本文選題：塊狀珊瑚羥基磷灰石 + 成骨效能　； 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究背景 人們經(jīng)濟(jì)水平的提高和種植技術(shù)的發(fā)展,為種植體廣泛應(yīng)用于部分缺牙或無(wú)牙頜患者提供了更大的可能。種植區(qū)骨量是評(píng)估預(yù)測(cè)種植體能否長(zhǎng)期行使功能的一個(gè)重要因素。然而,很多時(shí)候,患者因?yàn)橥鈧⒀乐苎椎惹闆r,缺牙區(qū)牙槽嵴高度喪失,給種植義齒修復(fù)缺失牙及重建咬合功能帶來(lái)了挑戰(zhàn),增加了外科手術(shù)的難度。 下頜后牙區(qū)是臨床上最主要的缺牙部位之一。由于下頜神經(jīng)管的存在,很多垂直高度重度吸收的患者往往無(wú)法容納種植體的植入。針對(duì)這個(gè)問(wèn)題,臨床上有多種術(shù)式可供選擇,常見(jiàn)的處理方式有引導(dǎo)骨組織再生術(shù)、牽張成骨術(shù)、onlay植骨術(shù)、下牙槽神經(jīng)游離術(shù)。onlay植骨,又名上置法植骨,是將移植材料固定于牙槽骨表面以增加高度的植骨方法。onlay植骨因其骨增量效果的肯定性,在臨床上已經(jīng)得到了廣泛地應(yīng)用。 onlay植骨術(shù)中,自體骨塊因其特有的成骨活性、骨誘導(dǎo)性以及骨傳導(dǎo)性,一直是該術(shù)式的金標(biāo)準(zhǔn)。自體骨塊移植是由患者自身取新鮮骨組織來(lái)恢復(fù)受體區(qū)骨缺損的方法。自體骨塊移植包括血管化自體骨塊移植以及非血管化自體骨塊移植兩種。非血管化自體骨塊移植因其操作簡(jiǎn)便、創(chuàng)傷較小,已經(jīng)在onlay骨增量手術(shù)中得到了廣泛地應(yīng)用。自體骨塊來(lái)源于患者本身,其主要優(yōu)點(diǎn)是無(wú)排斥反應(yīng),移植存活率高。但自體骨塊移植因其來(lái)源有限,需要開(kāi)辟第二術(shù)區(qū),給患者增加了額外的痛苦,并增加了患者一定的經(jīng)濟(jì)負(fù)擔(dān)。 針對(duì)自體骨塊移植的不足,人們開(kāi)始廣泛關(guān)注同種異體骨塊。同種異體骨塊移植指患者骨缺損處獲得的骨源來(lái)自骨捐贈(zèng)者捐贈(zèng)的相應(yīng)骨組織,可以是即取即用,也可以是先通過(guò)骨庫(kù)保存后,在合適的時(shí)間使用。同種異體骨移植物的來(lái)源相對(duì)自體骨塊來(lái)說(shuō)較為廣泛。其形狀可以是致密較脆的皮質(zhì)骨、疏松多孔的松質(zhì)骨,或者是兩者的結(jié)合物。同種異體骨保存技術(shù)的發(fā)展,以及更加完善的骨庫(kù)的建立,使同種異體骨移植在多個(gè)國(guó)家得到了應(yīng)用。但是,同種異體骨移植存在著交叉感染、免疫排斥以及移植物愈合較為緩慢等情況,這些是臨床醫(yī)生及患者必須考慮的問(wèn)題。 異種骨塊移植的主要來(lái)源是牛骨和豬骨。異種骨塊移植的數(shù)量幾乎不受限制,移植物可以根據(jù)需要預(yù)先制備成各種形狀,來(lái)滿足術(shù)中的要求。但異種骨的骨誘導(dǎo)活性跟其抗原性具有相同的物質(zhì)基礎(chǔ),在消除其抗原性的同時(shí),往往破壞了其骨誘導(dǎo)活性。兩者之間存在一定的矛盾關(guān)系。另一方面,由于瘋牛病的出現(xiàn),日本以及歐洲的部分國(guó)家已經(jīng)禁止使用牛骨來(lái)源的異種骨。 由于常規(guī)骨移植物的不足,骨移植物的生物替代材料成為了另一個(gè)人們廣泛關(guān)注的對(duì)象。珊瑚轉(zhuǎn)化的羥基磷灰石是其中的一個(gè)重要代表。珊瑚羥基磷灰石(coralline hydroxyapatite, CHA)是近年較常用的一種多孔羥基磷灰石,其作為一種新型骨替代材料,具有良好的生物相容性、骨傳導(dǎo)性、無(wú)免疫源性等獨(dú)特的優(yōu)勢(shì)。