本文選題：富血小板纖維蛋白 + 異種凍干骨　； 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的： 通過建立兔下頜骨骨缺損模型，并即刻植入鈦螺紋釘、異種凍干骨及其復(fù)合富血小板纖維蛋白（Platelet-rich fibrin，簡(jiǎn)稱PRF)，，觀察異種凍干骨及其復(fù)合PRF在修復(fù)鈦螺紋釘周圍骨缺損的效果，進(jìn)一步探討異種凍干骨修復(fù)骨缺損的能力及PRF在異種凍干骨修復(fù)骨缺損中的作用。 方法∶ 1實(shí)驗(yàn)動(dòng)物的分組：總共有12只新西蘭大耳白兔，將所有實(shí)驗(yàn)動(dòng)物隨機(jī)分成3組，根據(jù)實(shí)驗(yàn)設(shè)計(jì)，分別于術(shù)后4周、8周、12周處死。所有實(shí)驗(yàn)動(dòng)物均為右側(cè)下頜骨為實(shí)驗(yàn)組（植入異種凍干骨復(fù)合PRF），左側(cè)下頜骨為對(duì)照組（植入異種凍干骨），進(jìn)行自身對(duì)照。 2異種凍干骨的制備：取自人骨組織，經(jīng)骨髓清洗深度冷凍冷凍干燥和射線輻照等過程制備。 3PRF的制備：麻醉前，自兔耳中心動(dòng)脈采血5ml，置于無抗凝劑的離心管中。將離心管放入離心機(jī)中離心，轉(zhuǎn)速3000r/min，離心10min，靜置備用。離心后離心管內(nèi)血液由上至下分為三層：上層無細(xì)胞血漿，中間層PRF凝膠，下層紅細(xì)胞層。去除上層和下層，剩余部分即為PRF凝膠。然后用兩層紗布輕柔擠出PRF中血清，PRF凝膠變成堅(jiān)韌的膜狀。 4動(dòng)物骨缺損模型的建立：麻醉下，在兔右側(cè)（實(shí)驗(yàn)組）頰側(cè)皮膚沿下頜骨上緣走向作出一長(zhǎng)約15mm的切口，鈍性分離其下肌層、骨膜，充分暴露其無牙區(qū)牙槽骨上緣和頰側(cè)。在暴露的無牙區(qū)牙槽骨形成一約5mm×4mm×3mm的缺損，生理鹽水沖洗。左側(cè)（對(duì)照組）手術(shù)方法相同。 5鈦螺紋釘?shù)闹踩耄壕o貼骨缺損近中及遠(yuǎn)中邊緣牙槽骨各制備1個(gè)種植窩，造成種植窩周圍一壁骨缺損，植入1.5mm×3.5mm鈦螺紋釘。 6異種凍干骨及其復(fù)合PRF的植入：實(shí)驗(yàn)組骨缺損區(qū)植入異種凍干骨復(fù)合PRF，對(duì)照組骨缺損區(qū)僅植入異種凍干骨。 7觀察結(jié)果：術(shù)后4、8、12周處死各組動(dòng)物。大體觀察兩側(cè)缺損愈合情況及鈦螺紋釘有無松動(dòng)脫落情況。拍X線片觀察新生骨密度和缺損區(qū)骨吸收情況，骨密度用灰度值表示，將測(cè)量的灰度值進(jìn)行統(tǒng)計(jì)檢驗(yàn)，比較實(shí)驗(yàn)組與對(duì)照組骨密度的差別。將組織取材切片HE染色，光鏡下觀察。 結(jié)果： 1大體觀察：各期鈦螺紋釘無松動(dòng)脫落。各期實(shí)驗(yàn)組較對(duì)照組成骨情況好，新生骨骨質(zhì)較硬、表面更平整。 2X線觀察：各期鈦螺紋釘骨界面無明顯透射影像，未見異常骨吸收區(qū)，隨時(shí)間增加周圍骨組織密度逐漸升高。 3骨密度分析：采用統(tǒng)計(jì)分析軟件對(duì)X線片灰度值進(jìn)行統(tǒng)計(jì)學(xué)處理。結(jié)果表明，在相同的時(shí)間點(diǎn)（術(shù)后4周、8周或12周），實(shí)驗(yàn)組近中遠(yuǎn)中鈦螺紋釘骨缺損側(cè)新生骨灰度值比對(duì)照組的大，p 0.05，差異有統(tǒng)計(jì)學(xué)意義。 4組織學(xué)觀察：術(shù)后4、8、12周，實(shí)驗(yàn)組的新生骨組織更成熟，可見大量成骨細(xì)胞和骨細(xì)胞，骨小梁粗大致密排列規(guī)則，鈣化程度高；而對(duì)照組的成骨細(xì)胞、骨細(xì)胞比實(shí)驗(yàn)組少，骨小梁數(shù)量較少且鈣化程度較低。 結(jié)論： 1異種凍干骨作為一種骨替代材料可以修復(fù)鈦螺紋釘周圍骨缺損 2富血小板纖維蛋白在異種凍干骨修復(fù)骨缺損中有較顯著的促進(jìn)成骨的作用。
[Abstract]:Objective:
Through the establishment of rabbit model of mandibular bone defect, and immediate implantation of titanium screw, dissimilar freeze-dried bone and composite platelet rich fibrin (Platelet-rich fibrin, referred to as PRF), to observe the xenogeneic freeze-dried bone and composite PRF nail bone defect around the effect in the repair of titanium screw, further investigate the effects of xenogeneic freeze-dried and PRF bone repair the bone defect in xenogeneic freeze-dried bone in repairing the bone defect in the role.
