CGF联合引导骨组织再生术在颌骨囊性病变治疗中的疗效观察

发布时间：2018-06-03 23:42

本文选题：颌骨囊肿 + 富自体纤维蛋白凝胶　；参考：《山东大学》2017年硕士论文

【摘要】：目的探讨CGF(concentrate growth factors,浓缩生长因子)联合骨生成材料和口腔生物膜应用在颌骨囊肿术后骨缺损区,察看其与单纯依靠自体血机化修复的疗效比较,为临床治疗颌骨囊性病变做出指导。方法(1)选取山东大学口腔医院口腔颌面外科2014年7月-2016年10月间的颌骨囊性病变患者,共25例为实验组,患者知情同意下,于颌骨囊性病变手术后行CGF+骨粉+生物膜治疗。同时期选取25例颌骨囊肿病例作为对照组,患者知情同意下,只行颌骨囊性病变手术。实验组及对照组共计50例病例,年龄16-60岁,完全随机选择,无年龄及性别特殊性。(2)手术方法:50例患者手术前均需拍摄全口曲面断层片或口腔锥形束CT。并行颌骨囊性手术,实验组抽取患者自身静脉血,经差速离心13min后制取CGF,将CGF用无菌剪剪成直径约1mm颗粒与bio-oss骨粉混合,待囊肿摘除后骨腔内填充CGF+骨粉混合物,表面覆盖一人工生物膜,将其覆盖在骨创缘约2-3mm处的健康骨质上,严密缝合伤口。对照组在囊肿摘除术后囊腔内不置入CGF和bio-oss骨粉,也不放置人工生物膜。术后应用抗生素3d,益口含漱液漱口,10-12天拆线。在颌骨囊肿摘除术后3个月和半年复诊,并在同样的参数和同样的照射条件下拍摄CBCT。(3)影像学分析:①使用Adobe Photoshop对全口曲面断层片和锥形束CT的骨缺损区影像进行灰度值测量。CBCT选取病变最长径时的矢状面,冠状面,横断面为测量平面。每个图像测量空白区的灰度值和骨缺损区灰度值,两数相减即为骨缺损区的实际灰度值。每个图像测量3次,取3次平均数值为准。②测量实验组和对照组骨缺损区范围的变化。调整骨缺损区CBCT的矢状面,冠状面和横断面,测量按标准划定的骨缺损区实验组和对照组3个月和6个月时的垂直长度和水平长度。比较实验组和对照组相同切面(例如同时都是矢状面)的垂直线和水平线的平均长度。与手术前比较,差距越大的表明成骨越快。为避免误差,每个数据由同一人测量三次,取其平均值。(4)统计学分析:使用spss17.0统计软件分析,所有影像学的测量数据采用t检验。两组性别,囊肿部位,囊肿类型的比较采用卡方检验,年龄与囊肿大小采用非参数秩和检验。检验水准为双侧α =0.05,p0.05表示差异具有统计学意义。结果临床资料分析:经统计学分析,实验组和对照组在性别,年龄,囊肿部位,囊肿类型和囊肿面积方面均无显著差异(p0.05)。(1)曲面断层片分析颌骨囊肿术后3个月,对照组曲面断层片骨缺损区平均灰度值为15.86±2.70,实验组平均灰度值为84.34±2.97;对照组小于实验组,但经统计学分析,p0.05,两组比较具有显著差异。术后6个月,对照组为36.39±3.86,实验组为90.88±2.44,对照组显著小于实验组,经统计学分析p0.05,二者比较有显著差异。(2)CBCT不同切面灰度值的分析①冠状面CBCT:术后3个月,对照组CBCT骨缺损区的平均灰度值为17.83 ±2.96,实验组的平均灰度值为86.91±2.94,对照组低于实验组,经统计学分析,p0.05,二者比较具有显著差异;术后6个月,对照组的平均灰度值为37.01 ±2.35,实验组的平均灰度值为91.58±2.96,对照组低于实验组,经统计学分析,p0.05,二者比较具有显著差异。②矢状面CBCT:术后3个月,对照组CBCT骨缺损区的平均灰度值为16.48±2.85,实验组的平均灰度值为84.91±3.91,实验组高于对照组,经统计学分析,p0.05,二者比较具有显著差异。术后6个月,对照组的平均灰度值为35.87±2.41,实验组的平均灰度值为90.75±2.85,实验组高于对照组,经统计学分析,p0.05,二者比较具有显著差异。③横断面CBCT:术后3个月,对照组骨缺损区的平均灰度值为16.34±3.46,实验组的为85.01±2.73,实验组高于对照组,经统计学分析,p0.05,二者比较具有显著差异。术后6个月,对照组的平均灰度值为91.76±2.81,实验组的为91.76±2.81,实验组高于对照组,经统计学分析,p0.05,二者比较具有显著差异。(3)CBCT不同切面垂直长度和水平长度差值平均值的分析①冠状面CBCT:手术前实验组平均垂直长度为19.49±2.21mm,对照组为19.63±2.34mm,t值为-0.770,p0.05,二者比较没有显著差异。术后三个月实验组平均垂直长度为17.15±2.66mm,对照组为19.23士3.05mm,t值为-26.732,p0.05,二者比较具有显著差异。术后六个月实验组平均垂直长度为15.31±3.37mm,对照组为18.23±3.19mm,t值为-21.236,p0.05,二者比较具有显著差异。手术前实验组平均水平长度为17.65士2.06mm,对照组为17.85±2.31mm,t值为-0.859,p0.05,二者比较没有显著差异。术后三个月实验组平均水平长度为15.33±2.22mm,对照组为17.46±3.58mm,t值为-26.532,p0.05,二者比较具有显著差异。术后六个月实验组平均水平长度为13.27±3.56mm,对照组为16.13±3.59mm,t值为-24.937,p0.05,二者比较具有显著差异。②矢状面CBCT:手术前实验组平均垂直长度为19.45±2.06mm,对照组为19.18±2.47mm,t值为5.091,p0.05,二者比较没有显著差异。术后三个月实验组平均垂直长度为17.50±2.85mm,对照组为18.23±3.02mm,t值为-36.634,p0.05,二者比较具有显著差异。术后六个月实验组平均垂直长度为16.52±3.44mm,对照组为 17.95±3.20mm,t 值为-31.389,p0.05,二者比较具有显著差异。手术前实验组平均水平长度为17.45±2.06mm,对照组为17.65±2.47mm,t值为-0.862,p0.05,二者比较没有显著差异。术后三个月实验组平均水平长度为16.08±2.66mm,对照组为17.23±3.05mm,t值为-32.388,p0.05,二者比较具有显著差异。术后六个月实验组平均水平长度为14.31±3.37mm,对照组为16.23±3.19mm,t值为-27.628,p0.05,二者比较具有显著差异。③横断面CBCT:手术前实验组平均垂直长度为12.49±2.32mm,对照组为12.63±2.51mm,t值为-0.789,p0.05,二者比较没有显著差异。术后三个月实验组平均垂直长度为10.52±2.44mm,对照组为12.01±3.03mm,t值为-29.327mm,p0.05,二者比较具有显著差异。术后六个月实验组平均垂直长度为9.31±3.43mm,对照组为11.25±3.21mm,t值为-27.005,p0.05,二者比较具有显著差异。手术前实验组平均水平长度为13.52±2.14mm,对照组为13.65±2.31mm,t值为-0.715,p0.05,二者比较没有显著差异。术后三个月实验组平均水平长度为11.37士2.23mm,对照组为 12.86±3.54mm,t 值为-29.529,p0.05,二者比较具有显著差异。术后六个月实验组平均水平长度为9.58±3.66mm,对照组为11.13±3.44mm,t值为-29.899,p0.05,二者比较具有显著差异。结论本实验表明CGF联合引导骨组织再生技术对成骨有促进作用,而且比单纯依靠血液机化效果更显著,骨缺损区成骨速度更快,更有利于组织愈合及后期修复功能的恢复。
