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颌骨囊肿是临床上比较常见的造成颌骨缺损的疾病,手术摘除颌骨囊肿后所遗留的骨性空腔往往使得创口延期愈合或出现继发性感染[1]。颌骨缺损修复多采用囊腔植骨术和生物材料置入术,但是植骨术的骨来源大多为自体骨,需要开辟第二术区,给病人造成额外痛苦,生物材料置入也会存在一定的排异反应和感染风险[2]。近年来,我科使用富血小板纤维蛋白(platelet-rich fibrin, PRF)联合Bio-Oss骨粉修复颌骨囊肿术后骨缺损取得了良好的临床疗效,现作报道。
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术后2组病人随访观察3~12个月。其中观察组病人术后7 d创口均达到Ⅰ期愈合,CBCT影像学观察病人骨缺损空腔内的充填材料随着时间推移与新生骨及周围骨组织生长良好,可见植骨区与周围正常骨组织的界限和密度逐渐接近,颌骨囊肿术后骨缺损大小范围较术前明显缩小。对照组存在1例病人术后7 d创口轻度糜烂红肿,但未见充填材料排异溢露,经积极抗感染治疗5 d后好转,CBCT影像学观察相比较,术前2组病人骨缺损区骨密度值均较低,差异无统计学意义(P>0.05);观察组术后3、6、12个月骨缺损区骨密度均高于对照组,差异均有统计学意义(P < 0.05~P < 0.01)(见表 1)。
分组 术前 术后3个月 术后6个月 术后12个月 观察组 115.74±22.74 503.46±40.13 587.82±31.83 702.36±30.23 对照组 110.94±20.19 405.24±29.72 461.03±28.87 547.36±35.87 t 0.67 8.34 11.63 14.02 P >0.05 < 0.05 < 0.05 < 0.01 表 1 2组病人骨缺损区骨密度平均值比较(x±s;Hu)
富血小板纤维蛋白联合Bio-Oss骨粉修复颌骨囊肿术后骨缺损的疗效
Effects of platelet-rich fibrin combined with Bio-Oss bone substitute in the repair of postoperative bone defect of jaw cyst
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摘要:
目的观察使用富血小板纤维蛋白(platelet-rich fibrin, PRF)联合Bio-Oss骨粉修复颌骨囊肿术后骨缺损的临床疗效。 方法选取颌骨囊肿术后存在一定大小范围的骨缺损病人共36例作为研究对象,随机分为2组,各18例。对照组病人单纯使用Bio-Oss充填修复骨缺损;观察组病人使用PRF联合Bio-Oss充填颌骨囊肿造成的骨缺损空腔。所有病人术后分别于3、6、12个月进行定期随访观察,通过CBCT影像学检查测量骨密度值评估临床疗效。 结果观察组颌骨囊肿术后伤口愈合良好,对照组有1例术后7 d创口出现轻度糜烂红肿,未见充填材料排异反应。影像学检查显示观察组较对照组病人颌骨缺损空腔内的充填材料随着时间推移与新生骨及周围骨组织生长良好,能够达到临床满意的骨组织修复效果。观察组术后3、6、12个月骨缺损区骨密度均高于对照组,差异均有统计学意义(P < 0.05~P < 0.01)。 结论PRF联合Bio-Oss骨粉可有效提高颌骨囊肿术后骨缺损的成骨疗效。 Abstract:ObjectiveTo observe the clinical efficacy of platelet-rich fibrin(PRF) combined with Bio-Oss bone substitute in the repair of postoperative bone defect of jaw cyst. MethodsA total of 36 patients with bone defects in a certain range after maxillary cyst surgery were randomly divided into the control group and observation group(18 cases in each group).The control group was treated with Bio-Oss filling to repair bone defects, and the observation group was treated with PRF combined with Bio-Oss filling to repair the cavity of bone defect caused by jaw cyst.All patients were regularly followed up for 3, 6 and 12 months after surgery, and the CBCT imaging was used to measure bone mineral density to evaluate the clinical efficacy. ResultsThe wounds of jawbone cyst in the observation group healed well after surgery, 1 case with mild erosion and redness in the control group was identified after 7 days of surgery, and no rejection reaction of filling material was be observed.The results of imaging examination showed that compared with the control group, the filling materials in the cavity of jaw defect in the observation group grew well with the new bone and surrounding bone tissue over time, and the bone tissue repair effect could achieve clinical satisfactory.The bone mineral density in observation group was higher than that in control group at 3, 6 and 12 months after surgery(P < 0.05 to P < 0.01). ConclusionsThe PRF combined with Bio-Oss bone substitute can effectively promote the osteogenic effect of bone defect after maxillary cyst surgery. -
