不同骨替代物对骨缺损修复效果的对比研究
摘要
目的:比较两种骨替代物与自体骨之间的成骨效果,为临床骨缺损修复提供实验依据。
材料与方法:选择8条12-16个月的健康杂种犬为实验对象,全麻下在双侧前磨牙区颊侧骨面制备3个3mm直径,3mm深的圆柱形孔洞,孔洞间距离为2mm的,分别向三个孔洞中植入Bio-oss,β-TCP和周边取的自体骨,在一侧盖胶原膜,一侧不盖膜,拉拢缝合粘膜瓣。术后分别在1周、2周、4周、8周处死2条狗,做硬组织切片和脱钙后切片,进行组织形态学分析。
结果:
一、大体观察和影像学观察
实验动物无一例死亡。一周时切口未完全愈合,内灌注后可见粘膜及胶原膜因肿胀与骨面分开;两周时切口已基本愈合,但仍可见切口印记;四周时粘膜色泽正常,原伤口已愈合;八周时表面粘膜已与正常无明显区别,需通过X线方可找到植骨区。X线检查:三个骨孔较为容易确定,未盖胶原膜侧比盖膜侧骨孔清晰。随着周期的延长骨孔与正常骨逐渐融合。β-TCP孔中的β-TCP颗粒相对于其他骨孔的移植物,在1、2、4、8周均显示出最强的阻射影。
二、硬组织切片的组织形态学观察:
Goldner’s三色法和Giemsa法染色结果一致:一周时, Bio-oss、β-TCP、自体骨三骨孔可见骨孔内骨移植物未吸收,Bio-oss、β-TCP孔与正常骨组织之间存在大量的炎性细胞;两周时,Bio-oss、β-TCP骨孔中炎性细胞已大量减少,三骨孔中可见大量的纤维细胞组成的结缔组织结构并逐渐形成骨基质,在各骨孔边缘可见有岛状新生骨,自体骨孔中移植骨边缘可见有新生骨,而β-TCP和Bio-oss孔骨粉边缘的新生骨不明显;四周时,骨孔中骨移植物逐渐被吸收,在β-TCP和Bio-oss孔表面有较明显的新生骨生成,新生骨骨成熟度比两周时高,骨孔边缘处新生骨已与正常骨形成紧密、成熟的连接;八周时,Bio-oss、β-TCP、自体骨三骨孔成骨均比前期多,新形成骨呈板层状较正常骨排列紊乱,与骨孔边缘有明显的线性界限。自体骨孔中移植骨已基本完全吸收,骨孔大部分被新生骨所代替;Bio-oss孔中尚可见未被吸收的Bio-oss颗粒,骨质间的结缔组织较自体骨孔中多;β-TCP孔中较大未完全吸收的β-TCP颗粒,新生骨质较明显少于Bio-oss和自体骨孔中,且骨质间有较多的结缔组织。
三、硬组织切片组织形态学分析:
两周时,自体骨形成的新骨比Bio-oss和β-TCP多,p<0.05,有统计学意义;四周时,自体骨形成的新骨比Bio-oss和β-TCP多,p<0.05,有统计学意义;八周时,β-TCP形成的新骨比Bio-oss和自体骨少,p<0.05,统计学有显著性差异,Bio-oss和自体骨之间无显著性差异。
结论:
1.无论用哪种骨移植材料,骨缺损最终都会愈合。
2.自体骨修复骨缺损是三者之中最好的,在四周前,其成骨有明显的优越性。
3.β-TCP和Bio-oss在早期成骨效果无明显差别,八周后Bio-oss和自体骨的成骨量明显强于β-TCP,在使用β-TCP植骨后,植入种植体等二次手术需要延期。
Objective : The purpose was to qualitatively and quantitatively com- pare the bone formation of two different bone substitutes with autogenous bone as a positive control , to supply experiment foundation for clinical tr- eatment.
Materials and methods : After the general anesthesia, Three standar- dized bone defects were prepared in both mandibular of 8 dogs. The defects were grafted with either autograft , Bio-oss, or synthetic b-tricalcium phos- phate (b-TCP). one side were covered by collogen membranes ,and the other side were as control . Sacrifice was performed after 1, 2, 4, and 8 weeks for histologic and histomorphometric analysis.
