异体脱钙骨复合自体红骨髓修复下颌骨缺损

为研究异体脱钙骨与自体红骨髓在修复下颌骨缺损中的作用，作者在２０只成年家兔双侧下颌骨下缘造成骨缺损，将异体脱钙骨加自体红骨髓复合移植于骨缺损处。通过术后４、１４、２８、４２、５６、８４天的Ｘ线平片评分，９９Ｔｃ－ＰＹＰ骨扫描计数，组织学和组织化学染色及透射电镜观察复合移植的诱导成骨过程及其对骨缺损愈合的影响。结果：Ｘ线平片观察Ｐ＜０．０５，骨扫描计数Ｐ＜０．０５，组织学、组织化学和电镜观察实验组新骨形成的量明显优于对照组。说明复合移植是通过诱导机制形成新骨，它可促进和加速骨愈合。     

GBR技术在颌骨囊肿手术中的临床应用观察

目的:观察膜引导骨再生技术(guide bone regeneration,GBR)在颌骨囊肿术后对颌骨缺损修复的临床疗效。方法:小型颌骨囊肿50例,囊肿大小为1.5 cm×1.5 cm~3.0 cm×3.0 cm,均采用颌骨囊肿摘除术治疗。术中将颌骨囊肿完整摘除,确认未与鼻底及上颌窦穿通后,将人工骨粉与自体静脉血混合充填入颌骨囊肿骨缺损区,再以生物膜覆盖,常规缝合切口。结果:术后2周拆线,除5例外切口均愈合良好;术后6个月复查全景片,充填材料复合体密度与颌骨密度趋于一致;术后1年,充填材料与周围颌骨生长完全融合,不能分辨,原囊肿区可见正常的骨小梁网纹结构。结论:GBR技术对修复小型颌骨囊肿术后的局部骨质缺损安全有效。     

β-TCP植入与口腔修复膜覆盖治疗对颌骨囊肿术后骨缺损的修复效果分析

目的:分析β-磷酸三钙人工骨(β-TCP)植入与口腔修复膜覆盖治疗对颌骨囊肿术后骨缺损的修复效果.方法:选取2018年7月～2019年9月我院颌骨囊肿患者116例,采用随机数字表法将其分为对照组和观察组,每组各58例.对照组经囊肿摘除术刮治后对创面采用口腔修复膜覆盖治疗,观察组经囊肿摘除术刮治后放置β-TCP充填骨缺损...     

根尖囊肿摘除术中应用羟基磷灰石的疗效观察

目的观察羟基磷灰石生物陶瓷填塞根尖囊肿术中骨腔的效果。方法4箩例根尖囊肿病灶牙及囊肿累及邻牙行热牙胶尖垂直加压充填完成根管治疗后，按随机原则分为2组，试验组25例根尖囊肿摘除术中应用羟基磷灰石生物陶瓷骨粉填塞骨缺损；对照组23例采用传统的囊肿骨腔血凝块机化愈合方法。观察两组疗效，比较术后感染、血肿及成骨情况。结果术后随诊6个月-2年，试验组25例患者术后均无感染，血肿发生；6个月后术区骨密度明显增高，骨化程度良好。对照组6个月后出现2例失败病例,21例术区骨化程度低于试验组。结论根尖囊肿应用羟基磷灰石生物陶瓷填塞骨缺损可有效引导骨再生，减少术后并发症，值得临床推广应用。     

Cem-OsteticTM修复颌骨囊肿术后骨缺损的临床观察

目的 探讨Cem-OsteticTM人工骨浆修复颌骨囊肿术后骨缺损的可行性.方法 12名上颌骨或下颌骨根尖囊肿、鼻腭囊肿和含牙囊肿的患者,在囊肿刮除后置入Cem-OsteticTM人工骨浆,术后观察6至12个月,观察手术术区创口生长情况,行X线检查观察各个时期骨缺损区的成骨情况.结果 10名患者术后术区均愈合良好,术区植骨未见不良反应,术后3个月后植入的人工骨大部分吸收并被新骨取代,术后6个月术区骨缺损均可见成骨,大部分缺损已修复.2名患者术后2周出现术区渗出,植入骨粉大部分渗出,行局部冲洗换药后创口逐渐愈合.结论 Cem-OsteticTM人工骨浆可以充填囊肿摘除后遗留的空腔,并在3至4个月内逐渐吸收且促进新骨形成,是一种良好的新型骨修复材料,但对颌骨大型骨腔缺损(大于5cm)应谨慎使用.     

