应用自体肋骨异位预构血管化下颌骨的实验研究
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摘要
由于肿瘤切除、炎症及创伤等原因造成的下颌骨缺损,可以导致咬合关系错乱、咀嚼功能降低、下颌偏斜等一系列问题,给患者带来较大的生理和心理负担,因此近年来对于下颌骨缺损的修复方法一直是研究热点,从血管化、非血管化骨移植到金属替代物、反求技术、组织工程技术等,希望可以寻求一种简便、安全、功能恢复好、创伤小的修复方式。目前下颌骨缺损修复方法主要是血管化或非血管化自体骨移植,其主要缺点是造成二次创伤和继发畸形。近年来,组织工程在骨缺损的基础与临床研究中取得巨大进步,但实际应用于临床还有待时日。本文首先对同期行自体游离髂骨修复重建下颌骨缺损患者的临床资料进行回顾性分析,并通过自体松质骨异位预构建血管化下颌骨的动物实验研究,为下颌骨缺损修复提供一种新思路和方法。
第一部分
目的：对同期行自体游离髂骨修复重建下颌骨缺损患者的临床资料进行回顾性分析,并比较非血管化/血管化两种髂骨移植形式修复下颌骨部分／节段性缺损术后的成活率。方法：选择2008年1月-2010年12月期间,在武汉大学口腔医院口腔颌面外科行同期自体游离髂骨移植修复重建下颌骨缺损的患者为研究对象。回顾的临床资料包括：性别,年龄,病变类型、下颌骨缺损的部位和大小、修复重建方法以及骼骨的成活率。结果：血管化和非血.管化髂骨的平均长度分别为5.9±1.2cm和5.5±1.4cm(P-0.407)；平均高度分别为2.7±0.4cm和2.3±0.6cm(P<0.05)。血管化骼骨和非血管化髂骨的总成活率分别为100%和76.2%(P<0.05)。非血管化髂骨修复重建下颌骨部分缺损和节段性缺损的成活率分为别91.7%和55.6%(P=0.055)。非血管化髂骨长度>5.5cm和≤5.5cm的下颌骨缺损的成活率分别为63.6%和91.7%(P=0.311)。结论：血管化髂骨适用于长度在8cm以内的下颌骨体部部分或节段性缺损的修复重建；非血管化髂骨适用于修复重建长度小于5.5cm的下颌骨部分缺损。
第二部分
目的：构建带血管蒂的下颌骨以修复下颌骨缺损。方法：将肋骨松质骨碎块填入预制的下颔骨外形钛钢支架中,植入5只实验犬背阔肌内并使胸背动静脉血管穿过钛网支架。术后3个月后取出标本,通过大体标本、组织学及免疫组化染色观察骨组织形成及血管化情况。结果：在实验犬体内再造出了以胸背动静脉为蒂的骨组织,并具有下颌骨的解剖外形;组织学及免疫组化染色证实,新骨形成及血管化较好。结论：应用自体松质骨可以异位预构建血管化下颌骨具有可行性,为下颌骨缺损修复提供一种新思路和方法。
Mandibular defect can be caused by tumor resection, inflammation and trauma, it can lead to confusion of occlusal relationship, reduced masticatory function, mandibular deviation of a series of questions, to bring greater physical and psychological burden to the patient. so in recent years for the mandibular defects has been a research hotspot, vascular and non-vascular bone transplanted to a metal substitute, reverse engineering, tissue engineering technology, can seek a simple, safe, good functional recovery, trauma repairway. Mandibular defect repair vascular and non-vascular autogenous bone graft, its main drawback is causing secondary trauma and secondary deformity. In recent years, tissue engineering has made great progress in basic and clinical research in bone defects, but the actual clinical application remains to be seen.
PART ONE
Objective:This study is to retrospectively evaluate the clinical data of patients with mandibular defects using autogenous iliac bone graft for contemporary mandibular reconstruction, and then to compare success rate of vascularized/non-vascularized iliac bone grafts for the reconstruction of segmental/partial mandible defect. Methods:Patients who underwent immediate mandibular reconstruction at the Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, between January2008and December2010were reviewed. The evaluated contents included gender, age, pathologic disorder, site and size of mandibular defect and success rate of iliac bone grafts. Results: The average length of vascularized and non-vascularized iliac bone grafts was5.9±1.2cm and5.5±1.4cm, respectively (P=0.407). The overall success rate of vascularized and non-vascularized iliac bone grafts was100%and76.2%, respectively (P<0.05). The success rate of non-vascularized iliac bone grafts used for segmental and partial mandible defect was91.7%and55.6%, respectively (P=0.055). The success rate of non-vascularized il iac bone grafts larger then5.5cm and less than5.5cm was63.6%and91.7%, respectively (P=0.311).Conclusions: Vascularized iliac bone graft is suitable for segmental and partial defects less than9cm in length of body of the mandible; Non-vascularized iliac graft remains a usable choice in mandibler reconstruction of partial defects less than5.5cm in length.
