部分脱矿异体骨移植修复大块下颌骨缺损的实验研究

实验制备部分脱矿异体骨，用以修复狗下颌骨３ｃｍ长的连续性骨缺损（１４例），并与新鲜自体皮质骨移植（８例）相比较．术后用Ｘ线、四环素荧光标记、血管内墨汁灌注、组织学分析等方法连续观察６个月，并测定骨移植侧下颌骨术后第４月和第６月的机械强度．实验结果表明：部分脱矿异体骨具有较好的组织相容性，其愈合过程与新鲜自体皮质骨移植相同．术后第６月时绝大部分移植骨已被宿主新生骨所替代．仅有小块岛状移植骨残留并与新生骨相互融合．部分脱矿异体骨移植后其机械强度逐渐增高．不易发生疲劳骨折．     

部分脱矿异体骨诱导玻璃陶瓷表面成骨的实验研究

本实验用块状生物活性玻璃陶瓷复钛网及部分脱矿异体骨修复犬下颌骨４－５ｃｍ长的节段性缺损（６例）并与单纯用块状生物活性玻璃陶瓷移植复相比较。     

bFGF复合部分脱矿异体骨修复兔下颌骨缺损的实验研究

目的探讨bFGF（basic fibroblast growth factor，碱性成纤维细胞生长因子）复合部分脱矿冻干辐照异体骨在修复下颌骨缺损中的应用。方法在21例兔双侧下颌骨缺损模型中，按照完全随机原则，一侧选用bFGF复合部分脱矿冻干辐照异体骨修复骨缺损，作为实验组；另一侧单纯以部分脱矿冻干辐照异体骨修复，作为对照组。术后3、6、12周分别处死7只实验动物，对标本进行大体观察、X线片观察、组织学病理切片镜下观察。依据Lane—Sandhu X线评分标准和Lane—Sandhu组织学评分法，对X线片观察结果和组织学病理切片镜下观察结果进行量化和统计学处理。结果实验组和对照组手术创口均为一期愈合，宿主对移植物未发生排斥反应。术后不同时期，实验组新生血管的量、新生纤维组织及纤维母细胞、类骨质等均较对照组多。经对X线片和病理切片进行评分，并对评分数据统计分析，实验组和对照组评分结果有显著性差异（P〈0.01）。结论bFGF可促进异体骨植骨区骨质形成。     

同种异体冻干下颌骨移植修复下颌骨缺损的临床应用

目的：探讨同种异体冻干下颌骨移植修复下颌骨缺损的可行性，并讨论其抗原性、生物力学特性、骨愈合机制及优缺点。方法：对进行同种异体冻干下颌骨移植修复下颌骨大节段肿瘤切除后缺损和颞下颌关节移植置换的7例患者进行随访研究，根据临床检查及X线片对手术效果进行评估。结果：手术切口均一期愈合，未发生排斥反应及骨折现象，移植骨愈合良好，外形及功能恢复满意。结论：同种异体冻干下颌骨移植是修复下颌骨大节段肿瘤性缺损和颞下颌关节移植置换的可行方法。     

异体部分脱矿骨在颌面部骨缺损中的临床应用

应用异体部分脱矿骨对１０例颌面部骨缺损的患者进行修复。通过１￣２４个月随访观察，Ｘ线片或ＣＴ片显示：１年后植骨区均为正常骨组织修复。患者面形对称，复视及眼球运动障碍消失。镶牙后咀嚼力恢复良好，无并发症。临床实践表明：异体部分脱矿骨具有组织相容性好，骨诱导能力强、机械强度高，易修剪塑形的优点。其移植修复后，面形恢复好、牙槽嵴高度恢复满意，是颌面部骨缺损修复的较理想材料，尤其适用于下颌骨大块骨缺损的修     

下颌骨部分缺损的修复研究

目的 比较自体肋骨、自体髂骨、同种异体骨修复下颌骨部分缺损的效果.方法 对25例下颌骨体部或颏部节断性缺损患者进行Ⅰ期修复,其中8例用自体肋骨修复, 10例用自体髂骨修复, 7例用同种异体骨修复.结果 2例用肋骨修复后伤口出现感染并瘘管形成,抗炎、冲洗、碘仿纱条填塞治疗2个月后伤口愈合; 2例用同种异体骨修复后出现排斥反应,需取出同种异体骨;其余21例均Ⅰ期愈合.结论 下颌骨部分缺损后若能选择合适的植骨方法,就能达到理想的治疗效果.     