牛骨粉(Bio-Oss)/人工生物膜(海奥)联合治疗下颌骨缺损骨腔的临床观察

目的　　探讨下颌骨囊肿术中使用牛骨粉(Bio-Oss)/人工生物膜(海奥)联合治疗疗效。方法　选取下颌骨囊肿患者12例病例,囊肿摘除后,分成2组,1组骨粉填塞,并用生物膜覆盖,另1组不作处理。根据临床及影像学资料分析评估囊肿术后骨缺损处的骨质再生和改建情况。结果　骨粉/生物膜联合治疗组术后患者骨缺损区成骨较好。结论　下颌骨囊肿术后骨缺损使用骨粉/生物膜联合治疗,效果确切、可靠。     

组织工程骨修复9例颅骨缺损畸形初步报道

目的：探讨利用自体骨髓间充质干细胞（BMSC）作为种子细胞的组织工程骨修复外伤后颅骨缺损畸形的可行性。方法：运用自体BMSC组织工程骨技术,对9例外伤术后颅骨缺损患者行颅骨修复手术。抽取患者自体骨髓,密度梯度离心法分离BMSC,经体外扩增和成骨诱导后,接种部分脱钙骨支架材料,构建组织工程骨。细胞材料复合物体外共培养1周后,手术植入颅骨缺损区。分别于术后1周和3、6、12个月进行临床外形和三维CT检查,随访治疗效果。结果：术后1周三维CT显示,颅骨缺损区被所植入的组织工程骨填充,头颅外形明显改善。术后3至12个月CT显示,组织工程骨形成并修复颅骨缺损,新生骨与骨缺损断端融合。9例患者中2例术后失访,2例高龄患者及大面积骨缺损患者发生不同程度的组织工程骨吸收现象,其余均良好地修复了颅骨缺损。结论：通过选择适宜的病例,以自体BMSC作为种子细胞,运用组织工程技术可以在人体内形成稳定的组织工程化骨并修复颅骨缺损。     

用含骨髓的粒状骨植入整复下颌骨缺损

含骨髓的粒状骨植入修复骨缺损自七十年代始至今在美，日及欧洲一些国家得到了较为广泛的研究和应用，取得了令人鼓舞的效果，但国内应用甚少，近几年来，本文作用用含髓骨的粒状骨（Pariculate Cancellous BOne Marrow简称PCBM）植入整复下颌骨缺损，取得了良好效果，本组8例不同程度的下凳，骨缺损病员均为肿瘤切除术后，立即以自体含骨髓的粒状骨植入整复。7例一期愈合，1例延期愈合，本组病例，植骨术后不同间期X线片随访观察显示良好的新骨形成和下颌骨的改建，随着时间的推移，这样的重建和改建日趋0，功能和形态恢复满意。笔者本着不断探索的愿望，对这一技术的方法，影响植骨术成败因素，修复机制，应用展望，口内进路法切除下颌骨肿瘤燕重建下颌骨等有关问题进行了分析讨论。     

用含骨髓的粒状骨植入整复下颌骨缺损

含骨髓的粒状骨植入修复骨缺损自七十年代始至今在美、日及欧洲一些国家得到了较为广泛的研究和应用,取得了令人鼓舞的效果,但国内应用甚少。近几年来,木文作者用含骨髓的粒状骨(Pariculate Cancellous Bone Marrow简称PCBM)植入整复下颌骨缺损,取得了良好效果。本组8例不同程度的下颌骨缺损病员均为肿瘤切除术后立即以自体含骨髓的粒状骨植入整复。7例一期愈合、1例延期愈合。本组病例,植骨术后不同间期x线片随访观察显示良好的新骨形成和下颌骨的改建,随着时间的推移,这样的重建和改建日趋完善,功能和形态恢复满意。笔者本着不断探索的愿望,对这一技术的方法、影响植骨术成败因素、修复机制、应用展望、口内进路法切除下颌骨肿瘤并重建下颌骨等有关问题进行了分析讨论。     

