本文選題：牙槽突裂　切入點：二期牙槽植骨　出處：《山東大學》2014年碩士論文　論文類型：學位論文

【摘要】：背景和目的：牙槽突裂為唇腭裂常見伴隨癥狀之一,唇腭裂的治療已經(jīng)由單純的關(guān)閉唇腭裂裂隙發(fā)展為序列治療,包括正畸治療、矯正修復、牙槽突裂植骨、語音訓練及心理治療等,其中牙槽突裂植骨(alveolar bone graft, ABG)為序列治療一個重要環(huán)節(jié)。采用自體髂骨移植是治療牙槽突裂的金標準,目前,仍然沒有一種人工材料可以替代自體骨組織。但是,自體骨移植治療牙槽突裂存在很多問題,一方面骨移植手術(shù)后成功率不高,此外,手術(shù)后存在一定的骨吸收一影響治療效果。近年來,口腔生物材料的發(fā)展迅速,一些引導成骨的生物膜和骨替代材料不斷應用于臨床實踐。其中生物引導膜(biological guide membrane,Bio-Gide)、無機牛骨骨粉(anorganic bovine bone,Bio-Oss)在口腔臨床尤其口腔種植中應用廣泛,取得一定臨床效果。然而,Bio-Gide、Bio-Oss應用于牙槽突裂的臨床報道較少,并且也缺少系統(tǒng)的臨床研究。因此,本實驗擬研究Bio-Gide、Bio-Oss聯(lián)合髂骨松質(zhì)骨移植修復牙槽突裂骨缺損的臨床效果,為臨床修復牙槽突裂方法提供新的思路。 方法：1.實驗組及對照組的建立：通過收集山大二院2010年至2014年,年齡在9-22歲的單側(cè)完全性牙槽突裂患167例,將患者隨機分為3組,A組56名患者,B組56名患者,分別采用Bio-Gide、Bio-Oss聯(lián)合髂松質(zhì)骨移植修復方法以及Bio-Gide聯(lián)合自體髂松質(zhì)骨移植修復方法,作為實驗組；C組55名患者,采用單純髂松質(zhì)骨移植修復方法,作為對照組。 2.骨形成情況：在患者術(shù)前及術(shù)后6個月對其拍攝全口曲面斷層片及錐型束CT (cone beam CT,CBCT),采用改良Bergland牙槽突裂植骨分級標準結(jié)果評價患者骨形成高度情況,同時利用CBCT從植骨區(qū)域成骨的厚度分析牙槽骨植骨的效果。 結(jié)果：1.術(shù)后一周發(fā)現(xiàn)A組3名患者、B組5名患者及C組6名患者術(shù)后髂骨區(qū)創(chuàng)口淤血腫脹,但無明顯感染現(xiàn)象,術(shù)后2周腫脹減輕,術(shù)后半年未見明顯感染及功能異常。A組8名患者、B組7名患者和C組10名患者口內(nèi)牙齦感染紅腫患者,其中A組4名患者、B組2名患者及C組2名患者口內(nèi)紅腫現(xiàn)象經(jīng)過加強口腔護理后恢復,余感染患者見植入骨顆粒脫出,刮除感染植入骨并修剪牙齦轉(zhuǎn)移組織瓣縫合后,創(chuàng)口愈合良好。 2.術(shù)后6個月對植骨成功患者拍攝曲面斷層片及CBCT,顯示3組患者植骨區(qū)域植入骨存在一定骨吸收, Bio-Gide、Bio-Oss聯(lián)合髂松質(zhì)骨移植術(shù)后6個月骨吸收最少,術(shù)后6個月植入骨與周圍骨組織部分或者完全融合,新生骨組織與原有骨組織曲面斷層片肉眼顯示骨密度無明顯差異。統(tǒng)計學分析后,表明Bio-Gide、Bio-Oss聯(lián)合髂松質(zhì)骨移植修復牙槽突裂明顯優(yōu)于余兩種方法(P0.05,有顯著差異性)。 結(jié)論：采用Bio-Gide、Bio-Oss聯(lián)合自體髂骨移植修復牙槽突裂方法明顯優(yōu)于其余兩種方法。牙槽骨裂植骨修復后存在一定骨吸收,單純髂松質(zhì)骨移植骨骨吸收最多,垂直向高度較低,并且唇腭向骨質(zhì)厚度較�。籅io-Gide、Bio-Oss聯(lián)合髂松質(zhì)骨移植修復牙槽突裂,骨吸收最少,垂直向高度較高,并且唇腭向骨質(zhì)最厚。
[Abstract]:Background and objective: the alveolar cleft lip and palate is one of the common symptoms, treatment of cleft lip and palate is simple closure of cleft lip and palate fissure development sequence of treatment, including orthodontic treatment, orthodontic repair of alveolar cleft bone grafting, speech training and psychological therapy, the alveolar cleft bone grafting (alveolar bone graft, ABG for the treatment of a sequence) important link. The autogenous iliac bone graft is the gold standard for alveolar cleft, at present, is still not a kind of artificial material can replace autologous bone tissue. However, autologous bone graft in the treatment of alveolar cleft exists many problems, a bone transplant success rate is not high, in addition, there are the bone absorption effect after surgery. In recent years, the rapid development of oral biological materials, some biological membrane guided bone and bone substitute materials have been applied in clinical practice. The biological film guide (biologic Al guide membrane, Bio-Gide), bone bone (anorganic bovine bone, Bio-Oss) in oral clinic especially in oral implant applications, has certain clinical effect. However, Bio-Gide, the application of Bio-Oss in the alveolar cleft with few clinical reports, and lack of clinical research system. Therefore, this study intends to study the Bio-Gide. The clinical effect of Bio-Oss combined with iliac cancellous bone graft for repair of alveolar cleft bone defect, to provide new ideas for clinical repair of alveolar cleft.
