自体骨游离移植修复下颌骨缺损效果观察

自体骨游离移植仍然是目前临床上最常用的下颌骨缺损修复方法之一,现就我科自1995年以来自体骨游离移植修复下颌骨缺损方法做临床总结。     

髂骨游离移植在下颌骨缺损重建中的应用

<正> 下颌骨的一些肿瘤或类肿瘤病变,通常需要切除部分或全部下颌骨,造成骨的连续性和完整性中断。在头颈重建外科领域中,口腔下颌骨缺损的修复与重建更具有重要性,因其除了解剖形态的恢复外,更为重要的是恢复患者病前的功能。迄今为止,下颌骨缺损重建的方法有许多,如传统的非血管     

自体骨游离移植修复下颌骨缺损的临床疗效观察

目的:观察自体髂骨、肋骨游离移植修复下颌骨缺损的临床疗效。方法:回顾性总结分析49例自体髂骨、肋骨游离移植修复下颌骨缺损病例,经随访0.5～14年,观察移植骨存活、咬合关系与咀嚼功能及颌面部外形恢复情况。结果:45例植骨区伤口一期愈合,占91.8%;47例移植骨完全成活,占95.9%;34例咬合关系与咀嚼功能恢复良好,占69.4%;42例面部外形恢复满意,占85.7%。随访1年时,有39例整体效果满意,满意率为79.6%。颜面外形及咀嚼功能恢复较差者多为大范围缺损行游离肋骨移植病例。结论:单纯自体骨游离移植修复下颌骨缺损术式简单,操作简便,只要严格掌握适应证,修复效果满意,在下颌骨缺损修复中具有较大应用价值。但单纯应用肋骨修复下颌骨体     

游离髂骨移植修复下颌骨缺损59例临床观察

目的　观察游离髂骨移植修复下颌骨缺损的临床效果。方法　对下颌骨肿瘤切除后即刻游离髂骨移植重建下颌骨的5 9例患者进行回顾性分析。结果　下颌骨不同骨段缺损的游离髂骨移植都取得良好的效果,但以下颌支、体部分缺损的重建最为理想。结论　游离髂骨移植较适合于下颌支、体部部分切除骨缺损的重建。     

小切口自体髂骨松质骨移植牙槽突裂修复术

唇腭裂畸形治疗已由单纯关闭唇腭部裂隙 ,发展到序列治疗[1] 。术前后正畸 ,腭裂术后语音训练 ,腭咽闭合不全的二次手术 ,应用自体髂骨松质移植 ,行牙槽裂修复术 ,已成为唇腭裂畸形序列治疗的重要步骤之一。它可恢复上颌牙弓的完整性 ,彻底关闭口鼻腔前庭瘘 ,为正畸及正颌外科打下基础 ,并帮助矫正鼻底继发塌陷畸形。国外在 80年代已广泛开展 ,对其成功率、并发症、影响成功的因素等方面已有文献报道 ,其结论有所不同[2～ 4 ] 。国内在 90年代初开始了自体骨移植牙槽突裂修复术。本文通过同一术者应用圆筒形取骨器 ,小切口自体髂骨松质行牙…     

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。     

游离髂骨加前臂皮瓣修复上颌缺损（附4例报告）

目的：通过4例上颌骨肿瘤行上颌骨低位切除后缺损的修复,评估上颌重建的效果。方法：采用游离髂骨加前臂皮瓣移植上颌缺损。结果：4例患者的游离髂骨及前臂皮瓣均成活,经术后半年随访,移植之髂骨及前臂皮瓣生长良好。结论：游离髂骨加前臂皮瓣上颌低位重建的较满意的方法,它可恢复患者的面形及语言和吞咽功能,解决患者的生理和心理负担。     

自体冷冻病变骨—髂骨复合移植修复下颌骨缺损的临床研究（评述）

下颌骨缺损是口腔颌面部最常见的硬组织缺损,多由于外伤、感染、颌面部肿瘤累及下颌骨需行手术切除以及头颈部恶性肿瘤放射治疗等所造成。由于下颌骨在维持面下部外形、发挥口腔功能上发挥着极其重要的作用,如不及时修复,影响患者正常的生活和社会交往,给患者带来巨大的心理压力。因此,重建下颌骨的外形及功能,对提高该类患者的生存质量有着重要的意义。理想的口腔下颌骨修复至少应包括以下几个方面:接近正常的外形,正常的牙列及咬合,正常的吞咽功能,良好的咀嚼功能,正常的语音功能等等。另外,理想的修复方法还应该快速简便、安全可靠,并且…     