复合珊瑚骨修复颌骨实验性骨缺损

珊瑚人工骨具有良好的生物相容性，生物降解性和骨传导性；单纯植入机体后有定的体积丧失。本文将珊瑚骨和自体骨髓复合，修复兔下颌骨实验性骨缺损，术后不同时间行Ｘ线检查，＾９９ｍＴｃ－ＭＤＰ骨显像和组织学检查。     

Bio-Oss骨复合富血小板纤维蛋白修复兔牙周骨缺损

目的探讨组织工程骨Bio-Oss骨复合富血小板纤维蛋白（PRF）修复牙周骨缺损中骨形成蛋白2（BMP-2）、骨保护素（OPG）和核因子κB受体活化因子配体（RANKL）的表达及意义。 方法3月龄雄性新西兰大白兔36只,采用随机数表法分为4组,每组9只,制备单侧牙周骨缺损模型,于骨缺损处分别植入Bio-Oss骨（Bio-Oss组）、PRF（PRF组）和Bio-Oss/PRF复合物（Bio-Oss/PRF组）,以未植入任何材料者作为空白对照。术后4、8和12周处死动物,行大体观察、Masson染色及BMP-2、OPG、RANKL免疫组化观察,并对其表达进行析因设计的方差分析。 结果Masson染色结果显示,Bio-Oss/PRF组术后8周时见部分成熟骨,12周见骨板形成,骨成熟度较高。析因分析显示Bio-Oss组在4、8和12周时BMP-2表达量逐渐增高,差异有统计学意义（F = 51.30,P<0.001）;OPG表达量随时间延长先升高后减低,差异有统计学意义（F = 167.03,P<0.001）;RANKL表达量随时间延长逐渐减低,差异有统计学意义（F = 5.39,P = 0.046）。PRF组在4、8和12周时BMP-2表达量无统计学意义（F = 0.68,P = 0.544）;OPG和RANKL表达量随时间延长逐渐减低,差异有统计学意义（F_OPG = 1070.93,P_OPG<0.001;F_RANKL = 2306.15,P_RANKL<0.001）。Bio-Oss/PRF组在4、8和12周时BMP-2、OPG和RANKL表达量逐渐降低,差异有统计学意义（F_BMP-2 = 13.29,P_BMP-2<0.001;F_OPG = 237.91,P_OPG<0.001;F_RANKL = 132.48,P_RANKL<0.001）。空白对照组在4、8和12周时BMP-2和OPG表达量先升高后减低,差异有统计学意义（F_BMP-2 = 88.33,P_BMP-2<0.001;F_OPG = 30.06,P_OPG<0.001）,RANKL表达量随时间推移逐渐减低,差异有统计学意义（F = 56.52,P<0.001）。 结论Bio-Oss骨复合PRF应用可促进成骨以修复牙周骨缺损。     

以管状脱矿骨基质支架构建组织工程骨的实验研究

目的：探讨应用脱矿管状骨基质支架复合骨髓基质成骨细胞在动物体内构建组织工程骨的方法。方法：体外培养的新西兰兔骨髓基质细胞，经地塞米松诱导后，与藻酸钙凝胶混合，置入长约1-1.5cm，管径约0.2-0.5cm的脱矿管状骨基质内，以自体细胞移植方式，将脱矿管状骨基质/骨髓基质成骨细胞复合物异位植入新西兰兔皮下组织，分别于4、8周取材进行大体，X线摄片显示呈点状阻射影。结果：4周时可见复合物中有类骨组织和新骨形成，X线摄片显示呈点状阻射影，8周时，新生骨组织类似正常成熟骨组织，呈板层结构，细胞椭圆形，位于陷宣传员中，排列规律，X线摄片显示呈均一阻射影，对照组仅有少量类骨组织形成。结论：脱矿管状骨基质为骨髓基质成骨细胞提供了外部支架，藻酸钙为骨髓基质成骨细胞提供了三维的立体载体结构。细胞在其中生长，分泌细胞外基质，最终形成新生骨组织。     