异体脱矿骨修复创伤性眶底缺损

应用异体脱矿骨对１２例病人进行创伤性眶底缺损的修复．在６－４３个月的观察随访中，８例进行了Ｘ片或ＣＴ检查，结果显示眶底和眶侧壁缺损为正常骨质所修复；临床检查复视和眼球下陷得到矫治，眼球运动功能无异常，无—例出现并发症．临床应用及结果表明，异体脱矿骨具有良好的组织相容性、诱导产生新骨及眶底骨缺损修复的能力，并具有使用方便、塑形容易等优点．因此认为，异体脱矿骨适用于创伤性眶底缺损的修复．     

血管化骨移植修复下颌骨缺损的研究

下颌骨的修复问题一直吸引着广大头颈外科医师进行不断地探索和研究,下颌骨的修复既要求有良好的外形,又要求能较好地恢复咀嚼、发音、吞咽等口腔功能。早在１８６０年Ｏｌｉｖｅｒ就对骨再生及骨移植等问题进行了探讨,之后相继出现了异种骨、异体骨、自体骨及人工骨移...     

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。     

多孔状生物微晶玻璃修复下颌骨缺损的实验研究

目的:探讨多孔状生物微晶玻璃植入实验兔下颌骨缺损中引导骨形成的作用,为骨组织的修复与重建筛选一种良好的骨移植替代材料。方法:12只成年新西兰大白兔,随机分为4组,每兔两侧下颌骨均制作1.0cm×0.8cm大小的贯通性骨缺损,实验侧植入多孔状生物微晶玻璃材料,对照侧植入自体骨骼。术后第2、4、8、12周时,分别处死一组动物,对标本进行影像学、组织学及扫描电镜检查,观察颌骨缺损处的成骨情况。结果:多孔状生物微晶玻璃植入体内后,并不引起明显的排斥反应,缺损周围类骨组织逐渐长入材料周边孔隙,并逐渐矿化成骨,术后12周时,材料与周围组织形成牢固的骨性连接。结论:多孔状生物微晶玻璃具有较强的修复骨缺损的能力,是一种较好的骨移植替代材料。     

种植体周围炎导致骨缺损的再结合研究

目的探索种植体周围炎症所致骨缺损的治疗方法,从组织学角度评价治疗后种植体周围骨再生和再结合情况。方法Beagle犬5条,双侧下颌植入标准型Br nemark种植体30颗,建立种植体周围炎骨缺损模型,随机分组进行治疗(1)单纯去除种植体周围炎性肉芽组织;(2)植入不可吸收生物膜;(3)生物膜 骨粉植入;(4)生物膜 生物活性玻璃植入。采用X线和手术直接测量以及荧光标记组织切片和不脱钙硬组织切片,观察种植体周围骨量。采用SPSS12.0软件对数据作方差分析。结果直观测量种植体周围骨量、X线测量骨接触水平、组织学测量矿化沉积率,各组间有显著性差异,P<0.05。骨粉植入组,种植体周围能形成较多的新生骨。结论炎症导致的种植体周围骨缺损,可通过治疗手段达到缺损骨的再生。     

