在移植骨上延期种植的实验研究

目的论证冷冻自体下颌骨复合髂骨移植后延期种植的可行性。方法16只成年雄性杂种狗，制备下颌骨双侧骨缺损，左侧行冷冻自体下颌骨骨块的原位再植并结合髂骨松质骨移植，即复合移植组（composite transplantation group，CTG），右侧缺损行自体髂骨块移植即髂骨移植组（iliac transplantation group，ITG），术后3个月分别在两类骨块上植入IMZ TPS种植体，种植体植入后3、6、9、12周分别处死4只动物取材，采用数字化X线片对种植体与颌骨结合界面进行灰度定量分析，组织学观察种植体．骨结合情况。结果各期种植体周围均未见吸收性骨质密度减低影像。骨一种植体界面灰度定量分析显示，种植体植入两类移植骨3、6和9周时，其界面骨质密度改变差别明显，复合移植组明显优于髂骨移植组；种植体植入12周时，两组界面骨质已无明显差别，两类移植骨均与种植体有良好的骨结合，其骨愈合方式基本相同。结论冷冻自体下颌骨复合移植修复下颌骨缺损并延期植入牙种植体后，二者可形成良好的骨结合。     

纯钛种植体与非血管化髂骨骨结合的组织学观察

目的：研究纯钛种植体和非血管化髂骨块的骨结合情况。方法：10只杂种犬被随机分成5组，分别切取两侧游离髂骨移植于对侧，移植骨内同时植入钛种植体，术后不同时间点取材，组织学观察。结果：3周时，移植骨以吸收和坏死为主，6周时有新骨形成，9周时新骨形成的数量增加，12周时移植的骨块成活，骨组织改建完成，植入的钛种植体和移植的髂骨块之间无软组织介入，标志种植体与移植骨之间骨结合完成。结论：在本实验条件下，钛种植体和非血管化髂骨块可以形成完全骨结合。     

钛种植体与单纯珊瑚及复合BMP珊瑚代用品结合的实验研究

目的　研究单纯珊瑚与复合BMP的珊瑚表面贴附移植后与同期植入的钛种植体形成骨结合的情况。方法　将单纯珊瑚与复合BMP的珊瑚置于去皮质的犬髂骨表面 ,同时植入钛种植体 ,用种植体固定人工骨 ,不同时间取材 ,观察种植体与人工骨的骨结合情况。结果　种植体与单纯珊瑚与复合BMP的珊瑚均可以形成骨结合。单纯珊瑚 12周时 ,种植体与珊瑚之间形成结构不规则的骨界面 ;同时 ,材料有大量的吸收。珊瑚复合BMP时新骨明显增多 ,形成粗的骨小梁 ,骨髓腔变小 ,6周时与种植体之间已经形成基本完善的骨界面 ;且材料总体吸收量较少。结论　天然珊瑚具有良好的生物相容性 ,可以与钛种植体形成骨性结合 ;BMP、珊瑚复合材料植入可以加快成骨 ,延缓吸收。此复合材料可以应用于种植外科     

VEGF和TGF-β1促进非血管化骨移植同期种植骨结合的实验研究

目的:探讨外源性VEGF和TGF-β1对非血管化骨移植同期种植的影响。方法:选用实验犬24只(术前1个月拔除双侧下颌前磨牙),随机分为A、B 2组。选取左侧下颌骨造成2.5 cm全层骨缺损,植入同样大小的全层自体髂骨,钛板固定(髂骨块离体时间控制在20 min以内)。A组(12只)移植髂骨块内植入1枚钛种植体。B组(12只)将钛种植体与rhVEGF165和rhTGF-β1复合后再同法植入移植髂骨内。在所有实验犬的右侧下颌无牙区植入1枚种植体作为对照。术后1、2、4个月取材,行X线、组织学、显微CT观察和种植体骨结合力测试。结果:术后1、2个月B组种植体骨接触率较A组显著增高;对种植体周围骨小梁的显微CT分析表明,B组的成骨的作用较A组明显增强。术后4个月,A、B 2组BIC达到60%以上,种植体骨界面结合力接近220 N,已形成较好的骨结合。结论:VEGF和TGF-β1对NVBG同期种植体骨结合早期(术后1～2个月)有明显的促进作用。NVBG同期种植体在术后4个月可以进行上部义齿修复。     

