应用富血小板纤维蛋白修复颌骨缺损的临床观察

发布时间：2018-08-26 07:20

【摘要】：目的：将自体富血小板纤维蛋白(PRF)单独作为骨移植材料应用于骨量不足的种植区及颌骨缺损中，初步观察PRF促进骨组织修复的临床效果。方法：选择骨量不足的即刻种植修复患者5例，上颌窦提升病例5例，颌骨囊肿患者4例。术前抽取肘静脉血10-40ml于不含抗凝剂的试管中，立即以3500转/分，离心15分钟制成PRF。常规口内及口周颌面部消毒、铺手术巾，术区使用阿替卡因肾上腺素液行局部浸润麻醉，牙槽嵴顶做梯形切口，沿切口剥离牙龈，全层翻起黏骨膜瓣，暴露牙槽嵴顶和颊侧骨面，去净骨面粘连的软组织和肉芽组织。球钻定位后用先锋钻沿预定方向钻入，根据种植体直径情况逐级扩大，植入种植体。于骨缺损处放入PRF。如果种植体初期稳定性达到25Ncm以上，就放入愈合基台；如果初期稳定性不足25Ncm，则放入覆盖螺丝。囊肿摘除术后，将PRF植入骨缺损区。术后1周、3个月、6个月进行复查，记录软组织瓣的愈合情况，有无感染；拍摄牙片以了解填入PRF部位的骨改建情况及与种植体骨结合情况，以术后即刻拍摄的X线片为观察基点，将术后3个月和6个月的X线片与之对比，观察PRF植入区骨质的变化。检查种植体及上部修复体的稳定性、种植体周围牙龈情况、患者对修复体的咀嚼功能及美观的满意度。结果：种植体无一例松动脱落，留存率为100%。术后未出现明显疼痛症状者5例，仅有轻微疼痛者最多，达8例，1例囊肿伴感染者疼痛较重；术后7天口腔粘膜瓣颜色无异常，无明显水肿，达到初期愈合者共13例，仅1例上颌窦提升的患者术后眶下区肿胀，2周后恢复正常。随诊6月，患者均完成上部修复，对修复效果满意，其中单冠4例，，固定桥7例。种植体均可承受35Ncm扭矩，行使功能皆良好。未发现术后并发症。与术前X线对比显示：种植体周围骨密度增高，所有种植体均获得良好的骨结合。对于种植体周围较小的骨缺损和上颌窦提升病例，新生骨均能充满腔隙且种植体稳定；对于颌骨囊肿刮治后残留的较大的骨腔，单纯使用PRF可以促进新骨从四周向中央生长，但短期内不能完全充满骨腔。术后3个月的影像学分析显示，新生骨充填原骨缺损区，但此时新生骨质密度低于周围骨质；术后6个月骨密度进一步增高。结论：本临床观察证实了PRF促进组织再生的效果。单纯应用PRF作植骨材料，不仅可以加快种植体周围较小骨缺损的修复，对较大骨缺损中的骨再生也能起到促进作用。因此，PRF作为一种简便、安全、价廉的骨移植材料，在颌骨缺损修复再生中的效果可靠。PRF的应用避免了取自体骨的痛苦和使用人造骨的弊端，扩大了种植手术的适应症。但PRF促进骨再生的远期效果及与其他材料的联合应用的效果还有待研究。
[Abstract]:Objective: to investigate the clinical effect of autogenous platelet-rich fibrin (PRF) (PRF) on bone tissue repair in bone defects and grafts with insufficient bone mass using autologous platelet-rich fibrin (PRF) alone as bone graft material. Methods: 5 cases of immediate implant repair, 5 cases of maxillary sinus lifting and 4 cases of maxillary cyst were selected. Before operation, 10-40ml was extracted from elbow vein blood in a test tube without anticoagulant. PRF. was made by centrifugation for 15 minutes at 3500 rpm immediately. Routine intraoral and perioral maxillofacial disinfecting, spreading surgical towels, using Atevacaine epinephrine solution to perform local infiltration anesthesia, alveolar ridge top trapezoid incision, along the incision to remove the gingiva, the whole layer turned over the mucoperiosteal flap, The alveolar crest and buccal bone surface were exposed, and the soft tissue and granulation tissue were removed. After the ball is positioned, the pioneer drill is used to drill in along the predetermined direction and expand step by step according to the diameter of the implant to implant the implant. Place PRF. at bone defect If the initial stability of the implant is above 25Ncm, put in the healing base; if the initial stability is less than 25 Ncm, put in the cover screw. After cystectomy, PRF was implanted into the bone defect area. 1 week, 3 months and 6 months after operation, the healing of soft tissue flap was recorded, and any infection was recorded. X-ray films taken immediately after operation were compared with X-ray films taken at 3 and 6 months after operation to observe the changes of bone in PRF implantation area. Check the stability of implants and upper prostheses, gingiva around implants, patients' satisfaction with prosthetic masticatory function and beauty. Results: none of the implants loosened and shed, and the retention rate was 100%. There were no obvious pain symptoms in 5 cases, only slight pain occurred in 5 cases, and there were 8 cases of cyst with severe pain in infected persons, 7 days after operation, there was no abnormal color of oral mucosal flap, no obvious edema, and 13 cases reached initial healing. Only one patient with maxillary sinus elevation returned to normal after 2 weeks of suborbital swelling. After 6 months of follow-up, all the patients completed the upper repair, and the results were satisfactory, including 4 cases with single crown and 7 cases with fixed bridge. Implants can withstand 35Ncm torque and function well. No postoperative complications were found. Compared with preoperative X-ray, the bone density around implants increased and all implants had good bone bonding. For the patients with small bone defect around implant and maxillary sinus lifting, the new bone could be filled with space and the implant was stable. For the larger bone cavity left after curettage of maxillary cyst, the use of PRF alone could promote the growth of new bone from four sides to the center. But the bone cavity cannot be completely filled in the short term. Imaging analysis at 3 months after operation showed that the new bone filled the original bone defect area, but the density of the new bone was lower than that of the surrounding bone, and the bone density increased further 6 months after operation. Conclusion: this clinical observation confirmed the effect of PRF on tissue regeneration. Simply using PRF as bone graft material can not only accelerate the repair of small bone defects around implants, but also promote bone regeneration in larger bone defects. Therefore, as a simple, safe and inexpensive bone graft material, PRF has a reliable effect in the reconstruction of mandibular defects. The application of PRF avoids the pain from body bone and the malpractice of using artificial bone, and expands the indication of implant operation. However, the long-term effect of PRF on bone regeneration and the effect of combined application with other materials need to be studied.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782.4

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