制備珊瑚羥基磷灰石的天然材料主要來(lái)自石珊瑚中的濱珊瑚和角孔珊瑚,這兩種珊瑚在太平洋及西印度洋分布較為廣泛。濱珊瑚平均孔徑為200um,角孔珊瑚為500um。前者類(lèi)似人類(lèi)皮質(zhì)骨,后者與松質(zhì)骨孔徑接近,是理想的骨移植物替代材料。 臨床上使用的珊瑚羥基磷灰石主要有顆粒狀和塊狀兩種外形的產(chǎn)品。最近十幾年來(lái),隨著大量文獻(xiàn)報(bào)道了顆粒狀的珊瑚羥基磷灰石在種植術(shù)中引導(dǎo)骨再生的良好表現(xiàn)以及塊狀珊瑚羥基磷灰石加工工藝的進(jìn)步,塊狀珊瑚羥基磷灰石在下頜骨垂直onlay骨增量手術(shù)中的應(yīng)用,國(guó)外開(kāi)始有少量報(bào)道,并取得了良好的骨增量效果。但塊狀珊瑚羥基磷灰石因其質(zhì)地較脆,很難用小鈦釘固位,其固位問(wèn)題一直是影響其廣泛使用的一個(gè)原因,并且國(guó)內(nèi)外很少文獻(xiàn)報(bào)道塊狀珊瑚羥基磷灰石中心血供及成骨效能方面的情況,未能為塊狀珊瑚羥基磷灰石的應(yīng)用提供組織學(xué)方面的支撐。 目的 1.本課題通過(guò)研究珊瑚羥基磷灰石圓柱體植入兔子股骨遠(yuǎn)中干骺端后的血供情況、成骨效能,為塊狀珊瑚羥基磷灰石的臨床應(yīng)用提供組織學(xué)上的依據(jù)。 2.對(duì)比塊狀珊瑚羥基磷灰石與自體骨塊采用onlay植骨術(shù)恢復(fù)下頜后牙區(qū)牙槽骨高度的臨床效果,探討塊狀珊瑚羥基磷灰石通過(guò)箱狀洞形楔入力固位的臨床操作可行性以及愈合情況。 方法 1.動(dòng)物實(shí)驗(yàn)部分：30只健康雄性新西蘭大白兔隨機(jī)分為實(shí)驗(yàn)組和空白對(duì)照組兩組。實(shí)驗(yàn)組包含24只大白兔,在大白兔雙側(cè)股骨的遠(yuǎn)中干骺端,通過(guò)空心取骨鉆制備圓柱形極限骨缺損,并植入相應(yīng)大小的珊瑚羥基磷灰石圓柱體。觀察時(shí)間點(diǎn)分別為4周、8周、12周。在上述每個(gè)時(shí)間點(diǎn)分別處死8只動(dòng)物,共獲得48個(gè)標(biāo)本,定性觀察珊瑚羥基磷灰石圓柱體在各個(gè)時(shí)間點(diǎn)的成骨、降解以及血供的情況。對(duì)照組含有6只大白兔,在其雙側(cè)股骨的遠(yuǎn)中干骺處,制備與實(shí)驗(yàn)組大小一致的圓柱形骨缺損,不植入任何骨替代物,12周后處死,觀察該骨缺損的愈合情況。實(shí)驗(yàn)組不同時(shí)間段的新骨面積百分比,采用one way ANOVA進(jìn)行檢驗(yàn),P0.05兩者之間的差別具有統(tǒng)計(jì)學(xué)意義。 2.臨床試驗(yàn)部分：選擇2010-01至2014-06在廣東省口腔醫(yī)院種植中心接受牙種植的后牙缺失患者37人(男20人,女17人),由A、B兩組組成。A組19人,塊狀珊瑚羥基磷灰石通過(guò)箱狀洞形楔入力固定；B組18人,自體骨塊通過(guò)鈦釘常規(guī)固位。植骨6個(gè)月后行相應(yīng)種植手術(shù)。 (1)在植骨前、骨塊植入后、種植體植入時(shí)、修復(fù)完成即刻、修復(fù)完成后的每12個(gè)月復(fù)診,拍攝全景片并比較A、B兩組對(duì)應(yīng)時(shí)間段垂直骨高度的吸收值,采用Mann-Whitney檢驗(yàn),P0.05兩者之間的差別具有統(tǒng)計(jì)學(xué)意義。 (2)以種植術(shù)后即刻種植體邊緣骨水平L2為基線,分別計(jì)算A、B兩組修復(fù)完成即刻(T3)、修復(fù)完成后12月(T4)、修復(fù)完成后24月(T5)的種植體邊緣骨水平與基線的邊緣骨水平之差,分別記錄為種植體周緣骨吸收量L3-L2、L4-L2、L5-L2。采用Mann-Whitney檢驗(yàn),P0.05兩者之間的差別具有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.動(dòng)物實(shí)驗(yàn)部分 (1)手術(shù)共植入48塊珊瑚羥基磷灰石圓柱體,均固位良好,未見(jiàn)松動(dòng)及脫出,松動(dòng)率為0%。