冷冻自体下颌骨复合髂骨移植延期种植后种植体周围骨密度变化初探

目的:了解自体冷冻下颌骨复合髂骨移植延期种植后种植体周围骨密度的变化情况。方法:选择16只杂交狗为对象,液氮(-196℃)作为致冷剂,分别在动物双侧下颌骨体部制备骨缺损。左侧缺损行冷冻自体下颌骨骨块的原位再植并结合髂松质骨移植(复合移植组,composite transp lantation group,CTG),右侧缺损行自体髂骨块移植(髂骨移植组,iliac transp lantation group,ITG)。术后观察两类骨移植后的伤口愈合情况及骨新生与骨密度变化,术后3个月分别在两类骨块上植入IMZ(TPS种植体,每侧1枚,种植体植入后3、6、9、12周分别处死4只动物取材,通过标本的骨密度扫描进行种植体周围骨密度评价。结果:ITG种植体周围的骨密度均小于CTG,但随着时间的延长,这种差异逐渐缩小,到种植后12周时,这种差异已不明显。结论:骨密度测量结果提示,延期植入的牙种植体可与冷冻自体复合下颌骨形成良好的骨整合。骨密度值可以作为评价种植体周围骨整合情况的一个指标。     

活性胶原基纳米骨修复即刻种植体周围骨缺损的研究

目的:观察胶原基纳米骨(nHAC)及活性胶原基纳米骨(AnHAC)修复即刻钛种植体周围骨缺损的效果,为临床应用奠定理论依据。方法:犬下颌骨拔牙创区制造即刻种植体周围骨缺损,分别采用植入nHAC、AnHAC、自体牙槽松质骨及不植入任何材料4种不同方法修复种植体周骨缺损,术后6周、12周,采用X线摄片、骨密度测量及组织学检查,观察新骨形成情况和新骨与种植体的关系。结果:两组实验动物中,除空白对照组外,骨缺损区均愈合良好,未见种植体周围炎发生。1)nHAC组:术后6周已有新生骨小梁形成,术后12周修复骨缺损,种植体边缘可见较多新骨形成;2)AnHAC组:成骨过程较早,术后6周即有较多新生骨组织出现,术后12周新骨组织与宿主骨完全融合,并与种植体表面形成广泛的骨性结合。结论:nHAC具有良好的骨引导作用,可良好地修复种植体周骨缺损,复合rhBMP-2后效果更佳。临床上可根据具体情况选用修复即刻种植体周围骨缺损的方法。     

种植体周围骨缺损修复的组织学观察

目的 :观察脱钙冻干骨移植物 (DFDBA)在种植体周骨缺损的诱导成骨活性以及重组人骨形成蛋白 -2 (rhBMP -2 )和钛膜对DFDBA成骨作用的影响。方法 :犬股骨植入种植体周围 ,制造 4mm× 3mm× 3mm骨缺损 ,分别采用DFDBA、DFDBA rhBMP -2和DFDBA 钛膜三种不同方法修复种植体周骨缺损 ,术后 4、8、12周 ,组织学观察种植体周骨缺损修复情况。结果 :三组实验动物中 ,植骨创均愈合良好 ,种植体无松动 ,未见种植体周围炎发生。①DFDBA组 :术后 4周即有新生骨小梁形成 ,术后 12周修复骨缺损 ,但新骨组织与宿主骨之间仍见明显分界 ;②DFDBA rhBMP -2组 :成骨过程较早 ,术后 4周即有较多新生骨组织出现 ,术后 8周 ,成骨细胞较为丰富 ,术后 12周新骨组织与宿主骨完全融合 ;③DFDBA 钛膜 :术后 4周即见新生骨小梁沿钛膜生长 ,至术后 12周 ,完全覆盖骨缺损。结论 :DFDBA具有良好的骨诱导和骨引导作用 ,可用于修复种植体周骨缺损 ;rhBMP -2复合DFDBA ,可增强骨诱导作用 ,加速成骨过程 ;钛膜有助于维持骨再生空间 ,阻隔软组织长入 ,引导新骨生长 ,缩短修复过程。     