HA人工骨修复较大颌骨囊肿骨腔的临床探讨

本文对近10年来应用HA修复颌骨囊肿186例，及其中较大颌骨囊肿34例，进行了较系统的临床研究。手术切口一期愈合、外形满意27例（79．5％），较明显颗粒逸漏21例（61.7%），迟发性血清肿4例（2.9％）。并对4例单囊性角化囊肿用液氮冷冻后HA修复，经3年以上随访无复发。     

Imaging of periimplant bone levels of implants with buccal bone defects

The aim of the present study was to use four different methods to evaluate three radiographic techniques for their accuracy in assessing the marginal periimplant bone levels at implants with buccal bone defects in an experimental setting. Twenty-four implants were placed in the mandibles of six adult beagle dogs with substantial buccal bone defects, which were augmented by bone particles with and without resorbable membranes. After healing for 5 months, (1) periapical radiographs, (2, 3) reformatted images in (2) sagittal and (3) coronal planes from axial computer tomography (CT) scans and (4) direct magnification images (DIMA) were made and compared with histometric analysis of bone levels. Two values were used for comparison: (i) the lingual bone level and (ii) the true bone level calculated as a mean value from the lingual and the buccal bone levels of all histologic sections of each implant. Metric evaluation of periapical radiographs, sagittal reformation of CT scans and DIMA showed that the results were close to the histometrically assessed lingual bone level, while the true bone level was significantly lower and not reflected by any of the imaging modalities. Coronal reformation showed that there was significant overestimation of the lingual and underestimation of the buccal bone level when compared with histometric values. It is concluded that assessment of bone level and bone regeneration in implants with buccal bone defects remains problematic, and data from periapical radiograms tend considerably to overestimate the bone anchorage of these implants.     

应用骨髓基质细胞片层构建组织工程骨的实验研究

目的 应用犬骨髓基质细胞片层构建组织工程骨,为临床提供组织工程骨来源.方法 分离培养传代犬骨髓基质细胞(bone marrow stromal cell,BMSC).将经成骨诱导的第3代BMSC接种于温度反应性培养皿中,制备BMSC细胞片层.制备犬同种异体脱钙骨基质(decalcification bone matrixes,DBM).实验用16只犬分为4组,每组4只,采用自身对照.将复合体BMSC片层-人重组骨形态生成蛋白2( rhBMP-2) -BMSC-DBM植入犬左侧背阔肌肌筋膜下为实验侧,同法右侧植入DBM-rhBMP-2-BMSC为对照侧.术后4、8、12、16周取材行组织学观察,评价体内异位成骨的情况.结果 实验侧成骨优于对照侧,成骨面积实验侧＞对照侧,两侧差异有统计学意义(P＜0.05).术后16周,实验侧板层骨连接成片,可见骨单位,骨髓腔内可见红骨髓.结论 BMSC细胞片层可促进功能性组织工程骨的形成.     

Use of the mandibular staple bone plate with augmentation bone grafts

The mandibular staple bone plate is a helpful adjunct to the treatment of advanced mandibular atrophy when augmentation bone grafts are required. The vestibuloplasty procedure can often be eliminated or modified. The patient can be prosthetically rehabilitated sooner and experiences much greater stability than with the conventional denture. If instability contributes to bone loss, then the mandibular staple bone plate should decrease the rate of bone loss in these more vulnerable denture patients and subsequently improve the long term results of the augmentation procedures.     

