CBCT评价单侧完全性牙槽突裂植骨术后骨量变化的临床研究

发布时间：2018-10-17 11:32

【摘要】：目的:通过对单侧完全性牙槽突裂患者术前及术后不同时间段拍摄锥形束CT(cone beam computed tomography CBCT),准确测量出单侧完全性牙槽突裂患者植骨术前裂隙区缺损的大小及术后不同时期植骨区的骨剩余量的多少,准确地了解在植骨区域的骨量变化情况,为临床医生做植骨术前的评估及植骨术后各时期的评价提供参考。方法:选取南昌大学附属口腔医院26例单侧完全性牙槽突裂的住院患者,行常规髂骨松质骨植入术。根据尖牙是否萌出于牙龈,分为两组(A组和B组)。裂隙侧尖牙已萌出的患者归为A组,裂隙侧尖牙未萌出的患者归为B组,其中A组14例,B组12例。A、B两组所有人员均在术前1周及术后1周、1个月、3个月、6个月在我院影像科行CBCT拍摄,并将文件导入Ka Vo e Xam Vision软件及Image-J软件中,从而获取术前牙槽突裂的体积及术后骨剩余量的体积,并计算术后各阶段的植入骨体积的吸收量及吸收率。结果:A、B两组术后1个月骨吸收量分别为0.47±0.11cm3、0.25±0.09cm3;术后3个月骨吸收量分别为0.57±0.14cm3、0.45±0.18cm3;术后6个月骨吸收量分别为0.84±0.17cm3、0.63±0.20cm3。A、B两组术后1个月骨吸收率分别为29±4%、16±3%;术后3个月骨吸收率分别为36±5%、28±4%;术后6个月骨吸收率分别为52±2%、42±3%。AB组内比较:A组术后1周内植骨区的平均体积与术后1个月相比P0.05,差异有统计学意义。术后1个月植骨区的平均体积与术后3个月相比P0.05,差异无统计学意义。术后3个月植骨区的平均体积与术后6个月植骨区的平均体积相比P0.05,差异无统计学意义;B组术后1周内植骨区的平均体积与术后1个月相比P0.05,差异有统计学意义。术后1个月植骨区的平均体积与术后3个月相比P0.05,差异无统计学意义。术后3个月植骨区的平均体积与术后6个月植骨区的平均体积相比P0.05,差异无统计学意义。AB组间比较:术前1周裂隙区体积A、B两组间无统计学差异(P0.05);术后1周骨体积A、B两组间无统计学差异(P0.05);术后1个月骨吸收量体积A、B两组间有统计学差异(P0.05);术后3个月骨吸收量体积A、B两组间有统计学差异(P0.05);术后6个月骨吸收量体积A、B两组间有统计学差异(P0.05)。结论:1、通过CBCT软件并结合Image-J软件来计算牙槽突裂术前缺损体积及术后骨剩余量的体积,是既科学又可行的一种方法。2、无论在行牙槽突裂植骨手术时,患者的尖牙是否萌出,术后1个月内为体积吸收高峰期,3个月时为相对稳定状态。患者可以在术后1-3个月先行正畸治疗,3个月时进行后期的修复治疗。3、术后6个月内发生的骨吸收量及吸收率,尖牙未萌的患者一直小于尖牙已萌患者,植骨前要重点考虑患者的牙龄。4、通过计算术前裂隙区的体积及术后植骨区的体积,为临床医生手术入路、植骨的超填及术后评价各时间段植入骨的吸收情况提供了具有参考意义的理论依据。
[Abstract]:Objective: to accurately measure the size of fracture area defect before and after bone grafting in unilateral complete alveolar process fissure patients by using CT (cone beam computed tomography CBCT), of conical beam at different time points before and after operation. The amount of bone remaining in the bone graft area during the period, To accurately understand the changes of bone mass in the area of bone graft and to provide references for clinicians to evaluate before and after bone grafting. Methods: 26 inpatients with unilateral complete alveolar process fractures in the affiliated Stomatological Hospital of Nanchang University were selected and treated with conventional iliac cancellous bone implantation. They were divided into two groups (group A and group B) according to whether the canines were cute or not. The patients whose fissured canines had erupted were classified as group A, and those whose fissures did not erupt were classified as group B. There were 14 cases in group A and 12 cases in group B. all the people in group A and group B were photographed by CBCT in our department of imaging at 1 week before operation and 1 week, 1 month, 3 months and 6 months after operation, and the files were imported into Ka Vo e Xam Vision software and Image-J software. The volume of alveolar process fissure before operation and the volume of bone surplus after operation were obtained, and the absorption and absorptivity of implanted bone volume were calculated. Results: the bone resorption was 0.47 卤0.11 cm _ 3 0.25 卤0.09 cm _ 3 at one month, 0.57 卤0.14 cm _ 3 0.45 卤0.18 cm _ 3 at 3 months after operation, 0.84 卤0.17 cm _ 3 0.63 卤0.20 cm ~ (-3) bone resorption at 6 months after operation, and 29 卤4 ~ 16 卤3 cm ~ (th) at 1 month after operation in group A and B, and the bone resorption rate was 29 卤4 ~ 16 卤3 in group B at 1 month after operation, respectively, and at 3 months after operation, the bone resorption was 0.84 卤0.17 cm ~ (3) and 0.63 卤0.20 cm ~ (-3) in group A and B, respectively. The bone absorptivity at 6 months after operation was 52 卤2 and 42 卤3%.AB, respectively. The mean volume of bone graft area in group A was significantly higher than that in group A at 1 week after operation (P 0.05). There was no significant difference in the mean volume of bone graft area between 1 month and 3 months after operation (P 0.05). There was no significant difference between the average volume of bone graft area 3 months after operation and the average volume of bone graft area 6 months after operation (P 0.05), but the average volume of bone graft area in group B was significantly higher than that in group B (P 0.05) within 1 week after operation compared with that at 1 month after operation. There was no significant difference in the mean volume of bone graft area between 1 month and 3 months after operation (P 0.05). There was no significant difference between the average volume of bone graft area 3 months after operation and the average volume of bone graft area at 6 months postoperatively, there was no significant difference between the two groups in AB group: the volume of fissure area was no significant difference between the two groups at 1 week before operation (P0.05), and the bone body volume at 1 week after operation was not significantly different between the two groups (P0.05). There was no statistical difference between the two groups (P0.05), the volume of bone resorption at one month after operation was significantly different between the two groups (P0.05), the volume of bone resorption at 3 months after operation was significantly different between the two groups (P0.05), and the volume of bone resorption at 6 months after operation was significant between the two groups (P0.05). There was statistical difference between the two groups (P0.05). Conclusion: 1. It is a scientific and feasible method to calculate the volume of alveolar process fissure defect before operation and the volume of bone surplus after operation by CBCT software and Image-J software. The volume absorption peak within 1 month after operation was relatively stable at 3 months. Patients can be treated with orthodontic treatment in 1-3 months after operation, and later repair treatment at 3 months. 3. Bone resorption and absorption rate occurred within 6 months after operation. Before bone grafting, we should consider the patient's tooth age. 4. By calculating the volume of the fracture area before and after the operation, the volume of the bone graft area should be used as the clinician's operative approach. The overfilling of bone graft and the evaluation of bone resorption in each time period provide a theoretical basis for reference.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783.6

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