantom and to propose methods for objective analysis of simple radiographs. MATERIALS AND METHODS: We took simple radiographs with different projection angles using a C-arm image intensifier and measured five parameters of the foot on the simple radiographic images. Five parameters include lateral tibiocalcaneal angle, lateral talocalcaneal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and lateral calcaneo-first metatarsal angle. Intraobserver and interobserver reliability were verified, and then intraclass correlations of parameters were analyzed. RESULTS: Radiographic parameters of the foot showed high intraobserver and interobserver reliability. Lateral tibiocalcaneal angle has a strong negative linear relationship with rotation and a moderate negative linear relationship with tilt. Lateral talocalcaneal angle has a moderate positive linear relationship with rotation and a strong positive linear relationship with tilt. Naviculocuboid overlap has a strong positive linear relationship with rotation and a moderate positive linear relationship with tilt. Lateral talo-first metatarsal angle does not have a linear relationship with rotation and a moderate negative linear relationship with tilt. Lateral calcaneo-first metatarsal angle has a moderate positive linear relationship with rotation and tilt. CONCLUSION: More precise evaluation of the foot with a simple radiograph can be performed by understanding the changes of radiographic parameters according to radiation projection angle.

Difference of Kinematic Pattern According to the Severity of Limb Length Discrepancy: 3-Dimensional Analysis / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to analyze the compensatory motion and extent of the patient with leg length discrepancy. MATERIALS AND METHODS: Thirty seven patients with leg length discrepancy were tested by conventional gait analysis from 2003 to 2012. The patients were divided into mild, moderate, and severe groups. Pelvic obliquity, hip flexion, hip abduction, knee flexion in stance and swing phase, and ankle plantar flexion were measured with regard to affected and unaffected limb. RESULTS: Pelvic obliquity, hip flexion, hip abduction, knee flexion in swing phase, and ankle plantar flexion were significantly difference between affected and unaffected limb. The range of motions in pelvic obliquity and ankle plantar flexion of affected limb were significantly higher according to severity of limb length discrepancy. CONCLUSION: The patients with limb length discrepancy have the different compensatory motion according to affected side and severity. We should adjust the target of treatment in consideration of limb length discrepancy.

Foot Drop of Contralateral Limb after Deformity Correction in a Polio Patient: A Case Report / 대한족부족관절학회지

Postpoliomyelitis syndrome is a common neurological disorder that occurs in patients who have experienced paralytic poliomyelitis. Recently, as a result of vaccination against poliovirus, incidence of poliomyelitis is exceedingly low. However, many patients with postpolio syndrome may encounter anesthesia when undergoing surgery, such as for correction of foot deformity and other operations. We report on a 45-year-old woman who experienced paralysis of her contralateral limb after operation on the left foot under spinal anesthesia. Postoperative electromyography/nerve conduction study (EMG/NCS) was performed in order to determine the cause of paralysis. Motor power of the sequelae involved leg showed improvement with time and recovered fully to the preoperative level at six months after the index operation. A precise evaluation, including a physical examination and EMG/NCS, should be performed preoperatively when spinal anesthesia is planned for postpolio syndrome patients.

Negative-pressure wound therapy induces endothelial progenitor cell mobilization in diabetic patients with foot infection or skin defects

Non healing chronic wounds are difficult to treat in patients with diabetes and can result in severe medical problems for these patients and for society. Negative-pressure wound therapy (NPWT) has been adopted to treat intractable chronic wounds and has been reported to be effective. However, the mechanisms underlying the effects of this treatment have not been elucidated. To assess the vasculogenic effect of NPWT, we evaluated the systemic mobilization of endothelial progenitor cells (EPCs) during NPWT. Twenty-two of 29 consecutive patients who presented at the clinic of Seoul National Universty Hospital between December 2009 and November 2010 who underwent NPWT for diabetic foot infections or skin ulcers were included in this study. Peripheral blood samples were taken before NPWT (pre-NPWT) and 7-14 days after the initiation of NPWT (during-NPWT). Fluorescence-activated cell sorting (FACS) analysis showed that the number of cells in EPC-enriched fractions increased after NPWT, and the numbers of EPC colony forming units (CFUs) significantly increased during NPWT. We believe that NPWT is useful for treating patients with diabetic foot infections and skin ulcers, especially when these conditions are accompanied by peripheral arterial insufficiency. The systemic mobilization of EPCs during NPWT may be a mechanism for healing intractable wounds in diabetic patients with foot infections or skin defects via the formation of increased granulation tissue with numerous small blood vessels.