血管化髂骨移植与下颌骨的功能重建

目的 寻求下颌骨大范围缺损的修复和功能重建的方法。方法 ７例患者用旋髂深务管为蒂的游离髂骨移植同期植入纯钛螺旋状骨内种植体。结果 术后６个月Ｘ线显示：种植体与移植骨块有结合。义齿修复后,随访６－３６个月,种植体无松动。Ｘ线片未见种植边缘骨吸收;恢复了咀嚼、语言、外形等,结论 该方法能较好地解决下颌骨大范围缺损的功能性重建。     

rhBMP-2在种植体周围骨缺损修复中应用的组织学观察

目的:研究rhBMP-2及不同载体在种植体周围骨缺损修复中的应用。方法:在beagle犬下颌骨植入种植体,颊侧形成裂开性骨缺损,置入复合了不同浓度rhBMP-2的珊瑚羟基磷灰石人造骨(CHA)或可吸收胶原海绵(ACS)。种植体植入后2、4、8、12周,获取含种植体骨标本,进行组织学观察。结果:2周时,rhBMP-2组可见极少量的新生骨组织。4周时,rhBMP-2/ACS组新骨组织由牙槽骨顶端向缺损区中心方向生长;rhBMP-2/CHA组人造骨颗粒内部和周围出现呈岛状生长的新生骨组织。8周时,rhBMP-2/ACS组的新骨形成大片状结构;rhBMP-2/CHA组人造骨颗粒周围较多骨岛形成。12周时,rhBMP-2组的缺损区内骨量和骨高度进一步增加,与种植体形成骨性结合。浓度为0.05 mg/ml和0.2 mg/ml,载体为CHA或ACS促进骨再生作用差异无统计学意义。结论:以CHA或ACS为载体rhBMP-2能促进种植体周围骨缺损区内的骨组织再生并与种植体表面较好地结合。     

全厚皮片结合骨移植同期植入种植体:1例报告

目的:前臂全厚皮片结合骨移植同期植入种植体行重建下颌的功能恢复.方法:下颌骨部分切除同期髂骨重建患者1例,术后6个月检查瘢痕组织严重,X片示重建下颌骨愈合良好,前牙区成V型骨缺损.术中植入4颗Tiunite种植体,植Rio-oss块状骨、骨粉与自体骨混合物于骨缺损区,同期于前臂内侧切8cm*5cm全厚皮片修复瘢痕粘膜,术后10个月行义齿修复.随访观察.结果:皮片移植成功,种植体与移植骨结合良好.修复后咬合恢复正常,咀嚼功能良好,患者满意.术后随访4年,成釉细胞瘤未复发,种植体周围未见明显骨吸收.结论:全厚皮片结合骨移植同期植入种植体可作为下颌重建伴瘢痕严重患者修复的可靠方法之一.     

Effects of the placement of endosseous implants in vascularized bone grafts on bone union in beagle dogs

