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颌骨囊肿是发生于颌骨的含有液体或半固体物质的病理性(或异常的)囊性肿物,常内衬上皮,并以牙源性颌骨囊肿(odontogenic cyst,OC)最多见[1]。颌骨囊肿摘除术是治疗OC的常用方法,且是大多数骨内、骨外囊肿的首选方法,术后遗留的无效腔,常致创口延期愈合[2]。OC摘除术为完全清除病灶,常将暴露于囊腔内的牙根尖切除,这减少了受累牙的骨内根长度,不利于患牙的稳固及后期修复。Bio-oss骨粉及海奥生物膜已广泛用于各种颌骨缺损的引导骨组织再生(guided bone regeneration,GBR)[3-4]。本研究拟在术中保留囊肿累及牙根尖,放置Bio-oss骨粉包埋骨腔内牙根面并联合海奥生物膜阻挡上皮组织干扰植骨区的愈合,旨在保留松动患牙、加速松动牙的稳固并为后期种植等修复工作打下基础。
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术后2组病人伤口均无感染且愈合良好,A组未出现生物膜暴露,骨粉流失等症状;术后6个月,2组病例均无复发症状且移位膨隆软硬组织基本恢复至正常解剖结构。术前2组受累牙数和囊肿所致丧失正常功能牙数差异均无统计学意义(P>0.05)(见表 1)。2组病人术后3、6、12个月复查丧失功能患牙恢复情况差异均有统计学意义(P<0.01),术后6个月及12个月后恢复情况均优于与术后3个月(P<0.01);且A组丧失功能患牙恢复数及恢复百分比均优于B组(P<0.01)(见表 2)。
分组 n 受累牙数 丧失正常功能牙数 A组 15 3.00±0.93 2.07±0.70 B组 40 3.60±1.08 2.40±0.90 t — 1.90 1.67 P — >0.05 >0.05 表 1 2组受累牙数和丧失正常功能牙数比较(x±s)
分组 n 术后3个月 术后6个月 术后12个月 F P MS组内 恢复正常数 A组 45 1.53±0.64 1.87±0.52* 2.00±0.67** 7.04 <0.01 0.376 B组 144 1.05±0.45 1.56±0.60** 1.68±0.57** 54.47 <0.01 0.296 t — 4.68# 3.12 3.15 — — — P — <0.01 <0.01 <0.01 — — — 恢复正常百分比 A组 45 0.79±0.28 0.93±0.14** 0.98±0.09** 12.34 <0.01 0.035 B组 144 0.47±0.23 0.67±0.23** 0.73±0.22** 16.23 <0.01 0.051 t — 7.72 9.18# 11.00# — — — P — <0.01 <0.01 <0.01 — — — 与术后3个月比较*P<0.05,**P<0.01;#示t′值 表 2 术后3、6、12个月2组丧失功能牙恢复正常功能情况比较(x±s)
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A组术后3个月,骨腔内自体血愈合区骨密度增高不明显,成骨较慢;根尖植骨区骨密度明显高于术前,已形成部分新骨,与周围正常骨组织密度差异尚大。术后6个月植骨区骨纹理逐渐形成,可见不甚明显骨腔边界,骨整合有序进行,与自体骨密度尚不契合;自发愈合区成骨开始,但未见明显骨小梁结构,仍可见骨腔透射影像。术后12个月根尖植骨材料基本吸收,骨纹理清晰可见,与周围骨密度接近,基本无明显界限,自发愈合区骨密度较6个月时稍增高,但成骨质量明显差于根尖部,局部仍可见缺损区骨腔与周围骨界限。典型病例见图 1。
根尖保留联合引导骨组织再生在颌骨囊肿术中的应用研究
Application study of apical preservation combined with guided bone regeneration in jaw cyst surgery
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摘要:
目的探讨颌骨囊肿术中采用根尖刮治保留根尖联合应用Bio-oss骨粉/海奥人工生物膜的临床疗效。 方法选取颌骨囊肿病人55例,分为2组,A组(15例)术中行根尖周刮治术保留根尖,用骨粉覆盖牙根暴露于颌骨缺损的部分,并应用生物膜覆盖;B组(40例)行单纯囊肿摘除术+根尖切除术。所有病人术后均随访12个月以上,比较2组病人术前和术后颌骨囊肿累及牙功能恢复、颌骨缺损骨再生及改建情况。 结果A组术后囊肿累及牙恢复正常功能优于B组(P < 0.01),A组根尖植骨区成骨效果优于自体愈合区。 结论颌骨囊肿摘除术中保留根尖联合引导骨再生术疗效较好,效果可靠。 Abstract:ObjectiveTo explore the clinical effects of periapical curettage preservation combined with Bio-oss bone meal/Haiao artificial biomembrane in jaw cyst surgery. MethodsFifty-five patients with jaw cyst were divided into the group A(15 cases) and group B(40 cases).The group A was treated with the periapical curettage preserving the root tip, bone meal covering the lack of part of the root exposed to jaw and biofilm covering.The group B was treated with simple cyst excision combined with apicoectomy.All patients were followed up for more than 12 months.The recovery of tooth function, bone regeneration and reconstruction of jaw defects between two groups before and after operation were compared. ResultsAfter operation, the normal function recovery in cyst involved teeth in group A was faster than that in group B(P < 0.01).The osteogenic effect in bone graft area in group A was better than that in autogenous healing area. ConclusionsThe efficacy of apical preservation combined with guiding bone regeneration in jaw cyst excision is good and reliable. -
Key words:
- jaw cyst /
- apical preservation /
- guided bone regeneration /
- excision
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表 1 2组受累牙数和丧失正常功能牙数比较(x±s)
分组 n 受累牙数 丧失正常功能牙数 A组 15 3.00±0.93 2.07±0.70 B组 40 3.60±1.08 2.40±0.90 t — 1.90 1.67 P — >0.05 >0.05 表 2 术后3、6、12个月2组丧失功能牙恢复正常功能情况比较(x±s)
分组 n 术后3个月 术后6个月 术后12个月 F P MS组内 恢复正常数 A组 45 1.53±0.64 1.87±0.52* 2.00±0.67** 7.04 <0.01 0.376 B组 144 1.05±0.45 1.56±0.60** 1.68±0.57** 54.47 <0.01 0.296 t — 4.68# 3.12 3.15 — — — P — <0.01 <0.01 <0.01 — — — 恢复正常百分比 A组 45 0.79±0.28 0.93±0.14** 0.98±0.09** 12.34 <0.01 0.035 B组 144 0.47±0.23 0.67±0.23** 0.73±0.22** 16.23 <0.01 0.051 t — 7.72 9.18# 11.00# — — — P — <0.01 <0.01 <0.01 — — — 与术后3个月比较*P<0.05,**P<0.01;#示t′值 -
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