[Abstract]:Objective to investigate the application of CGF (concentrate growth factors, concentrated growth factor) combined with bone formation material and oral biofilm in the bone defect area after maxillofacial cyst operation, and to observe the comparison of the curative effect compared with the simple autologous blood machine repair. Method (1) select the oral and maxillofacial surface of the Shandong University stomatological hospital. A total of 25 cases of maxillofacial cystic lesions between July 2014 -2016 and October were treated as experimental group. Patients were treated with CGF+ bone powder plus biomembrane after informed consent. At the same time, 25 cases of maxillofacial cysts were selected as the control group. The patient's informed consent was performed only with the operation of maxillary cystic lesions. The total of the experimental group and the control group were 5. 0 cases, aged 16-60 years, were randomly selected, without age and sex particularity. (2) surgical methods: 50 patients were required to take full oral surface tomography or oral conical beam CT. parallel maxillofacial operation before operation. The experimental group took the patient's own venous blood, then made CGF after the differential 13min, and cut the CGF with a diameter of about 1mm. The granules were mixed with Bio-Oss bone powder. After the cyst was removed, the CGF+ bone powder mixture was filled in the bone cavity. The surface was covered with an artificial biofilm, covering it on the healthy bone of the bone margin of about 2-3mm, and suturing the wound closely. The control group did not put in the CGF and Bio-Oss bone powder in the capsule after the cyst extirpation, and no artificial biofilm was placed. After the operation, the antibiosis was applied. 3D, yitkou gargle, rinse the mouth for 10-12 days. 3 months and half a year after the removal of the jaw cyst, and take the CBCT. (3) imaging analysis under the same parameters and the same irradiation conditions: (1) the gray value measurement of the image of the bone defect area of the full oral surface fault and the conical bundle CT was measured by the Adobe Photoshop, and the length of the lesion was measured by the gray value. The sagittal plane, the coronal plane and the cross section of the diameter were measured. Each image measured the gray value of the blank area and the gray value of the bone defect area. The reduction of the two numbers was the actual gray value of the bone defect area. Each image was measured 3 times, and the average value of the 3 times was measured. 2. The changes in the bone defect area of the experimental and control groups were measured. The CBCT of the bone defect area was adjusted. Sagittal, coronal, and cross sections were used to measure the vertical length and horizontal length of the experimental group and the control group for 3 months and 6 months. The average length of the vertical and horizontal lines of the same section (such as the sagittal plane) was compared between the experimental group and the control group. The larger the gap was, the greater the difference between the experimental group and the control group. Fast. In order to avoid error, each data was measured by the same person three times, taking its average value. (4) statistical analysis: using SPSS17.0 statistical software analysis, all imaging data were measured by t test. Two groups of sex, cyst site, cyst type were compared with chi square test, age and cyst size using nonparametric rank sum test. Test level was Bilateral alpha =0.05 and P0.05 showed statistical significance. Results clinical data analysis: statistical analysis showed that there was no significant difference between the experimental group and the control group in sex, age, cyst site, cyst type and cyst area (P0.05). (1) 3 months after maxillofacial cysts analysis, and the bone defect of the control group, Qu Ping The average gray value is 15.86 + 2.70, the average gray value of the experimental group is 84.34 + 2.97, the control group is less than the experimental group, but the statistical analysis, P0.05, the two groups have significant differences. 