小切口自体髂骨骨松质修复牙槽嵴裂及口鼻瘘的临床研究

目的：分析小切口自体髂骨骨松质修复牙槽嵴裂的手术方法及影响植骨成功的因素。方法：对同一术者所行牙槽嵴裂植骨术的唇腭裂患者22例进行临床研究，所有患者均有术前及术后6个月以上的完整资料。探讨植骨区X线影像的临床分级与手术年龄、手术类型、裂隙类型类型等的关系。结果：植入骨成活率95.8％，临床成功率为91.7％；（2）18岁以上年龄组、完全性唇腭裂组、双侧唇腭裂组患者植骨的临床成功率相对较低；（3）本组病例均采用小切口，以骨移植用圆筒形取骨器切取髂骨骨松质，局部创伤小，术后疼痛轻。结论：以骨移植用圆筒形取骨器通过小切口自体髂骨骨松质是进行牙槽嵴裂植骨的一种良好方法。（2）良好植骨床的形成和植骨区无张力的严密缝合是保证牙槽嵴裂植骨成功的关键；植骨时机是植骨成功是否的重要因素；（3）牙槽嵴裂的植骨效果与手术年龄、裂隙类型、裂侧类型等有关。     

自体肋骨游离移植修复重建下颌骨缺损

目的：探讨自体肋骨游离移植修复下颌骨缺损的疗效。方法：按常规切除病变的下颌骨部分,根据缺损长度取自体肋骨游离移植修复下颌骨缺损。结果：自体肋骨游离移植修复下颌骨缺损17个病例中,16例恢复良好,1例轻度感染,经治疗后痊愈。结论：自体肋骨游离移植修复下颌骨缺损是一种理想的方法,可以恢复面部外形及功能。     

Augmentation of exposed implant threads with autogenous bone chips: prospective clinical study

Background: Autogenous bone chips can be harvested during drilling of implant sites and may be used as a graft material for bone augmentation and coverage of exposed implant threads. Purpose: The aim of this prospective study was to evaluate the possibility of augmenting exposed implant threads with autogenous bone chips. Materials and Methods: Twenty‐one consecutive patients treated with screw‐shaped oral implants with exposed threads due to buccal fenestration or marginal defects were augmented with autogenous bone harvested with a bone trap during drilling of the implant site. Both marginal (9 sites) and fenestration defects (12 sites), with 4 to 14 exposed implant threads, were registered clinically and with photography. The number of exposed implant threads was measured before and at second‐stage surgery 6 months after augmentation. Results: Complete bone coverage of the exposed implant threads was seen in 12 of the 21 implant sites. Six sites showed one to two remaining exposed threads, two showed about 40% coverage, and one showed flattening of the defect but with eight of nine exposed threads at 6 months follow‐up. The mean bone gain was 81% in patients with a marginal defect and 82% in patients with a fenestration defect. Conclusion: The results from this clinical study show that it is possible to gain bone over exposed implant threads by augmentation with autogenous bone chips. Conclusion It is concluded that it is possible to achieve coverage of exposed implant threads by augmentation with autogenous bone chips harvested during drilling of implant sites.     

A comparison of autogenous bone graft combined with deproteinized bovine bone and autogenous bone graft alone for treatment of alveolar cleft

This study assessed the use of composite autogenous bone and deproteinized bovine bone (DBB) for repairing alveolar cleft compared with autogenous bone alone in terms of clinical outcomes and patient morbidity. 30 patients with a mean age of 10.2 ± 1.7 years were randomly divided into two groups. Group I used autogenous cancellous bone graft harvested from the anterior iliac crests by the conventional trapdoor approach. Group II used a composite of DBB and autogenous cancellous bone harvested by a trephine bone collector; the proportion of 1:1 by volume was used. The bone graft quantities of both groups decreased with time. Their average changes were not statistically different over 24 months after grafting. The canines of both groups could spontaneously or orthodontically erupt through the grafting areas. Patients in group II recovered from uncomfortable walking significantly faster than those in group I (p < 0.05) and their duration of hospital stay was significantly shorter than those in group I (p < 0.05). The average operation time, intra-operative blood loss and postoperative pain were less in group II than in group I (p > 0.05).     