Methods:
1 animal grouping: a total of 12 New Zealand white rabbits, all the experimental animal were randomly divided into 3 groups according to the experimental design, respectively after 4 weeks, 8 weeks, 12 weeks of death. All experimental animal are the right mandible as experimental group (xenogeneic freeze-dried bone composite PRF), the left mandible for the control group (freeze-dried bone implants), self-control.
2 the preparation of xenolyophilized bone: from human bone tissue, by bone marrow cleaning, deep freezing, freeze drying, and ray irradiation.
Preparation of 3PRF: before anesthesia, from the rabbit ear central artery blood 5ml, centrifugal placed in non anticoagulant tube. The centrifugal tube into the centrifuge centrifuge, speed 3000r/min, centrifugal 10min, static reserve. After centrifugation tubes of blood from top to bottom is divided into three layers: the upper layer cell free plasma, the middle layer of PRF gel. The lower red cell layer. The removal of the upper and lower layers, the remaining part is PRF gel. Then with two layers of gauze gently out of the PRF in serum, PRF gel into membrane tough.
The establishment of animal model of 4 bone defects: anesthesia in rabbits (experimental group) of buccal skin along the upper edge of the mandible to make an incision about 15mm long, blunt dissection of the muscle layer, periosteum, fully exposed the alveolar bone on the edentulous area and buccal margin. In the defect exposed without teeth alveolar bone formation about 5mm * 4mm * 3mm, physiological saline (control group). The operation method of the same.
5 screw implantation: close to the bone defect near the distal edge of the alveolar bone and preparation of 1 planting nest, by planting a nest around the bone defect, the implantation of 1.5mm * 3.5mm screw.
6 implants of xenofreeze-dried bone and its compound PRF: in the experimental group, the bone defect area was implanted with the xenofreeze-dried bone combined with PRF, and the control group was only implanted with the xenofreeze-dried bone in the bone defect area.
7 observations: after 4,8,12 weeks killed each animal. The general observation on both sides of defect healing and screw loosening loss. X-ray observation of bone density and defect new bone resorption, bone mineral density represented by gray value, will measure the gray value of the statistical test, compared with the control the bone mineral density was different. The tissues were stained with HE, were observed under light microscope.
Result:
1 gross observation: there was no loosening of the titanium screw in each period. The experimental group was better than the control group. The bone of the new bone was hard and the surface was more smooth.
2 x - ray observation: there was no obvious transmission image on the bone interface of titanium screw, no abnormal bone resorption area was not found, and the bone tissue density increased gradually with time.
3 Analysis of bone mineral density: X-ray gray value was analyzed by statistical analysis software. The results show that at the same time (4 weeks, after 8 or 12 weeks), the experimental group mesiodistal titanium screw bone defect side of newborn bone values than the control group of P, 0.05, a the statistical significance of differences.
4 histological observation: 4,8,12 weeks after operation, new bone tissue of the experimental group is more mature, showing a large number of osteoblasts and bone cells, bone trabecular thick dense arrangement, calcification degree is high; while the control group, the osteoblasts, bone cells less than the experimental group, trabecular bone volume and less calcium level low.
Conclusion:
1 xenogeneic freeze-dried bone can be used as a bone substitute material to repair the bone defect around the titanium screw
2 platelet rich fibrin can significantly promote osteogenesis in the repair of bone defects in xenofreeze-dried bone.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R782.2

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