6 months after the operation, the control group is 36.39 + 3.86, the experimental group is 90.88 + 2.44, the control group is significantly smaller than the experimental group, statistically analyzed by P0.05, there are significant differences. (2) C BCT analysis of the gray value of different cutting surfaces (1) after 3 months of coronary CBCT:, the average gray value of the CBCT bone defect area of the control group was 17.83 + 2.96, the average gray value of the experimental group was 86.91 + 2.94, the control group was lower than the experimental group. The comparison between the P0.05 and the two groups was significantly different, and the average gray value of the control group was 37.01 + 2 after 6 months after the operation. .35, the average gray value of the experimental group was 91.58 + 2.96, the control group was lower than the experimental group. The statistical analysis showed that the average gray value of the CBCT bone defect area of the control group was 16.48 + 2.85, the average gray value of the control group was 84.91 + 2.85, and the experimental group was higher than the control group for 3 months after CBCT:, and the experimental group was higher than the control group. The average gray value of the control group was 35.87 + 2.41, the average gray value of the experimental group was 90.75 + 2.85, and the experimental group was higher than the control group at 6 months after the operation. The average gray value of the experimental group was higher than that of the control group. The average gray value of the bone defect area of the control group was 16.34 after the statistical analysis, P0.05 and two were significantly different. ((3) the average gray value of the bone defect area in the control group was 16.34. The average gray value of the control group was 16.34, and the average gray value of the control group was 90.75 + 2.85. The average gray value of the experimental group was 90.75 + 2.85. The average gray value of the bone defect area in the control group was 16.34. (3) the average gray value of the control group was 16.34. (3) the average gray value of the bone defect area of the control group was 16.34. (3) the average gray value of the two groups was 16.34. 3.46, the experimental group was 85.01 + 2.73, the experimental group was higher than the control group. The statistical analysis showed that the P0.05 and the two were significantly different. The average gray value of the control group was 91.76 + 2.81 after 6 months of operation. The experimental group was 91.76 + 2.81, the experimental group was higher than the control group. The statistical analysis showed that there were significant differences in P0.05 and two. (3) different sections of CBCT The average vertical length and the horizontal length difference mean value of the average vertical length of the experimental group before CBCT: operation was 19.49 + 2.21mm, the control group was 19.63 + 2.34mm, the T value was -0.770, P0.05, there was no significant difference between the two groups. The average vertical length of the experimental group was 17.15 + 2.66mm, the control group was 19.23 3.05mm, and the T value was -26.732 in the three months after the operation. P0.05, the comparison of the two was significant. The average vertical length of the experimental group was 15.31 + 3.37mm, the control group was 18.23 + 3.19mm, the T value was -21.236, P0.05, and the two were significantly different. The average length of the experimental group was 17.65 2.06mm, the control group was 17.85 + 2.31mm, the T value was -0.859, P0.05, the two were not significant. The average horizontal length of the three months after the operation was 15.33 + 2.22mm, the control group was 17.46 + 3.58mm, the T value was -26.532, and the two were significantly different. The average level of the experimental group was 13.27 + 3.56mm, the control group was 16.13 + 3.59mm, t value was -24.937, P0.05, and two had significant differences. Second, sagittal plane CBCT:. The average vertical length of the experimental group was 19.45 + 2.06mm, the control group was 19.18 + 2.47mm, the T value was 5.091, and the two had no significant difference. The average vertical length of the experimental group was 17.50 + 2.85mm, the control group was 18.23 + 3.02mm, the T value was -36.634, and the two of the experimental group had significant difference. The average drooping of the experimental group was six months after the operation. The direct length was 16.52 + 3.44mm, the control group was 17.95 + 3.20mm, the T value was -31.389 and P0.05. The average level of the experimental group before operation was 17.45 + 2.06mm, the control group was 17.65 + 2.47mm, t value was -0.862, P0.05, and there was no significant difference. The average level of the experimental group was 16.08 + 2.66mm in three months after the operation. The group was 17.23 + 3.05mm, and the value of T was -32.388 and P0.05. The comparison of the two were significantly different. The average length of the experimental group was 14.31 + 3.37mm, the control group was 16.23 + 3.19mm, the T value was -27.628, and the two had significant difference. (3) the average vertical length of the test group in the cross section was 12.49 + 2.32mm, and the control group was 12.63. Three months after operation, the average vertical length of the experimental group was 10.52 + 2.44mm, the control group was 12.01 + 3.03mm, the T value was -29.327mm, and the two of the two had significant differences. The average vertical length of the experimental group was 9.31 + 3.43mm and the control group was 11.25 + 3.21mm and t values were 11.25 after three months after the operation. 0.05, the comparison of the two was significant. The average length of the experimental group was 13.52 + 2.14mm, the control group was 13.65 + 2.31mm, the T value was -0.715, and the two had no significant difference. The average length of the experimental group was 11.37 2.23mm, the control group was 12.86 + 3.54mm, t value was -29.529, P0.05, and the two were more significant. The average length of the experimental group was 9.58 + 3.66mm, the control group was 11.13 + 3.44mm, the T value was -29.899, and the two of the two were significantly different. Conclusion this experiment showed that the combination of CGF and bone tissue regeneration could promote the osteogenesis, and was more significant than the effect of blood machine, and the osteogenesis speed of the bone defect area was more significant. Faster, more conducive to tissue healing and restoration of functional recovery later.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782

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