Alveolar ridge reconstruction with titanium mesh and autogenous particulate bone graft: computed tomography-based evaluations of augmented bone quality and quantity

Purpose: The purpose of this study was to evaluate the quality and quantity of augmented bone following alveolar ridge reconstruction with titanium mesh and autogenous particulate bone graft for implant placement in terms of the preoperative bone defect. Materials and Methods: Forty‐one patients (50 sites) rehabilitated between September 2000 and May 2009 with autogenous particulate intraoral bone or iliac cancellous bone marrow grafts and micro‐titanium meshes were enrolled. We classified the bone defects by means of shape as complex horizontal–vertical (HV), horizontal (H), and socket (S) types, and the augmented bone was evaluated based on preoperative computed tomographic data. The postsurgical complications were assessed during the healing period and after implant superstructure placement. Results: The bone defects were successfully augmented using the titanium mesh technique. The HV‐type defect was the most difficult to augment (mean horizontal gain, 3.7 ± 2.0 [SD] mm; mean vertical gain, 5.4 ± 3.4 [SD] mm). The mean horizontal gain with the H‐type defect was 3.9 ± 1.9 mm. The S‐type defect achieved the most efficient bone augmentation (mean horizontal gain, 5.7 ± 1.4 [SD] mm; mean vertical gain, 12.4 ± 3.1 [SD] mm). The major postsurgical complications were mesh exposure, infection, total or partial bone resorption, and temporary neurological disturbances. Implant failure was observed in one case. The HV‐type defect showed significantly higher bone resorption (p < .05) than the other defect types. Conclusions: Autogenous bone grafting with titanium mesh allows adequate vertical and horizontal alveolar bone reconstruction both quantitatively and qualitatively for implant placement. However, the clinical outcome of augmentation depends on the type of preoperative bone defect.     

自体牙骨粉与异种牛骨粉修复牙槽骨缺损的对比研究

目的 对比拔牙后牙槽窝内填塞自体牙骨粉与异种牛骨粉的成骨效果,为临床应用提供实验依据。方法 全身麻醉下拔除12只雄性大白兔双侧上颌中切牙,随机分为3组,每组4只。每组动物中有3只为实验组,1只为空白对照组。实验组中选择动物的左侧中切牙牙槽窝植入异种牛骨粉,右侧中切牙牙槽窝中植入自体牙骨粉;空白对照组只拔除牙齿,不植入任何骨粉。4、8、12周后分别处死3组实验动物,通过免疫荧光染色观察新生骨组织矿化程度,通过组织学观察新生骨形成情况。结果 术后4、8、12周,自体牙骨粉组的矿化沉积率均大于异种牛骨粉组,差异均有统计学意义（P<0.05）;异种牛骨粉组的骨小梁较自体牙骨粉组稀疏、纤细,编织骨较多,板层骨较少,骨增量少于自体牙骨粉组。结论 作为骨移植材料,自体牙骨粉较异种牛骨粉在成骨方面更具有优势。     