所有兔子在實(shí)驗(yàn)中均未出現(xiàn)創(chuàng)口感染化膿等情況。 (2)大體標(biāo)本觀察：實(shí)驗(yàn)組切開(kāi)大白兔的股骨干骺端皮膚,可見(jiàn)之前切開(kāi)的骨膜已經(jīng)緊密覆蓋植入的圓柱狀珊瑚羥基磷灰石,圓柱狀骨塊與受體區(qū)嵌合良好,穩(wěn)固無(wú)松動(dòng)。4周時(shí),實(shí)驗(yàn)組珊瑚羥基磷灰石圓柱體與周?chē)泽w骨結(jié)合良好,生物相容性佳,無(wú)明顯炎癥反應(yīng)及肉眼可見(jiàn)縫隙。植入物與周?chē)泽w骨邊界尚清楚。8周時(shí),實(shí)驗(yàn)組珊瑚羥基磷灰石圓柱體與周?chē)泽w骨結(jié)合良好,周?chē)琴|(zhì)長(zhǎng)入珊瑚羥基磷灰石圓柱體四周,兩者之間的邊界模糊。12周時(shí),實(shí)驗(yàn)組珊瑚羥基磷灰石圓柱體與周?chē)琴|(zhì)邊界基本消失,周?chē)琴|(zhì)長(zhǎng)入圓柱體中,其橫切面白色圓形區(qū)域縮�。豢瞻讓�(duì)照組創(chuàng)面縮小,有部分軟組織長(zhǎng)入。 (3)組織學(xué)觀察：實(shí)驗(yàn)組珊瑚羥基磷灰石圓柱體的標(biāo)本在脫鈣后行石蠟組織學(xué)切片以及HE染色,圓柱體的邊緣可看見(jiàn)明顯的骨組織長(zhǎng)入其中,并伴有珊瑚羥基磷灰石的降解。珊瑚羥基磷灰石區(qū)域被染成深藍(lán)色,新長(zhǎng)入的骨組織被染成顏色較深的紅色物質(zhì),間充質(zhì)成近似淺藍(lán)色物質(zhì)。 4周時(shí)的實(shí)驗(yàn)組骨組織切片均可見(jiàn)紅色新生骨沿著圓柱體的邊緣生長(zhǎng),骨細(xì)胞被生長(zhǎng)快速的新生骨基質(zhì)包繞其中。邊緣的珊瑚羥基磷灰石有少量降解。新生骨與周?chē)乃拗鞴蔷o密結(jié)合,形成骨性連接,無(wú)明顯纖維組織介入。這個(gè)階段的新生骨主要由含較多骨細(xì)胞的編織骨組成。 8周時(shí),柱狀珊瑚羥基磷灰石的邊緣結(jié)構(gòu)進(jìn)一步溶解,新生骨組織明顯增多,骨小梁變粗并發(fā)生融合。周?chē)乃拗鞴桥c新生骨形成骨性緊密結(jié)合,無(wú)明顯纖維組織介入。圓柱體中央有少量血管長(zhǎng)入,并有少量新骨形成。這個(gè)階段的新生骨主要由較為細(xì)小的編織骨構(gòu)成。 12周時(shí),圓柱體植入?yún)^(qū)邊緣珊瑚羥基磷灰石降解明顯,圓柱體邊緣新生骨量進(jìn)一步增多,板狀骨有相當(dāng)規(guī)模的量形成,少量骨髓腔分化形成。圓柱體與周?chē)乃拗鞴切纬删o密結(jié)合的骨性連接,無(wú)纖維組織介入。圓柱體中央有較多血管長(zhǎng)入,骨小梁增粗融合。12周時(shí),對(duì)照組圓柱形骨缺損的邊緣僅有少量新骨生成,缺損主要由炎癥細(xì)胞以及成纖維細(xì)胞構(gòu)成,缺損中心為空白區(qū)域,沒(méi)有明顯骨組織長(zhǎng)入。 (4)實(shí)驗(yàn)組新生骨計(jì)量學(xué)統(tǒng)計(jì)分析：實(shí)驗(yàn)組4周、8周、12周的新生骨面積百分比采用One-Way ANOVA,對(duì)各時(shí)間段間進(jìn)行兩兩比較,4周與8周時(shí)比較,4周時(shí)明顯小于8周,差異具有統(tǒng)計(jì)學(xué)意義(P=0.02)；4周與12周時(shí)比較,4周時(shí)明顯小于12周,差異具有統(tǒng)計(jì)學(xué)意義(P=0.001)；8周時(shí)明顯小于12周(P=0.03)。 2.臨床試驗(yàn)部分 (1)A、B兩組植骨成功率以及統(tǒng)計(jì)學(xué)分析：A組19個(gè)患者植入39塊珊瑚羥基磷灰石,兩個(gè)患者中的4塊珊瑚羥基磷灰石骨高度增量失敗,一例植骨區(qū)血供不佳,例患者植骨區(qū)骨質(zhì)疏松,塊狀CHA固位不良。