Recently, reconstructive surgery with revascularized osteocutaneous flaps has been used to restore function in patients with bone defects caused by surgery for oral cancer. However, few basic studies have addressed problems such as the union of bone segments after osteotomy, the effects of dental implant placement on blood flow, and bone formation at the bone:implant interface in grafted bone. Nine adult beagle dogs were divided into three groups of three dogs each. Each group received osteotomized vascularized tibial grafts, osteotomized tibial grafts with implants (implants placed in contralateral limbs as control), or simple (non-vascularized) tibial grafts. The development of bone around the implants was studied by histological examination, contact micro-radiography (CMR), and fluorescent bone labeling. In the dogs receiving osteotomized vascularized tibial grafts, bone bridging was confirmed at both the medial and distal junctions of the bone segments after 4 weeks. Additional newly formed bone was observed after 8 weeks, and bone union at the surface of the segments was completed after 12 weeks. In contrast, bone formation was clearly delayed in dogs receiving simple (non-vascularized) tibial grafts. Histologically, no difference in bone union was evident between limbs with dental implants in tibial bone and control limbs without implants, suggesting that implant placement does not negatively affect revascularization. Fluorescent bone labeling technique confirmed high vascularity of the vascularized tibial bone grafts but not of the simple (non-vascularized) tibial bone grafts early after the procedure. Our results suggest that osseointegration occurred around dental implants placed at the same time as reconstruction with osteotomized vascularized bone grafts in this animal model.     

钛网成形自体颗粒骨修复下颌骨缺损并同期种植的实验研究

目的 观察犬钛网成形自体颗粒骨移植修复下颌骨节段性缺损并同期植入钛种植体后的骨愈合和骨结合情况.方法 5只Beagle犬,一侧下颌骨制备长40 mm的节段性缺损;钛网成形修复下颌骨缺损.将切除后的下颌骨和自体髂骨剪成直径约2mm颗粒,骨皮质、骨松质体积比3∶1混合,紧密充填在钛网内,将2枚纯钛种植体埋置于颗粒骨内,术后6个月处死动物.用下颌骨X线片、组织学切片、扫描电镜以及能谱分析观察钛网内颗粒骨愈合以及种植体骨结合的情况.结果 钛网成形自体颗粒骨移植重建后的下颌骨外形满意,功能正常、颗粒骨成骨良好、结构优良,未见明显骨吸收.同期植入的种植体能够与周围骨组织形成良好的骨结合,并有促进邻近骨组织结构优化的趋势.结论 钛网成形自体颗粒骨移植是一种修复下颌骨节段性缺损的好方法,当修复后下颌骨形态良好、骨质优良、骨量充足时可以同期植入种植体.     

非血管化髂骨移植同期种植重建下颌骨节段缺损的临床研究

目的：研究非血管化髂骨移植同期种植重建下颌骨节段缺损的方法及临床效果。方法：选取下颌骨节段缺损的病人，通过非血管化髂骨移植建立下颌骨连续性，同期植入牙种植体。结果：移植的骨块成活，植入的种植体可以实现骨结合并完成种植义齿修复，行使功能。结论：此方法可以实现下颌骨的功能重建。     

非血管化骨-人重组骨形成蛋白-2复合种植体同期移植的超微结构观察

目的对于非血管化自体骨移植同期植入种植体,目前仍有争议.近年的研究表明非血管化自体骨植入后,早期即可有新骨形成.本研究旨在探讨非血管化自体骨-种植体同期植入后种植体的愈合过程,并观察骨形成蛋白对与非血管化骨同期植入的种植体愈合过程的促进作用.方法健康犬12只,随机分为2组.在犬双侧下颌角区各截取3cm×4cm骨段,实验组骨段内植入含有重组人骨形成蛋白-2的种植体,对照组植入普通纯钛种植体.植入种植体后,将骨块及种植体植回对侧下颌角,并以不锈钢丝固定.术后2、4、6、8及12周各处死2只动物,标本行扫描电子显微镜观察.结果实验组种植体-骨界面在术后2周即可见明显的新骨形成,术后6～8周,已基本形成骨性结合;术后12周时,可见较为成熟的骨融合.而对照组骨融合在术后6～8周方开始形成,术后12周时仍未完成.实验结果显示,实验组骨融合的时间较对照组至少可提前4周.结论骨形成蛋白的骨诱导活性可以促使种植体在植入后早期与非血管化骨形成骨融合,从而为提高同期植入种植体的成功率提供了新的途径.     

