医用硫酸钙、β-磷酸三钙及生物玻璃治疗颌骨囊肿的疗效观察

发布时间：2018-05-01 08:01

本文选题：医用硫酸钙 + β-TCP　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的颌骨囊肿是口腔颌面外科最常见的疾病之一,这类疾病早期不容易被患者察觉,因为其病情发展比较缓慢,且病变的早期没有明显的自觉症状。当病灶范围增大,造成患者局部面容发生改变,或者继发感染,引起正常组织结构遭到破坏,患者的正常生活受到影响时才会引起关注。颌骨囊肿的治疗方法多种多样,迄今为止,囊肿刮除术仍然是其主要的治疗术式,如何处理颌骨囊肿刮除后遗留下的骨腔缺损?这是口腔颌面外科临床上面临的重要课题。多年以来,人工骨替代材料由于避免了自体骨取材有限及二次手术创伤等不足,又防范了异体骨免疫排异及污染等风险,因此,它在颌骨缺损修复中起到不可取代的作用。本课题通过比较医用硫酸钙,β-磷酸三钙(β-TCP)和生物玻璃这三种人工骨替代材料在颌骨囊肿治疗中的作用,从生物材料的降解情况,新骨的生成速度,骨腔的愈合情况,患者术后反应等方面来分析和比较这三种材料的临床效能,以期为临床治疗工作提供一定的参考。方法本课题选择2014年10月-2016年8月期间来安徽医科大学附属口腔医院就诊的颌骨囊肿病例45例,术前影像学资料显示囊肿的直径均大于或等于2.5cm。经过术前谈话,在患者知情并且同意的前提下,行囊肿刮除术,按骨腔内充填的人工骨替代材料的不同,将病例分为四组:A组:医用硫酸钙组;B组:β-磷酸三钙组;C组:倍骼生组;D组:空白组。术后观察患者术区肿胀程度,且1,3,6,12个月后预约患者回访,拍摄锥形束CT(CBCT)或曲面体层片(OPT),测量骨腔大小,通过统计学处理,比较各组术区骨愈合速度,观察材料的降解情况。结果45例患者均得到随访,随访期间,除了医用硫酸钙组中的一例患者发生材料排异反应外,没有出现诸如颌骨病理性骨折、颌骨的功能异常及面部外形改变等并发症。医用硫酸钙组患者术后一周内术区肿胀比较明显,一周后肿胀逐渐缓解,β-磷酸三钙组、生物玻璃组及空白组患者术后无明显肿胀。另外,从影像学资料上看,医用硫酸钙组和倍骼生组患者手术6个月后,术区与正常骨组织基本无明显区别,β-磷酸三钙组患者手术12个月后,新骨几乎充填整个骨腔;空白组病例的骨腔愈合时间长达18个月,有的甚至更长,新骨形成速度明显较材料组缓慢。结论部分医用硫酸钙组患者手术后一周内会出现术区及面部肿胀等不适反应,这可能与医用硫酸钙在降解吸收过程中形成局部微酸的环境有关。而在骨缺损修复方面,医用硫酸钙、β-磷酸三钙和生物玻璃这三种人工骨替代材料充填骨腔,对新骨的形成和骨腔的修复起到了一定的促进作用,能使骨愈合的时间大大减少。
[Abstract]:Objective jaw cyst is one of the most common diseases in oral and maxillofacial surgery. When the lesion area is enlarged, the patient's local facial appearance changes, or the secondary infection, causes the normal tissue structure to be destroyed, the patient's normal life is affected only then will cause the concern. The treatment of maxillary cyst is varied, so far, cyst curettage is still the main treatment, how to deal with the bone cavity defect left after the maxillary cyst curettage? This is an important subject in oral and maxillofacial surgery. For many years, artificial bone substitute material can not be replaced in the repair of maxillary defect because of avoiding the limitation of autogenous bone extraction and secondary surgical trauma, and preventing the risk of allogeneic bone immunity rejection and contamination, so the artificial bone substitute material plays an irreplaceable role in the repair of jaw bone defect. The purpose of this study was to compare the effects of three artificial bone substitute materials, calcium sulfate, 尾 -TCPand bioglass, in the treatment of maxillary cyst, including the degradation of biomaterials, the rate of new bone formation, and the healing of bone cavity. The clinical efficacy of these three materials was analyzed and compared in terms of patients' postoperative response, in order to provide some reference for clinical treatment. Methods from October 2014 to August 2016, 45 cases of maxillary cyst were selected from the affiliated Stomatological Hospital of Anhui Medical University. The preoperative imaging data showed that the diameter of the cyst was greater than or equal to 2.5 cm. After preoperative conversation, with the patient's knowledge and consent, cyst curettage was performed according to the difference of the artificial bone replacement materials filled in the bone cavity. The patients were divided into four groups: group A: medical calcium sulfate group, group B: group C, 尾 -tricalcium phosphate, group D, group D: blank group. After operation, the swelling degree of the operation area was observed, and after 12 months, the patients were appointed to visit back, and then the conical bundle CTCT-CTT) or the curved slice of the body were photographed. The size of bone cavity was measured. The bone healing rate of each group was compared by statistical analysis, and the degradation of the material was observed. Results all 45 patients were followed up. Except for one patient in the medical calcium sulfate group, there were no complications such as pathological jaw fracture, abnormal jaw function and facial shape change except for one patient in the medical calcium sulfate group. In the medical calcium sulfate group, the swelling of the operation area was obvious within one week after operation, and gradually relieved after one week, but there was no obvious swelling in the 尾 -tricalcium phosphate group, the bioglass group and the blank group. In addition, according to the imaging data, there was no significant difference between the operation area and the normal bone tissue after 6 months operation in the medical calcium sulfate group and the iliac group. After 12 months of operation, the new bone almost filled the whole bone cavity in the 尾 -tricalcium phosphate group. The healing time of bone cavity in blank group was up to 18 months, some were even longer, and the rate of new bone formation was slower than that of material group. Conclusion some patients in the group of medical calcium sulfate may have discomfort reactions such as area of operation and facial swelling within one week after operation, which may be related to the formation of local micro-acid in the process of degradation and absorption of medical calcium sulfate. In the aspect of bone defect repair, three kinds of artificial bone substitute materials, calcium sulfate, 尾 -tricalcium phosphate and bioglass, were used to fill the bone cavity, which promoted the formation of new bone and the repair of bone cavity, and greatly reduced the time of bone healing.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.1

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