A組珊瑚羥基磷灰石的植骨成功率為90%。B組18個(gè)患者,其中一名患者切口裂開(kāi),植骨失敗,B組的植骨成功率為94%。A、B組移植成功率進(jìn)行四格表資料的卡方檢驗(yàn),兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 (2)A、B兩組通過(guò)垂直onlay植骨,植骨后到6個(gè)月后種植體植入這一階段,垂直骨高度的吸收值(H1-H2),A組B組,差異具有顯著性(P0.01)；骨塊植入后到上部結(jié)構(gòu)完成這一階段,垂直骨高度的吸收值(H1-H3),A組B組,差異具有顯著性(P0.01)；骨塊植入后到上部結(jié)構(gòu)完成后12個(gè)月,A組的垂直骨高度吸收值(H1-H4)顯著小于B組(P0.01)；骨塊植入后到上部結(jié)構(gòu)完成后24個(gè)月,垂直骨高度的吸收值(H1-H5),A組B組,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。A、B組內(nèi)四個(gè)階段的骨高度吸收值差異具有統(tǒng)計(jì)學(xué)意義,植骨6個(gè)月內(nèi)吸收值最小,完成修復(fù)后24個(gè)月骨高度吸收值最大。 (3)A、B兩組中種植體周緣骨吸收量,以種植術(shù)后種植體邊緣骨水平L2為基線,修復(fù)完成時(shí)的周緣骨吸收值(L3-L2),A組B組,差異具有統(tǒng)計(jì)學(xué)意義(P=0.028)；修復(fù)完成后12個(gè)月的周緣骨吸收值(L4-L2),A組B組,差異具有統(tǒng)計(jì)學(xué)意義(P=0.025)：修復(fù)完成后24個(gè)月的種植體周緣骨吸收量(L5-L2),A組顯著小于B組(P=0.013)。A、B組內(nèi)三個(gè)階段的種植體周緣骨吸收量差異具有統(tǒng)計(jì)學(xué)意義,植骨6個(gè)月內(nèi)種植體周緣骨吸收量最小,完成修復(fù)后24個(gè)月種植體周緣骨吸收量最大。 結(jié)論 1.珊瑚羥基磷灰石圓柱體在大白兔股骨干骺端標(biāo)準(zhǔn)骨缺損模型中愈合良好。2.珊瑚羥基磷灰石圓柱體具有良好的骨傳導(dǎo)活性,標(biāo)準(zhǔn)骨缺損大小的圓柱狀珊瑚羥基磷灰石在植入8周后可以獲得較好的中心血供以及成骨效能。 3.塊狀珊瑚羥基磷灰石在低平的下頜后部缺牙區(qū)通過(guò)箱狀洞形楔入固位具有良好的可操作性,臨床固位效果可靠。 4.塊狀珊瑚羥基磷灰石與自體骨塊兩種材料均能有效地恢復(fù)下頜后牙區(qū)垂直高度,兩者成功率無(wú)統(tǒng)計(jì)學(xué)差異。塊狀珊瑚羥基磷灰石增加的骨高度表現(xiàn)出良好的穩(wěn)定性。
[Abstract]:Research background
The improvement of people's economic level and the development of implant technology provide a greater possibility for the widespread use of dental implants for partial or dental implants. Bone mass is an important factor in assessing the long-term function of the implant. However, the patient has many cases, such as trauma, periodontitis, and the high alveolar ridge in the odontic area. The loss of degree has brought challenges to implant denture restoration and reconstruction of occlusal function, which has increased the difficulty of surgical operation.