PART TWO
Objective:To explore a method for ectopic prefabrication of mandible with vascular pedicle. Methods:Cancellous bone blocks harvested from the dog ribs were packaged with mandible-shaped titanium mesh scaffold, and implanted into latissimus dorsi of dog with thoracodorsal artery and vein through the scaffold. After12weeks, bone formation and vascularization were evaluated by gross inspection, histological examination and immunohistochemistry. Results:Vascularized mandible with thoracodorsal artery and vein were formed and histological staining and immunohistochemisty confirmed new bone formation and vascularization. Conclusion:There is feasibility for ectopic prefabrication of vascularized mandible graft using cancellous ribs, which provide a new method for mandibular defect reconstruction.
第一部分
目的：对同期行自体游离髂骨修复重建下颌骨缺损患者的临床资料进行回顾性分析,并比较非血管化/血管化两种髂骨移植形式修复下颌骨部分／节段性缺损术后的成活率。方法：选择2008年1月-2010年12月期间,在武汉大学口腔医院口腔颌面外科行同期自体游离髂骨移植修复重建下颌骨缺损的患者为研究对象。回顾的临床资料包括：性别,年龄,病变类型、下颌骨缺损的部位和大小、修复重建方法以及骼骨的成活率。结果：血管化和非血.管化髂骨的平均长度分别为5.9±1.2cm和5.5±1.4cm(P-0.407)；平均高度分别为2.7±0.4cm和2.3±0.6cm(P<0.05)。血管化骼骨和非血管化髂骨的总成活率分别为100%和76.2%(P<0.05)。非血管化髂骨修复重建下颌骨部分缺损和节段性缺损的成活率分为别91.7%和55.6%(P=0.055)。非血管化髂骨长度>5.5cm和≤5.5cm的下颌骨缺损的成活率分别为63.6%和91.7%(P=0.311)。结论：血管化髂骨适用于长度在8cm以内的下颌骨体部部分或节段性缺损的修复重建；非血管化髂骨适用于修复重建长度小于5.5cm的下颌骨部分缺损。
第二部分
目的：构建带血管蒂的下颌骨以修复下颌骨缺损。方法：将肋骨松质骨碎块填入预制的下颔骨外形钛钢支架中,植入5只实验犬背阔肌内并使胸背动静脉血管穿过钛网支架。术后3个月后取出标本,通过大体标本、组织学及免疫组化染色观察骨组织形成及血管化情况。结果：在实验犬体内再造出了以胸背动静脉为蒂的骨组织,并具有下颌骨的解剖外形;组织学及免疫组化染色证实,新骨形成及血管化较好。结论：应用自体松质骨可以异位预构建血管化下颌骨具有可行性,为下颌骨缺损修复提供一种新思路和方法。
Mandibular defect can be caused by tumor resection, inflammation and trauma, it can lead to confusion of occlusal relationship, reduced masticatory function, mandibular deviation of a series of questions, to bring greater physical and psychological burden to the patient. so in recent years for the mandibular defects has been a research hotspot, vascular and non-vascular bone transplanted to a metal substitute, reverse engineering, tissue engineering technology, can seek a simple, safe, good functional recovery, trauma repairway. Mandibular defect repair vascular and non-vascular autogenous bone graft, its main drawback is causing secondary trauma and secondary deformity. In recent years, tissue engineering has made great progress in basic and clinical research in bone defects, but the actual clinical application remains to be seen.
PART ONE
Objective:This study is to retrospectively evaluate the clinical data of patients with mandibular defects using autogenous iliac bone graft for contemporary mandibular reconstruction, and then to compare success rate of vascularized/non-vascularized iliac bone grafts for the reconstruction of segmental/partial mandible defect. Methods:Patients who underwent immediate mandibular reconstruction at the Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, between January2008and December2010were reviewed. The evaluated contents included gender, age, pathologic disorder, site and size of mandibular defect and success rate of iliac bone grafts. Results: The average length of vascularized and non-vascularized iliac bone grafts was5.9±1.2cm and5.5±1.4cm, respectively (P=0.407). The overall success rate of vascularized and non-vascularized iliac bone grafts was100%and76.2%, respectively (P<0.05). The success rate of non-vascularized iliac bone grafts used for segmental and partial mandible defect was91.7%and55.6%, respectively (P=0.055). The success rate of non-vascularized il iac bone grafts larger then5.5cm and less than5.5cm was63.6%and91.7%, respectively (P=0.311).Conclusions: Vascularized iliac bone graft is suitable for segmental and partial defects less than9cm in length of body of the mandible; Non-vascularized iliac graft remains a usable choice in mandibler reconstruction of partial defects less than5.5cm in length.
PART TWO
Objective:To explore a method for ectopic prefabrication of mandible with vascular pedicle. Methods:Cancellous bone blocks harvested from the dog ribs were packaged with mandible-shaped titanium mesh scaffold, and implanted into latissimus dorsi of dog with thoracodorsal artery and vein through the scaffold. After12weeks, bone formation and vascularization were evaluated by gross inspection, histological examination and immunohistochemistry. Results:Vascularized mandible with thoracodorsal artery and vein were formed and histological staining and immunohistochemisty confirmed new bone formation and vascularization. Conclusion:There is feasibility for ectopic prefabrication of vascularized mandible graft using cancellous ribs, which provide a new method for mandibular defect reconstruction.
引文
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