The effect of platelet-rich plasma combined with autogenous bone graft for bone regeneration in bone defects

The objective of the present study was to evaluate the effect of PRP on bone healing both quantitatively and qualitatively using histomorphometrical methods in a rabbit model. The examined materials were autogenous bone, PRP alone, a mixture of autogenous bone and PRP, and whole blood (as a control). These materials were implanted into artificial defects prepared in rabbit tibiae. The observation period was set at 1, 2, 3, and 4 weeks. All specimens were used for histologic evaluation and 2- and 4-week specimens were used for histomorphometrical evaluations. The bone quantity increased when autogenous bone was applied but the percentage of mature bone in the autogenous bone site was smaller than in the PRP applied site. The results of this study suggested that the quantity of newly formed bone increased when autogenous bone was applied, but not when PRP only was applied. However, PRP might accelerate bone maturation by activating bone remodeling. According to this study, the bone quality could be altered by the application of PRP.     

Bone induction using autogenous bone mixed with demineralised bone matrices

The aim of the present study was to examine the healing of endochondral (EC) autogenous bone grafts in the presence of demineralised bone matrix prepared from intramembranous bone (DBMIM), or prepared from endochondral bone (DBMEC) using quantitative analysis. Thirty bone defects were created on the parietal bone of fifteen New Zealand White rabbits. In the experimental groups, five defects were grafted with EC bone, five defects were grafted with EC bone mixed with DBMIM (EC-DBMIM) and six defects were grafted with EC bone mixed with DBMEC (EC-DBMEC). In the control groups, ten defects were left empty (passive control) and four defects were grafted with rabbit skin collagen (positive control). They were all sacrificed at day fourteen post grafting, and the defects were prepared for histological analysis. Serial sections were cut across the whole defect. Quantitative analysis was performed on 152 sections of the experimental groups by image analysis. Four hundred and fourteen per cent more new bone was formed in defects grafted with composite EC-DBMIM than those grafted with EC bone alone (p < 0.001). Eighty-five per cent more new bone was formed in defects grafted with composite EC-DBMEC than those grafted with EC bone alone (p < 0.001). No bone was formed in either passive or positive controls. In conclusion, DBM, especially DBMIM, have extremely high osteoinductive properties and greatly enhance the integration of EC bone grafts with defects created in IM bone.     

Bio-Oss骨粉联合富血小板纤维蛋白在牙槽骨缺损种植引导骨再生后的骨量变化

目的：探讨Bio-Oss骨粉联合富血小板纤维蛋白在牙槽骨缺损种植引导骨再生后骨量的变化。方法：选择106例单颗前牙缺失伴唇侧骨缺损患者,进行种植体种植同期引导骨再生。按随机数字表法随机分为2组,实验组（53例）采用Bio-Oss骨粉联合富血小板纤维蛋白+生物膜引导骨再生,对照组（53例）采用Bio-Oss骨粉联合生物膜引导骨再生。评价2组种植成功率、术后并发症率、种植体唇侧骨壁厚度、骨缺损再生情况。采用SPSS 25.0软件包对数据进行统计学分析。结果：2组种植体种植成功率差异无统计学意义（96.23%:88.68%,P>0.05）。种植后12个月,实验组种植体唇侧骨壁厚度显著大于对照组[（2.72±0.43） mm:（2.51±0.36） mm,P<0.05],不同位点种植体唇侧骨壁厚度大于对照组（P<0.05）,出血指数[（0.32±0.02）:（0.42±0.03）]、探诊深度[（3.31±0.69） mm:（4.32±0.95） mm]、附着丧失[（3.06±0.52） mm:（5.24±1.35） mm]均显著小于对照组（P<0.05）,植骨高度[（2.61±0.52） mm:（2.31±0.35） mm]、成骨高度[（2.59±0.32） mm:（2.01±0.16） mm] 显著大于对照组（P<0.05）。2组患者并发症发生率相比差异无统计学意义（1.89%:5.66%, P>0.05）。结论：Bio-Oss骨粉联合富血小板纤维蛋白可减少骨缺损种植引导骨再生后骨量丢失,促进骨缺损再生。