The posterior mandibular region is one of the most important parts of the clinical teeth. Because of the existence of the mandibular canal, many patients with severe vertical height and severe absorption are often unable to accommodate implant implantation. There are many surgical options for this problem. The common treatment methods include guided bone tissue regeneration, distraction osteogenesis, and onlay bone grafting. Surgery, inferior alveolar nerve free operation.Onlay bone graft, also known as the upper method of bone graft, is the implant material fixed to the surface of the alveolar bone to increase the height of bone graft method.Onlay bone graft because of its positive bone increment effect, has been widely used in clinical.
In onlay bone graft, autogenous bone mass is the gold standard of this type because of its unique osteogenic activity, bone inducibility and bone conductivity. Autogenous bone graft is a method for restoring bone defect in the recipient region by the patient's own fresh bone tissue. Autogenous bone graft includes vascularized self bone graft and non vascularized autogenous bone graft. The two. Non vascularized autologous bone graft has been widely used in onlay bone increment surgery because of its simple operation and less trauma. Autologous bone mass originates from the patient itself, its main advantage is no rejection reaction and high survival rate. However, autogenous bone graft needs to open up the second operation area and increase the amount of the patient because of its limited source. External pain and increase the patient's financial burden.
In view of the shortage of autologous bone graft, people begin to pay wide attention to allograft bone blocks. The bone source obtained from allograft bone graft recipients is derived from the corresponding bone tissue donated by bone donors. It can be used as an immediate use, and can be used first through the bone bank and at a suitable time. The source of allograft allograft. Compared with the autogenous bone mass, the shape can be a compact, crisp cortical bone, loose porous cancellous bone, or a combination of the two. The development of the allograft bone preservation technology and the establishment of a more perfect bone bank make allograft bone graft in many countries. However, allograft bone graft exists. Cross infection, immune rejection and slow healing of graft are the problems that clinicians and patients must consider.
The main source of xenograft bone graft is bovine bone and pig bone. The number of xenograft bones is almost unrestricted, and the grafts can be prepared in various shapes to meet the requirements. However, the bone induction activity of the xenobone has the same material basis as its antigenicity, and is often destroyed while eliminating its antigenicity. There is a certain contradiction between the bone induced activity. On the other hand, because of the emergence of BSE, some countries in Japan and Europe have banned the use of xenogeneic bones from bovine bone origin.
Coralline hydroxyapatite (CHA) is one of the most commonly used hydroxyapatite (CHA) as a new type of porous hydroxyapatite as a new type of bone in recent years. The two corals are widely distributed in the Pacific and Western India oceans. The average pore size of the corals is 200um, and the angle Kong Shanhu is 500um.. The former is similar to human cortical bone, and the latter is close to the cancellous bone. It is an ideal substitute for bone graft.
Coralline hydroxyapatite is clinically used mainly for granular and massive two shaped products. In the last decade, with a large number of reports on the good performance of granular coral hydroxyapatite in implant guided bone regeneration and the progress of the massive coralline hydroxyapatite processing technology, massive coral hydroxyapatite has been reported. The application of vertical onlay bone increment in the mandible has been reported in a small amount, and good bone incremental effect has been achieved abroad. However, massive coral hydroxyapatite is difficult to use with small titanium nails because of its brittle texture. Its retention problem has been one of the reasons for its widespread use, and the massive coral hydroxyl groups are rarely reported at home and abroad. The blood supply and osteogenic efficiency of apatite core did not provide histological support for the application of coralline hydroxyapatite.
objective
1. this study provides a histological basis for the clinical application of the massive coral hydroxyapatite by studying the blood supply of the coralline hydroxyapatite cylinder implanted in the distal metaphysis of the femur of the rabbit.
2. the clinical effect of restoring the height of the alveolar bone in the mandibular posterior region by onlay bone grafting and massive coral hydroxyapatite was compared with the autogenous bone mass, and the clinical operation feasibility and healing condition of the massive coral hydroxyapatite through the Cape shaped wedge force fixation were discussed.