珊瑚、异体脱钙骨、自体骨髓复合可注射骨替代物异位成骨的研究

目的 :检验珊瑚 (NC)、异体脱钙骨基质 (DBM )、自体骨髓 (AM )复合可注射骨替代材料的异位诱导成骨能力。方法 :将 2 4只新西兰兔随机分为 4组 ,分别在背部皮下注射NC/DBM /AM、NC/DBM、NC/AM、NC ,术后 2、4周取材 ,通过X线、组织学检查、碱性磷酸酶 (ALP)测定 ,进行比较观察。结果 :X线、组织学检查结果均表明NC/DBM /AM组有较多新骨形成 ,NC/AM组诱导出少量骨 ,NC/DBM组仅见微量软骨和骨新生 ,NC组未见新生骨。NC/DBM /AM组ALP水平较NC/DBM组、NC/AM组、NC组高 ,统计学上具有显著性差异 (P <0 .0 1)。结论 :NC/DBM /AM复合可注射骨替代材料具有良好的骨诱导性和临床应用价值     

富血小板血浆与脱矿冻干骨联合应用治疗牙周骨缺损的meta分析

目的: 从临床和影像学两方面系统评价富血小板血浆（platelet rich plasma,PRP )与脱矿冻干骨（demineralized freeze-dried bone allografts, DFDBA）联合应用治疗牙周骨内缺损的临床疗效。方法: 计算机检索Pubmed、The Cochrane Library、EMbase、中国知网、万方及维普数据库,检索PRP与DFDBA联合应用与PRP或DFDBA单独使用治疗牙周骨内缺损的随机对照试验（RCT),检索时限均从建库至2016年12月。由2名研究员按照纳入和排除标准独立筛选文献、提取资料,评价纳入研究的方法学质量。采用RevMan 5.2 软件进行统计学分析。结果: 最终纳入6个RCT,205个牙周骨内缺损位点。6个研究结果显示,牙周基础治疗后,PRP与DFDBA联合应用组与PRP或DFDBA组的探诊深度（probing depth, PD）改变量差异无统计学意义[MD=0.35,95%CI（-0.09,0.79),P=0.12],而临床附着丧失（clinical attachment loss,CAL）改变量2组间差异显著[MD= 0.68,95%CI（0.41,0.94）,P<0.00001]。有3个研究从影像学方面评估了治疗后骨充盈的改变量,其中釉-牙骨质界到牙槽骨缺损底部间距离(CEJ-BD)的改变量2组间差异显著[MD=0.71,95%CI（0.46,0.95）,P<0.00001];牙槽嵴缺损顶点到缺损底部间距离(AC-BD)的改变量2组间差异具有显著性[MD=0.64,95%CI（0.41,0.87),P<0.00001];而釉-牙骨质界到牙槽嵴缺损顶点的距离的改变量（CEJ-AC)2组间差异无显著性[MD=0.03,95%CI（-0.10,0.16),P=0.68]。结论: 现有研究证据表明,在牙周基础治疗后,PRP与DFDBA联合应用治疗牙周骨缺损在附着丧失和骨充盈上优于单用PRP或DFDBA组,而探诊深度无显著差异。受纳入研究数量及质量的限制,上述研究需要更多高质量、大样本的研究予以证实。     

Healing around implants placed in bone defects treated with Bio‐Oss®. An experimental study in the dog.

The aim of the present experiment was to (i) study the healing after 3 and 7 months of bone defects filled with cancellous bovine bone mineral and (ii∥ compare the healing around implants placed in normal bone and in defects filled with bovine bone mineral. 5 beagle dogs, about l-year-old, were used. At baseline, extractions of all mandibular left and right premolars were performed. Bone defects were prepared in the left mandibular quadrant. The defect was immediately filled with natural bovine cancellous bone mineral particles (Bio-Oss®, Geistlich Sons Ltd. Wolhusen, Switzerland). No resective surgery was performed in the right jaw quadrant. In both quadrants the flaps were adjusted to allow full coverage of the edentulous ridge and sutured. 3 months later, 2 dogs (group I) were euthanized and biopsies from the premolar regions obtained and prepared for histologic analysis. The 3 remaining dogs (group II) were at this time interval (3 months) subjected to implant installation in the premolar region of both the right and left mandibular jaw quadrants. 2 fixtures of the ITI Dental Implant System (Straumann, Waldenburg, Switzerland; solid-screw; 8 x 3.3 mm) were installed in each side. The fixtures in the test side were placed within the previously grafted defect area, while the fixtures in the control side were placed in normally healed extraction sites. A 4 month period of plaque control was initiated. At the end of this period, a clinical examination including assessment of plaque and soft tissue inflammation was performed and radiographs obtained from the implant sites. Biopsies were harvested and 4 tissue samples were yielded per dog, each including the implant and the surrounding soft and hard peri-implant tissues. The biopsies were processed for ground sectioning or “fracture technique” and the sections produced were subjected to histological examination. The volume of the hard tissue that was occupied by clearly identified Bio-Oss® particles was reduced between the 3- and 7-month intervals. This indicates that with time, Bio-Oss® becomes integrated and subsequently replaced by newly formed bone. In other words, this xenograft fulfils the criteria of an osteoconductive material. It was also observed that 4 months after implant installation, the titanium/hard tissue interface at test and control sites exhibited, from both a quantitative and qualitative aspect, a similar degree of “osseointegration”.     