慢速法制备种植体窝洞原位取骨的临床疗效评价

目的:牙缺失后,牙槽骨存在不同程度的吸收,给后期的种植治疗造成不利的影响。由于自体骨是修复骨缺损的最佳植入材料,目前,临床上常用的种植体窝制备方法是在不同的种植体窝制备阶段使用不同的转速,且需要全程冲水以防止产生过热的温度,切屑的骨组织被水冲走而流失,如需要收集这部分自体骨需要特别的器械,效果却并不好。因此,我们对需要植骨的种植患者,通过用常规钻慢速法(<50rpm)制备种植体窝,制备过程中不冲水,收集自体骨。本研究评价常规钻慢速法制备种植体窝在产热,种植体骨整合等方面的影响以及收集的自体骨的临床应用疗效。材料和方法:52例患者接受种植治疗,共植入136颗种植体。其中ITI28颗,OSSTEM83颗,Anyklos25颗。常规法52颗,慢速法84颗。慢速法中44颗种植体窝制备完后用生理盐水冲洗种植体窝,40颗不冲洗。慢速法制备种植体窝过程中收集的自体骨以全部自体骨,人工骨粉与自体骨混合物及先在种植体表面填入自体骨再在自体骨表面覆盖人工骨粉的"三明治"技术三种不同的运用方法用于修复骨缺损。术后疗效评价包括临床观察和X线,全景片,CBCT等检查。结果:134颗植入种植体成功,60颗已行上部结构修复,74颗未行上部结构修复。术后拆线时观察130颗种植体伤口一期愈合(伤口无明显炎症,种植体无暴露),4颗种植体伤口有炎症但无种植体暴露。术后6～12月观察种植体无松动,术区软硬组织无炎症。X线检查种植体与骨结合良好,种植体颈部无明显骨吸收,与常规法无差异。有2颗种植体失败,一例种植体松动,一例种植体有暴露。收集的自体骨修复骨缺损效果良好,一例全部以自体骨修复骨缺损时效果不佳。结论:慢速法制备种植体窝的优点明显,不仅可以收集自体骨用来修复骨缺损或上颌窦提升,而且在疏松骨质的种植术中可以更好的控制方向和力量。收集的自体骨量:I类骨>II类骨>III类骨>IV类骨。常规钻慢速法制备种植体窝在产热,骨整合与常规法无明显差异。     

Treatment of severe peri‐implant bone loss using autogenous bone and a resorbable membrane. Case report and literature review.

Clinical case reports and animal studies have demonstrated that the principle of guided bone regeneration can be applied for surgical treatment of moderate to profound peri‐implant bone loss (peri‐implantitis). However, the degree of bone regeneration within the peri‐implant osseous defect was reported to be variable depending on different clinical factors and on the postoperative course. Most papers dealing with surgical treatment of peri‐implantitis advocate the use of a non‐resorbable ePTFE membrane for secluding the peri‐implant bone defect enabling bone regeneration. Additionally some surgeons fill the defects with allografts or alloplasts. The present case report demonstrates another surgical approach by using autogenous cancellous bone for grafting into the peri‐implant bone defect and placing a bioresorbable polylactide membrane as a matrix barrier. The successful out‐come of this modified surgical approach enabled the patient to maintain the implant for prosthetic reconstruction after early but severe bone loss.     

动脉蒂植入自体游离移植骨再血管化的实验研究

目的研究动脉蒂植入非血管化自体骨后移植骨血管再生的情况。方法将36只大白兔双侧桡骨部分截断,剥离骨膜,分别植入双侧咬肌区,其中一侧将远端结扎的颌外动脉蒂植入游离桡骨骨髓腔作为实验侧,另一侧单纯移植作为对照侧。术后3 d、1周、2周、3周、4周、6周处死动物取材,通过组织学检查、血管墨汁灌注、CD34免疫组化染色检测移植骨微血管密度（MVD）,观察移植骨的再血管化情况。结果实验侧术后3 d,对照侧术后2周移植骨出现再血管化。术后3 d、1周、2周、3周、4周,实验侧移植骨的再血管化程度高于对照侧;术后4周,实验侧再血管化程度达到高峰。结论动脉蒂植入非血管化自体骨的方法具有促进移植骨血管生成的作用。     

外斜线取骨自体骨移植及其他牙槽嵴骨增量法的研究进展

针对严重骨缺损且有种植修复意向的牙列缺损位点，自体骨移植是实现种植体三维方向充足骨量的“经典方案”，常用的口内供骨区有颏部和外斜线区域。相比颏部取骨，下颌骨外斜线取骨移植后神经并发症少，但跟其他牙槽嵴骨增量方式相比，术后骨吸收率大。本文重点讲述下颌骨外斜线块状取骨及其局限性，并阐述了其他临床应用广泛的牙槽骨增量方法，对比移植骨术后牙槽嵴宽度及高度变化、术后骨吸收率，为临床提供减小外斜线块状取骨局限性的其他骨增量方法。