生物引导膜、无机牛骨骨粉联合髂松质骨移植修复牙槽突裂临床观察

发布时间：2018-03-07 02:28

本文选题：牙槽突裂　切入点：二期牙槽植骨　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：背景和目的：牙槽突裂为唇腭裂常见伴随症状之一,唇腭裂的治疗已经由单纯的关闭唇腭裂裂隙发展为序列治疗,包括正畸治疗、矫正修复、牙槽突裂植骨、语音训练及心理治疗等,其中牙槽突裂植骨(alveolar bone graft, ABG)为序列治疗一个重要环节。采用自体髂骨移植是治疗牙槽突裂的金标准,目前,仍然没有一种人工材料可以替代自体骨组织。但是,自体骨移植治疗牙槽突裂存在很多问题,一方面骨移植手术后成功率不高,此外,手术后存在一定的骨吸收一影响治疗效果。近年来,口腔生物材料的发展迅速,一些引导成骨的生物膜和骨替代材料不断应用于临床实践。其中生物引导膜(biological guide membrane,Bio-Gide)、无机牛骨骨粉(anorganic bovine bone,Bio-Oss)在口腔临床尤其口腔种植中应用广泛,取得一定临床效果。然而,Bio-Gide、Bio-Oss应用于牙槽突裂的临床报道较少,并且也缺少系统的临床研究。因此,本实验拟研究Bio-Gide、Bio-Oss联合髂骨松质骨移植修复牙槽突裂骨缺损的临床效果,为临床修复牙槽突裂方法提供新的思路。方法：1.实验组及对照组的建立：通过收集山大二院2010年至2014年,年龄在9-22岁的单侧完全性牙槽突裂患167例,将患者随机分为3组,A组56名患者,B组56名患者,分别采用Bio-Gide、Bio-Oss联合髂松质骨移植修复方法以及Bio-Gide联合自体髂松质骨移植修复方法,作为实验组；C组55名患者,采用单纯髂松质骨移植修复方法,作为对照组。 2.骨形成情况：在患者术前及术后6个月对其拍摄全口曲面断层片及锥型束CT (cone beam CT,CBCT),采用改良Bergland牙槽突裂植骨分级标准结果评价患者骨形成高度情况,同时利用CBCT从植骨区域成骨的厚度分析牙槽骨植骨的效果。结果：1.术后一周发现A组3名患者、B组5名患者及C组6名患者术后髂骨区创口淤血肿胀,但无明显感染现象,术后2周肿胀减轻,术后半年未见明显感染及功能异常。A组8名患者、B组7名患者和C组10名患者口内牙龈感染红肿患者,其中A组4名患者、B组2名患者及C组2名患者口内红肿现象经过加强口腔护理后恢复,余感染患者见植入骨颗粒脱出,刮除感染植入骨并修剪牙龈转移组织瓣缝合后,创口愈合良好。 2.术后6个月对植骨成功患者拍摄曲面断层片及CBCT,显示3组患者植骨区域植入骨存在一定骨吸收, Bio-Gide、Bio-Oss联合髂松质骨移植术后6个月骨吸收最少,术后6个月植入骨与周围骨组织部分或者完全融合,新生骨组织与原有骨组织曲面断层片肉眼显示骨密度无明显差异。统计学分析后,表明Bio-Gide、Bio-Oss联合髂松质骨移植修复牙槽突裂明显优于余两种方法(P0.05,有显著差异性)。结论：采用Bio-Gide、Bio-Oss联合自体髂骨移植修复牙槽突裂方法明显优于其余两种方法。牙槽骨裂植骨修复后存在一定骨吸收,单纯髂松质骨移植骨骨吸收最多,垂直向高度较低,并且唇腭向骨质厚度较薄；Bio-Gide、Bio-Oss联合髂松质骨移植修复牙槽突裂,骨吸收最少,垂直向高度较高,并且唇腭向骨质最厚。
[Abstract]:Background and objective: the alveolar cleft lip and palate is one of the common symptoms, treatment of cleft lip and palate is simple closure of cleft lip and palate fissure development sequence of treatment, including orthodontic treatment, orthodontic repair of alveolar cleft bone grafting, speech training and psychological therapy, the alveolar cleft bone grafting (alveolar bone graft, ABG for the treatment of a sequence) important link. The autogenous iliac bone graft is the gold standard for alveolar cleft, at present, is still not a kind of artificial material can replace autologous bone tissue. However, autologous bone graft in the treatment of alveolar cleft exists many problems, a bone transplant success rate is not high, in addition, there are the bone absorption effect after surgery. In recent years, the rapid development of oral biological materials, some biological membrane guided bone and bone substitute materials have been applied in clinical practice. The biological film guide (biologic Al guide membrane, Bio-Gide), bone bone (anorganic bovine bone, Bio-Oss) in oral clinic especially in oral implant applications, has certain clinical effect. However, Bio-Gide, the application of Bio-Oss in the alveolar cleft with few clinical reports, and lack of clinical research system. Therefore, this study intends to study the Bio-Gide. The clinical effect of Bio-Oss combined with iliac cancellous bone graft for repair of alveolar cleft bone defect, to provide new ideas for clinical repair of alveolar cleft.
