自体髂骨游离移植同期种植体植入修复骨量不足区牙缺失的动物实验研究

目的:利用自体髂骨游离移植一期植入种植体的动物实验研究,揭示自体髂骨游离移植同期植入种植体的愈合过程,为临床工作提供理论依据和借鉴。方法:选择16只健康成年雄性日本大耳白兔,在双侧髂骨制备髂骨缺损模型,游离移植自体髂骨,并同期分别在双侧髂骨植骨区及非植骨区植入自制圆柱状羟基磷灰石种植体。随机分成4组,每组4只。术后2周、4周、8周、12周各处死一组动物,切取标本。进行大体标本观察,放射线、组织学(脱钙HE染色)、扫描电镜检查、力学测试。结果:大体标本观察见各组种植体和髂骨结合紧密。肉眼见种植体和髂骨之间多为骨性结合,仅2周标本及4周实验组标本一些区域可见一薄层纤维样组织。放射线检查:2周标本可见有放射线透射区,实验组密度稍低于对照组密度;余各组种植体周围均未见明显的放射线透射区;4周标本实验组密度稍低于对照组;8周标本、12周标本实验组密度与对照组密度基本无差别。组织学及扫描电镜检查实验组与对照组种植体均与骨质形成不同程度的骨结合;对照组种植体比实验组形成更好的骨结合;各组种植体4周、8周、12周依次形成更好的骨结合。力学测试(反向推出实验)显示2周、4周、8周、12周骨结合实验组最大负荷分别是66.3N/cm2、143.9N/cm2、194.6N/cm2、248.3N/cm2。对照组最大负荷分别是108.6N/cm2、229.2N/cm2、307.1N/cm2、377.6N/cm2。结论:自体髂骨游离移植同期种植修复骨量不足区牙缺失是切实可行的修复方法。

Study of Repairing Bone Defects with Autogenous Nonvascular Iliac Bone Graft and Simultaneous Implantation

Objective:To observe the bone growth and osseointegration during healing process after autogenous nonvascular iliac bone graft and simultaneous implantation and supply proof of this type surgery in clinic by investigating the different results in animal experiment. Methods: Sixteen healthy and white adult male Japanese rabbits, with iliac bone loss imposed and bilateral iliac bone isolated, and then self-made column hydroxide phosphorite implanted simultaneously in the bilateral area of iliac bone with and without autogenous nonvascular bone graft, were randomly divided into 4 groups and four rabbits in each group. the rabbits in every groups was sacrificed at 2,4,8,12 weeks postoperation respectively and the dissected samples were used for general and histological observation, electron microscope scanning and reverse pushing out tests. Results: Implants were connected tightly with iliac bone and the implants weren't flexible in every group from general observation. Osseointegration between the implants and the iliac bone can be found and a thin fibrous tissue was observed only in some sample areas of two-week and four-week autogenous nonvascular iliac bone graft group by the naked eyes. Radial examination shows: There is no obvious x-ray transmission area around the implant but in two-week group . The density of grafting bone area is a bit lower than that of non- grafting area at two-week and four-week groups while at eight-week? twelve week group there is basically no difference in both areas. Histological and scanning electron microscope examination shows: Implants in grafting bone and non-grafting bone group are both osseointegrated with bone while osseointegration in non-graftting bone group is much better. Along with time, osseointegration in every group is much better in turn. Mechanics test (reverse pushing out test) shows that the maximum load of grafting bone group in four, eight and twelve weeks is 66.3 N/cm2?143.9N/cm2?194.6 N/cm2?248.3 N/cm2?respectively while it is 108.6 N/cm2?229.2 N/cm2?307.1 N/cm2?377.6 N/cm2 in non-graftting bone group. Conclusions: The method of autogenous nonvascular iliac bone graft and simultaneous implantation is an effective way to repair the bone difficiency.