Results : There are the same consequences in Goldner’s and Giemsa dyeing:At 1weeks,it can be observed that the bone substitutes are not absor- ted in the bone defects of Bio-oss ,β-TCP and autograft , and there are lots of infl. cells in the defects of Bio-oss andβ-TCP . At 2 weeks , the amount of infl. cells is decreased , there are lots of connective tissue consisting of fibrocyte and gradually forming bone matrix. New bone can been seen at the marginal of all the bone defects and that of the autograft,but it is notobvious at the marginal of Bio-oss andβ-TCP . At 4 weeks, the bone substitutes are gradually absorbing,and there is obviously new bone at the marginal of Bio- oss andβ-TCP ,the degree of maturity of the new bone in the three bone de- fects is higher than that at 2 weeks . At 8 weeks , there is more new bone in the defects filling with Bio-oss ,β-TCP and autograft, the autograft has basi- absorbed completely, there is Bio-oss still and more connective tissue,whileβ-TCP absorbed slowly than Bio-oss . At 2 weeks, more new bone formation was seen in defects filled with autograft than with Bio-oss ( P< 0.05) andβ- TCP (P < 0.05) . After 4 weeks,there was no significant difference betweenβ-TCP and Bio-oss.Defects grafted with autograft still exhibited more bone formation as compared with the other two bone substitutes ( P< 0.05) . At 8 weeks more bone formation was observed in defects grafted with autograft ( P< 0.05) and Bio-oss ( P< 0.05) than withβ-TCP.There was no significant difference between Bio-oss and autograft in statistics . But the bone forma- tion of Bio-oss was observed less than autograft.β-TCP absorbed slowly th- an the other two bone substitutes over 8 weeks.
Conclusion:
1 . All defects ultimately regenerated with newly formed bone and a developing bone marrow.
2 . Autograft is the best bone substitutes in the Both bone substitutes seemed to decelerate bone regeneration.It is obviously well in the bone for- mation before four weeks.
3 .β-TCP and Bio-oss had no differences in bone formation at early, while at 8 weeks,the bone formation of the autograft and Bio-oss were much better than that ofβ-TCP.Ifβ-TCP is selected as the bone substitutes,the se- cond surgery should be prolong so as to get more newly formed bone around the implant.
材料与方法:选择8条12-16个月的健康杂种犬为实验对象,全麻下在双侧前磨牙区颊侧骨面制备3个3mm直径,3mm深的圆柱形孔洞,孔洞间距离为2mm的,分别向三个孔洞中植入Bio-oss,β-TCP和周边取的自体骨,在一侧盖胶原膜,一侧不盖膜,拉拢缝合粘膜瓣。术后分别在1周、2周、4周、8周处死2条狗,做硬组织切片和脱钙后切片,进行组织形态学分析。
结果:
一、大体观察和影像学观察
实验动物无一例死亡。一周时切口未完全愈合,内灌注后可见粘膜及胶原膜因肿胀与骨面分开;两周时切口已基本愈合,但仍可见切口印记;四周时粘膜色泽正常,原伤口已愈合;八周时表面粘膜已与正常无明显区别,需通过X线方可找到植骨区。X线检查:三个骨孔较为容易确定,未盖胶原膜侧比盖膜侧骨孔清晰。随着周期的延长骨孔与正常骨逐渐融合。β-TCP孔中的β-TCP颗粒相对于其他骨孔的移植物,在1、2、4、8周均显示出最强的阻射影。
二、硬组织切片的组织形态学观察:
Goldner’s三色法和Giemsa法染色结果一致:一周时, Bio-oss、β-TCP、自体骨三骨孔可见骨孔内骨移植物未吸收,Bio-oss、β-TCP孔与正常骨组织之间存在大量的炎性细胞;两周时,Bio-oss、β-TCP骨孔中炎性细胞已大量减少,三骨孔中可见大量的纤维细胞组成的结缔组织结构并逐渐形成骨基质,在各骨孔边缘可见有岛状新生骨,自体骨孔中移植骨边缘可见有新生骨,而β-TCP和Bio-oss孔骨粉边缘的新生骨不明显;四周时,骨孔中骨移植物逐渐被吸收,在β-TCP和Bio-oss孔表面有较明显的新生骨生成,新生骨骨成熟度比两周时高,骨孔边缘处新生骨已与正常骨形成紧密、成熟的连接;八周时,Bio-oss、β-TCP、自体骨三骨孔成骨均比前期多,新形成骨呈板层状较正常骨排列紊乱,与骨孔边缘有明显的线性界限。自体骨孔中移植骨已基本完全吸收,骨孔大部分被新生骨所代替;Bio-oss孔中尚可见未被吸收的Bio-oss颗粒,骨质间的结缔组织较自体骨孔中多;β-TCP孔中较大未完全吸收的β-TCP颗粒,新生骨质较明显少于Bio-oss和自体骨孔中,且骨质间有较多的结缔组织。
三、硬组织切片组织形态学分析:
两周时,自体骨形成的新骨比Bio-oss和β-TCP多,p<0.05,有统计学意义;四周时,自体骨形成的新骨比Bio-oss和β-TCP多,p<0.05,有统计学意义;八周时,β-TCP形成的新骨比Bio-oss和自体骨少,p<0.05,统计学有显著性差异,Bio-oss和自体骨之间无显著性差异。
结论:
1.无论用哪种骨移植材料,骨缺损最终都会愈合。
2.自体骨修复骨缺损是三者之中最好的,在四周前,其成骨有明显的优越性。
3.β-TCP和Bio-oss在早期成骨效果无明显差别,八周后Bio-oss和自体骨的成骨量明显强于β-TCP,在使用β-TCP植骨后,植入种植体等二次手术需要延期。
Objective : The purpose was to qualitatively and quantitatively com- pare the bone formation of two different bone substitutes with autogenous bone as a positive control , to supply experiment foundation for clinical tr- eatment.