非血管化髂骨移植重建下颌骨缺损的临床分析

目的对非血管化髂骨移植重建下颌骨缺损的病例进行临床回顾性分析,探讨其治疗效果及手术注意事项。方法选择因肿瘤和外伤致下颌骨缺损后行自体非血管化髂骨同期移植重建术修复的34例患者为研究对象,分析其手术方法、术后效果及并发症的发生情况。结果采用游离非血管化髂骨同期移植重建下颌骨缺损的34例患者中,小钛板双排内固定31例,重建板内固定3例。34例患者中,成功病例27例（79.41%）,良好病例3例（8.82%）,失败病例4例（11.76%）。失败原因均为感染而取出植入骨。结论自体非血管化髂骨移植重建术是下颌骨缺损重建的重要方法之一,内固定的方式有小钛板和重建板。     

低强度脉冲超声促进钛种植体骨结合的实验研究

目的 建立种植体植入动物模型,研究低强度脉冲超声(low intensity pulsed ultrasound,LIPUS)对种植体骨结合的促进作用.方法 选用雌性SD大鼠24只,每只大鼠双侧胫骨干骺端内侧植入螺纹状钛种植体.植入术后第2天对右侧胫骨种植体周围进行LIPUS刺激作为实验侧,每日20 min,左侧胫骨种植体植入部位不刺激作为自身对照侧.超声刺激后第4、8、12 周分批处死动物,每批8只,获取双侧胫骨标本.采用X线片、显微CT、组织切片等观察LIPUS对种植体骨结合的作用.结果 3个时间点种植体与骨组织之间均形成了不同程度的骨结合.显微CT组织形态计量学分析结果显示,种植体周骨结合率在实验侧第4、8、12周分别为(45.708±3.316)%、(46.231±1.954)%、(46.807±1.451)%,在对照侧分别为(43.021±3.558)%、(44.272±3.023)%、(44.894±4.215)%,第4周时差异具有统计学意义(P<0.05).种植体周骨体积分数在第4、8周,种植体周骨小梁厚度及第8周、第12周各向异性程度,实验侧均高于自身对照侧,差异有统计学意义(P<0.05).组织学切片可见实验侧种植体周新生骨组织厚度明显大于自身对照侧,骨结合量更多.结论 LIPUS可以促进种植体周围骨组织的愈合,加快种植体骨结合,并能促进骨小梁早期呈一定方向改建.

Abstract：

Objective To establish an animal model of titanium implant and to investigate the effects of low intensity pulsed ultrasound(LIPUS)on the implant osseointegration. Methods Twenty-four female Sprague Dawley(SD)rats were used. Titanium implants were inserted into tibia metaphysis bilaterally in each SD rat. Since the second day following implant surgery, LIPUS stimulation were carried out around the implant on the right side for 20 minutes per day, and implants on the left side remain untouched as self-control. Eight rats were sacrificed and tibiae specimens were harvested on the end of the 4th, 8th, and 12th week respectively. X-ray picture,micro-CT analysis and histological sections were performed to evaluate the effects of LIPUS on the implant osseointegration. Results Osseointegration at the interface between the implant and bone tissue was observed bilaterally. In the micro-CT histomorphometry analysis, the percentage of osseointegration(%OI)of experiment side were (45.708±3.316)%, (46.231±1.954)%, and (46.807±1.451)% on the end of the 4th, 8th, and 12th week. Meanwhile, the %OI of control side were (43.021±3.558)%, (44.272±3.023)%, and (44.894±4.215)% respectively. The %OI on the 4th weekend, bone volume ratio(BV/TV)on the 4th and 8th weekend,trabecular thickness(Tb. Th)and degree of anisotropy(DA)on the 8th and 12th weekend of the experiment side tibia were significantly greater than those on the control side(P<0.05). The histological examination showed that the thickness of new bone around the implant and the bone-implant contact area was obviously greater in the LIPUS treated side compared to the control side.Conclusions The LIPUS therapy may accelerate the bone healing and osseointegration at the interface between titanium implant and bone, and promote remodeling of bone trabecula on the early stage.     