Key words:
- jaw cyst /
- platelet-rich fibrin /
- Bio-Oss bone substitute /
- bone defect
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表 1 2组病人骨缺损区骨密度平均值比较(x±s;Hu)
分组 术前 术后3个月 术后6个月 术后12个月 观察组 115.74±22.74 503.46±40.13 587.82±31.83 702.36±30.23 对照组 110.94±20.19 405.24±29.72 461.03±28.87 547.36±35.87 t 0.67 8.34 11.63 14.02 P >0.05 < 0.05 < 0.05 < 0.01 -
[1] ZHANG ZY. Oral and maxillofacial surgery[M]. 7th ed. Beijing: People's Medical Publishing House, 2012: 177. [2] ZHOU J, DU RH. Assessment on the treatments for cyst of the jaws[J]. J Oral Maxillofac Surg, 2012, 22(4): 229. [3] CHIAPASCO M, ROSSI A, MOTTA JJ, et al. Spontaneous bone regeneration after enucleation of large mandibular cysts: a radiographic computed analysis of 27 consecutive cases[J]. J Oral Maxillofac Surg, 2000, 58(9): 942. doi: 10.1053/joms.2000.8732 [4] AKRAM M, FAROOQ FM, SHAHZAD ML, et al. A comparison of treating unicameral bone cyst using steroids and percutaneous autologous bone marrow aspiration injection[J]. J Pak Med Assoc, 2015, 65(11 Suppl 3): S156. [5] 王国世, 李韶伟, 蔡露. 牙种植采用引导骨再生术Bio-oss吸收的定量分析[J]. 上海口腔医学, 2012, 21(3): 317. [6] SIVOLELLA S, BRESSAN E, SALATA LA, et al. Deproteinized bovine bone mineral particles and osseointegration of implants without primary bone contact: an experimental study in dogs[J]. Clin Oral Implants Res, 2014, 25(3): 296. doi: 10.1111/clr.12154 [7] AMIT A. Evolution current status and advances in application of platelet concentrate in periodontics and implantology?[J]. World J Clin Cases, 2017(5): 159. [8] DOHAN DM, CHOUKROUN J, DISS A, et al. Platelet-rich fibrin(PRF): a second-generation platelet concentrate. Part Ⅲ: leucocyte activation: a new feature for platelet concentrates[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2006, 101(3): e51. doi: 10.1016/j.tripleo.2005.07.010 [9] 方冬冬, 后军, 杨全全, 等. 富血小板纤维蛋白复合骨诱导在颌骨缺损中的应用疗效[J]. 安徽医学, 2016, 37(7): 868. [10] 周延民, 付丽. 富血小板纤维蛋白在口腔软硬组织再生中的作用——回顾与展望[J]. 口腔医学, 2018, 38(11): 961. [11] SHAH R, THOMAS R, MEHTA DS. An update on the protocols and biologic actions of platelet rich fibrin in dentistry[J]. Eur J Prosthodont Restor Dent, 2017, 25(2): 64. [12] AZITA T, HOSSEIN B, FEREYDOUN P, et al. The effect of autologous leukocyte platelet rich fibrin on the rate of orthodontic tooth movement: a prospective randomized clinical trial[J]. World J Clin Cases, 2017(5): 159. [13] DEYHIMI P, RAZAVI SM, SHAHNASERI S, et al. Rare and extensive malignant melanoma of the oral cavity: report of two cases[J]. J Dent (Shiraz), 2017, 18(3): 227. [14] RAY H, MARCELINO J, BRAGA R, et al. Long-term follow up of revascularization using platelet-rich fibrin[J]. Dental Traumatol, 2016, 32(1): 80. [15] BORIE E, OLIVI D, ORSI IA, et al. Platelet-rich fibrin application in dentistry: a literature review[J]. Int J Clin Exp Med, 2015, 8(5): 7922.