Materials and methods : After the general anesthesia, Three standar- dized bone defects were prepared in both mandibular of 8 dogs. The defects were grafted with either autograft , Bio-oss, or synthetic b-tricalcium phos- phate (b-TCP). one side were covered by collogen membranes ,and the other side were as control . Sacrifice was performed after 1, 2, 4, and 8 weeks for histologic and histomorphometric analysis.
Results : There are the same consequences in Goldner’s and Giemsa dyeing:At 1weeks,it can be observed that the bone substitutes are not absor- ted in the bone defects of Bio-oss ,β-TCP and autograft , and there are lots of infl. cells in the defects of Bio-oss andβ-TCP . At 2 weeks , the amount of infl. cells is decreased , there are lots of connective tissue consisting of fibrocyte and gradually forming bone matrix. New bone can been seen at the marginal of all the bone defects and that of the autograft,but it is notobvious at the marginal of Bio-oss andβ-TCP . At 4 weeks, the bone substitutes are gradually absorbing,and there is obviously new bone at the marginal of Bio- oss andβ-TCP ,the degree of maturity of the new bone in the three bone de- fects is higher than that at 2 weeks . At 8 weeks , there is more new bone in the defects filling with Bio-oss ,β-TCP and autograft, the autograft has basi- absorbed completely, there is Bio-oss still and more connective tissue,whileβ-TCP absorbed slowly than Bio-oss . At 2 weeks, more new bone formation was seen in defects filled with autograft than with Bio-oss ( P< 0.05) andβ- TCP (P < 0.05) . After 4 weeks,there was no significant difference betweenβ-TCP and Bio-oss.Defects grafted with autograft still exhibited more bone formation as compared with the other two bone substitutes ( P< 0.05) . At 8 weeks more bone formation was observed in defects grafted with autograft ( P< 0.05) and Bio-oss ( P< 0.05) than withβ-TCP.There was no significant difference between Bio-oss and autograft in statistics . But the bone forma- tion of Bio-oss was observed less than autograft.β-TCP absorbed slowly th- an the other two bone substitutes over 8 weeks.
Conclusion:
1 . All defects ultimately regenerated with newly formed bone and a developing bone marrow.
2 . Autograft is the best bone substitutes in the Both bone substitutes seemed to decelerate bone regeneration.It is obviously well in the bone for- mation before four weeks.
3 .β-TCP and Bio-oss had no differences in bone formation at early, while at 8 weeks,the bone formation of the autograft and Bio-oss were much better than that ofβ-TCP.Ifβ-TCP is selected as the bone substitutes,the se- cond surgery should be prolong so as to get more newly formed bone around the implant.
引文
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2. Gleizal AM. Beziat JL. Maxillary and mandibular reconstruction using bicortical calvanal bone grafts: a retrospectire study of 122 reconstructions in 73 patients . Plast Reconstr Surg 2007;119 (2):542—548
3. Iizuka T,Smolka W ,Hallermann W el a1.Extensive augmentation of the alveolar ridge using autogenous calvarial split bone grafts for dental rehabilitation.Clin Orallmplants Res 2004;15(5):607—615
4.吴景泉,等.自体骨粉移植修复下颌骨部分缺损的组织学检测[J].中国组织工程研究与临床康复,2007;11(29);5661-5664
5. P.Leniz ,P.Ripalda ,F.Forriol .The incorporation of different sorts of cancellous bone graft and the reaction of the host bone. A histomorphometric study in sheep International Orthopaedics 2004;28:2-6
6. Feuille F,Kna P P Cl,Brunsvold MA et al.Clinical and histologic evaluation of bone replacement grafts in the treatment of loealized alveolar ridge defeets. Pa- rtl :mineraiized freeze-dried bone allograft. Int J eriodonties Rstorative Dent 2003; 23(1):29一35.
7. Andreana S,Cornelini R,Edsberg LE,et al. Maxillary sinus elevation for implant placement using caleium sulfate with and without DFDBA:six cases. ImPlant Dent,2004;13(3):270-277
8.耿威,宿玉成等.用Bio-oss结合Bio-gide膜修复种植体周围骨缺损的组织学研究[J]Journal of Oral Science Research2005;121(1):4-7
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