Method: 1. the establishment of the experimental group and the control group by collecting in No.2 Affiliated Hospital of Shandong University from 2010 to 2014, at the age of 9-22 years old of complete unilateral alveolar cleft patients in 167 cases, the patients were randomly divided into 3 groups, A group of 56 patients, B group of 56 patients, respectively Bio-Gide, Bio-Oss combined with iliac loose repair methods Bio-Gide combined with autologous iliac bone graft and bone graft repair method of loose, as the experimental group; C group of 55 patients, using a simple method to repair bone loose iliac transplantation, as the control group.
2. bone formation: in patients with preoperative and postoperative 6 months to shoot panoramic radiographs and cone beam CT (cone beam CT, CBCT), modified Bergland alveolar cleft bone grafting in patients with bone formation evaluation grading standard height, at the same time, the use of CBCT from the bone graft region analysis of alveolar bone bone graft bone thickness effect.
Results: 3 patients in group A were found in 1. one week after the surgery, 5 patients in B group and C group of 6 patients with postoperative bone wound congestion swelling, but no obvious infection, 2 weeks after surgery swelling, six months after operation, no obvious infection and abnormal function of.A group of 8 patients, B group 7 patients in group C and 10 patients in infection of the gums swelling patients, 4 patients in the A group, B group of 2 patients in C group and 2 patients in the mouth swelling phenomenon after strengthened oral care after recovery, patients infected with more than see bone particles prolapse, curettage and bone infection and pruning the gingival metastasis tissue flap after suture, the wound healed well.
2. after 6 months of successful bone graft were taken radiographs and CBCT, shows that 3 groups of patients with bone graft bone region exists in bone absorption, Bio-Gide, Bio-Oss combined with iliac cancellous bone transplantation after 6 months at least 6 months of bone resorption, bone and bone tissue section after surgery or completely fusion, new bone tissue and the bone tissue panoramicradiographs eyes showed no significant difference in bone mineral density. The statistical analysis showed that, Bio-Gide, Bio-Oss combined with iliac cancellous bone graft for repair of alveolar cleft is superior to other methods (P0.05, significant difference).
Conclusion: using Bio-Gide, Bio-Oss combined with autogenous iliac bone graft to repair alveolar cleft method is better than the other two methods. Some existing bone fractures of alveolar bone resorption after repair, simple iliac cancellous bone graft bone resorption, the vertical height of the lower lip and palate, and to bone thickness; Bio-Gide, Bio-Oss combined with iliac cancellous bone graft for repair of alveolar cleft, bone resorption at the vertical height is higher, and the thickness of labial palata bone.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782.2

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