牙种植体—血管化髂骨移植修复下颌骨缺损的临床评价

目的　评价血管化髂骨移植一期植入种植体修复下颌骨缺损的临床效果。方法　采用临床观察、摄X线片 ,并对种植义齿修复后进行咀嚼效率及咬合力测定。结果　种植义齿修复后 ,患者的咀嚼效率可恢复至正常人咀嚼效率的 6 0 7%～ 96 6 % ,说明种植体应用于血管化骨移植修复下颌骨缺损 ,可早期恢复患者的咀嚼功能。结论　种植体应用于血管化骨移植修复下颌骨缺损可早期恢复患者的咀嚼功能     

非血管化游离髂骨移植血供重建的动物实验研究

目的：研究非血管化游离髂骨移植血供重建的时间和规律,探讨血供和新骨生成的关系.方法：选用杂种犬6只,造成一侧下颌骨2.5 cm全层骨缺损,自体游离髂骨移植.术后1、2、4月摄X线片、行下牙槽动脉血管造影后处死动物,明胶墨汁颈总动脉灌注.标本作组织学观察,行微血管记数.结果：术后1月：移植骨大部分被吸收,网状骨小梁增生,骨间隙内大量微血管新生.术后2月：植骨区大部分为新生骨所占据,新生骨小梁粗大,新生血管数目增多.X线示移植区低密度影.术后4月：新生骨基本矿化成熟,新生血管数目下降.X线示移植区高密度影.6例血管造影均未见下牙槽动脉再通.结论：非血管化游离髂骨移植新生血管术后1月开始大量增生,2月时数目最多,4月时趋于正常水平.新骨的生长是以微血管为中心,以膜内成骨和软骨内成骨两种方式多生长点成骨.     

Effects of a mechanical barrier on the integration of cortical onlay bone grafts placed simultaneously with endosseous implant

Background: Previous experimental studies on onlay bone graft integration have shown either advantages or disadvantages to the use of mechanical barriers. This indicates that the role played by the biologic properties of transplanted bone and membrane in graft revascularization and bone remodeling has not yet been established. The outcomes regarding osseointegration of titanium dental implants applied in such a condition are still contradictory. Purpose: The rabbit's radius model that is grafted onto the mandibular lower border and covered by membrane can reproduce a challenging experimental situation to preliminarily study the factors involved in osseointegration under deprived blood vessels source. Materials and Methods: Fourteen New Zealand White rabbits had a 2.5‐cm segment of the right radius osteoectomized and fixed onto the right mandibular lower border using titanium screws. Two screw‐shaped titanium implants (2.5 mm wide 2.5 mm long) were installed 7 mm apart in the mid length of the grafted bone. In experimental sites, the graft with the implants and graft‐host bone junction were covered by expanded polytetrafluoroethylene (e‐PTFE) membrane; control sites were left uncovered. Eight animals from the experimental group and six animals from the control group were sacrificed at 6 and 24 weeks after surgery. Ground sections obtained from en bloc tissues containing graft, implants, and recipient bone were subjected to histologic evaluation and histomorphometric analysis (area occupied by the graft and bone‐to‐implant contact). Results: The graft showed significantly more resorption after 24 weeks than at 6 weeks (p .05) irrespective of the treatment (with or without membrane), although the amount of new bone was greater at 24 weeks in sites where a membrane was covering the graft. Compared with 6 weeks postoperatively, the bone‐to‐implant contact was considerably improved at 24 weeks (p .05), and the membrane seemed beneficial for implant osseointegration when compared with unprotected sites (p .05). As a result of graft resorption, the amount of soft tissue was considerably expanded in sites beneath membrane, accompanied by a sustained process of trabecular bone deposition close to the barrier. Conclusions: Cortical onlay grafts covered by membrane demonstrated delayed remodeling, probably as a consequence of a hindered process of graft revascularization. Grafts covered by membrane might rely on previous host bone resorption both to become revascularized and to remodel. The findings that the membrane‐protected grafts were most resorbed at 24 weeks might be attributable to better implant osseointegration, because the fixtures were exposed to greater mechanical stimulation in these sites.