Method: 1. the establishment of the experimental group and the control group by collecting in No.2 Affiliated Hospital of Shandong University from 2010 to 2014, at the age of 9-22 years old of complete unilateral alveolar cleft patients in 167 cases, the patients were randomly divided into 3 groups, A group of 56 patients, B group of 56 patients, respectively Bio-Gide, Bio-Oss combined with iliac loose repair methods Bio-Gide combined with autologous iliac bone graft and bone graft repair method of loose, as the experimental group; C group of 55 patients, using a simple method to repair bone loose iliac transplantation, as the control group.
2. bone formation: in patients with preoperative and postoperative 6 months to shoot panoramic radiographs and cone beam CT (cone beam CT, CBCT), modified Bergland alveolar cleft bone grafting in patients with bone formation evaluation grading standard height, at the same time, the use of CBCT from the bone graft region analysis of alveolar bone bone graft bone thickness effect.
Results: 3 patients in group A were found in 1. one week after the surgery, 5 patients in B group and C group of 6 patients with postoperative bone wound congestion swelling, but no obvious infection, 2 weeks after surgery swelling, six months after operation, no obvious infection and abnormal function of.A group of 8 patients, B group 7 patients in group C and 10 patients in infection of the gums swelling patients, 4 patients in the A group, B group of 2 patients in C group and 2 patients in the mouth swelling phenomenon after strengthened oral care after recovery, patients infected with more than see bone particles prolapse, curettage and bone infection and pruning the gingival metastasis tissue flap after suture, the wound healed well.
2. after 6 months of successful bone graft were taken radiographs and CBCT, shows that 3 groups of patients with bone graft bone region exists in bone absorption, Bio-Gide, Bio-Oss combined with iliac cancellous bone transplantation after 6 months at least 6 months of bone resorption, bone and bone tissue section after surgery or completely fusion, new bone tissue and the bone tissue panoramicradiographs eyes showed no significant difference in bone mineral density. The statistical analysis showed that, Bio-Gide, Bio-Oss combined with iliac cancellous bone graft for repair of alveolar cleft is superior to other methods (P0.05, significant difference).
Conclusion: using Bio-Gide, Bio-Oss combined with autogenous iliac bone graft to repair alveolar cleft method is better than the other two methods. Some existing bone fractures of alveolar bone resorption after repair, simple iliac cancellous bone graft bone resorption, the vertical height of the lower lip and palate, and to bone thickness; Bio-Gide, Bio-Oss combined with iliac cancellous bone graft for repair of alveolar cleft, bone resorption at the vertical height is higher, and the thickness of labial palata bone.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R782.2

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