Clinical results of alveolar ridge augmentation with mandibular block bone grafts in partially edentulous patients prior to implant placement

A group of 15 partially edentulous patients who needed alveolar ridge augmentation for implant placement, were consecutively treated using a two-stage technique in an outpatient environment. A total of 18 alveolar segments were grafted. During the first operation bone blocks harvested from the mandibular ramus or symphysis were placed as lateral or vertical onlay grafts and fixed with titanium osteosynthesis screws after exposure of the deficient alveolar ridge. After 6 months of healing the flap was re-opened, the screws were removed and the implants placed. Twelve months after the first operation implant-supported fixed bridges could be provided to the patients. Mean lateral augmentation obtained at the time of bone grafting was 6.5 +/- 0.33 mm, that reduced during healing because of graft resorption to a mean of 5.0 +/- 0.23 mm. Mean vertical augmentation obtained in the 9 sites where it was needed was 3.4 +/- 0.66 mm at bone grafting and 2.2 +/- 0.66 mm at implant placement. Mean lateral and vertical augmentation decreased by 23.5% and 42%, respectively, during bone graft healing (before implant insertion). Mandibular sites showed a larger amount of bone graft resorption than maxillary sites. All the 40 implants placed were integrated at the abutment connection and after prosthetic loading (mean follow-up was 12 months). No major complications were recorded at donor or recipient sites. Soft tissue healing was uneventful, and pain and swelling were comparable to usual dentoalveolar procedures. A visible ecchymosis was present for 4 to 7 days when the bone was harvested from the mandibular symphysis. From a clinical point of view this procedure appears to be simple, safe and effective for treating localised alveolar ridge defects in partially edentulous patients.     

The effect of demineralized intramembranous bone matrix and basic fibroblast growth factor on the healing of allogeneic intramembranous bone grafts in the rabbit

The aim here was to explore a new graft material that excludes the need to harvest autogenous bone from patients. Forty-two critical-size (10×15 mm) defects were created in rabbit mandibles bilaterally. Five groups of six defects each were grafted with autogenous endochondral (EC) bone, autogenous intramembranous (IM) bone, fresh-frozen allogeneic IM bone only, fresh-frozen allogeneic IM bone and demineralized bone matrix powder prepared from intramembranous bone (DBM_IM) only, and fresh-frozen allogeneic IM bone and basic fibroblast growth factor (bFGF) mixed with DBM_IM powder. The remaining defects were used as controls. Three weeks after surgery, the defects were retrieved for histological analysis. The amount of new bone formation was quantified by image analysis. No bone formed across the defect in the controls; 224% more new bone formed in defects grafted with composite allogeneic IM bone/DBM_IM than in those grafted with allogeneic IM bone alone (p<0.001); 550% more new bone was formed in defects grafted with composite allogeneic IM bone/DBM_IM/bFGF than in those grafted with allogeneic IM bone alone (p<0.001). The amount of new bone in the group receiving composite allogeneic IM bone/bFGF/DBM_IM was more than that in autogenous EC bone group, and very close to that in autogenous IM group. The results show that a composite of fresh-frozen allogeneic IM bone and bFGF in DBM_IM powder is a good graft material that warrants further clinical investigation.