Surgical Treatment of Diabetic Foot Disease / 임상당뇨병

Diabetic foot diseases which require surgical treatment consists of diabetic foot ulcer, infection and neuropathic arthropathy. Surgical procedures for diabetic foot ulcers and infections such as drainage, debridement, partial foot amputation and major limb amputation are most common procedures and arthodesis with or without deformity correction can be performed for specific diabetic neuropathic arthropathies. Underlying pathomechanism of diabetic foot disease includes diabetic peripheral neuropathy and vasculopathy. Treating physicians should be aware that concomitant complications of long-standing diabetic status such as cardiovascular and renal dysfunction should be addressed to treat intractable diabetic foot diseases successfully. However, with advent of adjuvant treatment which increases vascular supply on ischemic limb disease, proper surgical treatment on diabetic foot disease can prevent or delay major limb amputations, sustaining functional capability of diabetic patients.

Disturbed Osteoblastic Differentiation of Fibrous Hamartoma Cell from Congenital Pseudarthrosis of the Tibia Associated with Neurofibromatosis Type I

BACKGROUND: Fibrous hamartoma is the key pathology of congenital pseudarthrosis of the tibia (CPT), which was shown to have low osteogenicity and high osteoclastogenicity. This study further investigated the mechanism of impaired osteoblastic differentiation of fibrous hamartoma cells. METHODS: Fibroblast-like cells were obtained from enzymatically dissociated fibrous hamartomas of 11 patients with CPT associated with neurofibromatosis type I (NF1). Periosteal cells were also obtained from the distal tibial periosteum of 3 patients without CPT or NF1 as control. The mRNA levels of Wnt ligands and their canonical receptors, such as Lrp5 and beta-catenin, were assayed using reverse transcriptase PCR (RT-PCR). Changes in mRNA expression of osteoblast marker genes by rhBMP2 treatment were assayed using quantitative real time RT-PCR. Changes in mRNA expression of transcription factors specifically involved in osteoblastic differentiation by rhBMP2 treatment was also assayed using quantitative real-time RT-PCR. RESULTS: Wnt1 and Wnt3a mRNA expression was lower in fibrous hamartoma than in tibial periosteal cells, but their canonical receptors did not show significant difference. Response of osteoblastic marker gene expression to rhBMP2 treatment showed patient-to-patient variability. Col1a1 mRNA expression was up-regulated in most fibrous hamartoma tissues, osteocalcin was up-regulated in a small number of patients, and ALP expression was down-regulated in most fibrous hamartoma tissues. Changes in mRNA expression of the transcription factors in response to rhBMP2 also showed factor-to-factor and patient-to-patient variability. Dlx5 was consistently up-regulated by rhBMP2 treatment in all fibrous hamartoma tissues tested. Msx2 expression was down-regulated by rhBMP2 in most cases but by lesser extent than control tissue. Runx2 expression was up-regulated in 8 out of 18 fibrous hamartoma tissues tested. Osterix expression was up-regulated in 2 and down-regulated in 3 fibrous hamartoma tissues. CONCLUSIONS: Congenital pseudarthrosis of the tibia appears to be caused by fibrous hamartoma originating from aberrant growth of Nf1 haploinsufficient periosteal cells, which failed in terminal osteoblastic differentiation and arrested at a certain stage of this process. This pathomechanism of CPT should be targeted in the development of novel therapeutic biologic intervention.

Enhancement of Vasculogenesis and Osteogenesis Using Granulocyte-Colony Stimulating Factor in the Rat Model of Tibial Distraction Osteogenesis / 대한정형외과학회잡지

PURPOSE: Proper speed of distraction is critical for successful new bone formation in distraction osteogenesis. The purpose of this study was to evaluate the effect of granulocyte-colony stimulating factor (G-CSF) on formation of new blood vessels and new bones in the rat model of tibial distraction osteogenesis (DO) to develop enhancement method of bone formation while increasing the distraction speed. MATERIALS AND METHODS: Forty two rat-tibial DO models were included in this study, and were divided into 3 groups; group I (rapid distraction), group II (rapid distraction with G-CSF), and group III (slow distraction). The amount of bone formation and relative blood flow were analyzed by sequential radiographs and laser Doppler perfusion imaging (LDPI). Blood sampling was done before G-CSF injection, at 2 weeks and 5 weeks after G-CSF injection and surface expression such as Scal-1+ and C-kit+ of endothelial progenitor cells (EPCs) was analyzed by fluorescence-activated cell sorter (FACS) for the effects of G-CSF in inducing mobilization of EPCs. RESULTS: The amount of new bone formation in the distraction gap on serial radiographs was higher during the consolidation period in groups II and III than in group I but, the difference was not significant (p>0.05). The relative blood flow in the distraction gap in groups II and III increased more significantly than in group I (p<0.05). FACS analysis showed an increased EPCs fraction after G-CSF injection. CONCLUSION: We demonstrated that G-CSF administration ameliorated bone formation and blood flow during rapid distraction in the rat model of tibial distraction osteogenesis. We think that G-CSF has an effect on mobilization of EPCs resulting in an increase in the blood flow.