同种异体骨骨粉联合PRP与自体髂骨移植在治疗颌骨骨缺损的对比研究

目的　观察和比较同种异体骨骨粉联合PRP与自体髂骨移植在治疗颌骨骨缺损中的疗效和差异。方法：将22例上颌切牙/侧切牙和尖牙区牙缺失、骨缺损患者随机分为A组和B组，各11例。两组患者分别采用PRP联合同种异体骨骨粉或自体髂骨移植填充颌骨骨缺损区域。以1个月、2个月、3个月随访时原缺损区域的CT值数据为依据，对照正常骨质，评价填充区域内骨生长变化情况。在行二期牙种植手术时取骨质行病理分析，评价骨质质量，并测量种植体的ISQ值，了解种植体初始稳定性，评估新生骨对种植体的把持能力和生物力学。结果：在基线资料具有可比性的前提下，A、B两组骨缺损区域植骨术后组内比较的CT值各观察点上数据无统计学意义（A组P=0.98；B组P=0.14），A组CT值高于正常骨质（P=0.02），而B组CT值与正常骨质无显著差异性（P=0.51）。A、B两组牙种植术后的ISQ值比较无统计学意义（P=0.87）。新生骨病理切片提示A组新生骨质和纤维组织错杂，内有较多颗粒状钙化，B组标本为典型的松质骨，纤维组织极少，无钙化杂质夹杂。结论：PRP联合同种异体骨骨粉填充骨缺损可以避免额外有创操作和手术切口，更加容易被临床治疗接受，而自体髂骨移植有更好的组织相容性和骨生长，两种方法成骨在进行牙种植时均体现出良好的生物力学性质，不影响种植体的初始稳定。根据适应症和临床实际需要选择PRP联合同种异体骨骨粉或自体髂骨移植。

Clinical comparative study of PRP combined with allograft bone powder and autogenous iliac bone graft in the treatment of maxillofacial bone defect

Objective　To observe and compare the curative effect and difference of PRP combined allograft bone powder and autogenous iliac bone graft in the treatment of maxillofacial bone defect. Methods: 22 patients with maxillary lateral incisor and canine area of missing teeth and bone defect were randomly divided into A group and B group, 11cases in each. The two groups were treated with PRP combined with allograft bone powder or autogenous iliac bone graft to fill the bone defect area. Based on the CT data, the original defect area were evaluated in 1 months, 2 months and 3 months after the operation. Compared to the normal bone, the changes of bone growth in the filling area were measured. During the second dental implant operation, the bone was taken for pathological analysis, the bone quality was evaluated, and the ISQ value of the implant was measured. The initial stability of the implant was evaluated, and the grasping ability and biomechanics of the new bone to the implant were assessed. Results: Based on the precondition that the baseline data were comparable, in group A and B, the CT value was not statistically significant at all observation points after bone grafting operation(P > 0.05). The new bone CT value of group A was higher than the normal bone(P < 0.05),while the CT value of group B had no significant difference (P > 0.05).The ISQ value, which means initial stability of implants, had no significant difference between the two groups. New bone biopsy showed complex new bone and fibrous tissue with granular calcification in group A, but good quality cancellous bone with very few fibrous tissue and calcified impurities in group B. Conclusion: PRP combined with allograft bone filling bone defects can avoid extra invasive operation and surgical incision, more easily accepted by clinical treatment. Autogenous iliac bone graft has better biocompatibility and bone growth. Two methods of bone in dental implant both reflect good biomechanical properties and do not affect the initial stability of implants. PRP combined with allograft bone powder or autogenous iliac bone graft is selected according to the indications and clinical practice.