Method
1. animal experiment part: 30 healthy male New Zealand white rabbits were randomly divided into the experimental group and the blank control group (two groups). The experimental group included 24 white rabbits in the distal epiphysis of the bilateral femur of the white rabbit. The cylindrical ultimate bone defect was prepared through the hollow drill, and the corresponding large small coralline hydroxyapatite cylinder was implanted. 8 animals were killed at each time point at 4 weeks, 8 weeks and 12 weeks respectively. A total of 48 specimens were obtained. The osteogenesis, degradation and blood supply of the coralline hydroxyapatite cylinder at each time point were observed. The control group contained 6 large white rabbits in the distal epiphysis of the femur of both sides, to prepare the same cylindrical shape as the experimental group. Bone defect, no bone replacement, 12 weeks after death, to observe the healing of the bone defect. The percentage of the new bone area in the experimental group was tested by one way ANOVA at different time periods, and the difference between the two P0.05 was statistically significant.
2. clinical trial Part: 37 people (20 men and 17 women) were selected from 2010-01 to 2014-06 in Guangdong oral hospital planting center. 19 people in group.A were composed of A and B two groups, and massive coral hydroxyapatite was fixed by box shaped wedge force; 18 in group B, the autogenous bone was fixed by titanium nail for 6 months. The operation was performed accordingly.
(1) when the bone was implanted before the bone graft, the implant was implanted, the restoration was completed immediately, and the restoration was completed every 12 months. The panoramic film was taken and the absorption value of the vertical bone height in the corresponding time segments of the A, B two groups was compared, and the difference between the two of the P0.05 was statistically significant.
(2) the difference between the marginal bone level of the implants and the marginal bone level of the baseline after the completion of the repair completed in December (T4), and the difference in the marginal bone level of the baseline at 24 months (T5) after the completion of the repair was completed, with the baseline of the edge bone level L2 of the implants immediately after the implantation of the implant, respectively A, B two, and 24 months after the completion of the repair. The bone absorption of the implant margin L3-L2, L4-L2, and L5-L2. were detected by Mann-Whitney, respectively. The difference between P0.05 and the two has statistical significance.
Result
1. animal experiment part
(1) a total of 48 coralline hydroxyapatite cylinders were implanted in the operation, with good retention, no loosening and release, and the loosening rate of all rabbits in 0%. did not appear in the experiment.
(2) gross specimen observation: in the experimental group, the femoral metaphysis skin of the experimental rabbits was cut, and the periosteum of the anterior incision had been closely covered with the implanted cylindrical coral hydroxyapatite. The cylindrical bone mass was in good chimerism with the receptor area. The experimental group of coralline hydroxyapatite was well combined with the surrounding autologous bone when it was stable without loosening for.4 weeks. Good compatibility, no obvious inflammatory reaction and visible crevice in the naked eye. The boundary of the implant and the surrounding autogenous bone is clear for.8 weeks. The experimental group of coralline hydroxyapatite cylinder is well combined with the surrounding autologous bone and the surrounding bone grows into the coralline hydroxyapatite cylinder around it. The experimental group of coral hydroxyapatite when the boundary between the two is fuzzy for.12 weeks. The boundary of the cylinder and the surrounding bone disappeared basically, the surrounding bone grew into the cylinder, and the white circular area of the transverse section narrowed, and the wound in the blank control group narrowed and some soft tissue grew.
(3) histological observation: the specimens of the coralline hydroxyapatite cylinder in the experimental group were stained with paraffin tissue and stained with HE after decalcification. The edge of the cylinder could be seen to grow into the bone tissue, and the coral hydroxyapatite was degraded. The coral hydroxyapatite area was dyed deep blue, and the newly formed bone tissue was dyed into pigments. A dark red substance with a substance similar to a light blue substance.
The bone tissue section of the experimental group at 4 weeks shows that the red new bone grows along the edge of the cylinder, and the bone cells are wrapped around the new bone matrix with rapid growth. The coral hydroxyapatite on the edge has a little degradation. The new bone is closely combined with the surrounding host bone to form a bone connection without obvious fibrous tissue involvement. This stage is new. The bones are mainly composed of woven bone containing more bone cells.
At the 8 week, the marginal structure of the columnar coralline hydroxyapatite was further dissolved, the new bone tissue increased obviously, and the bone small Liang Bian was thicker and fused. The surrounding host bone formed bone closely with the new bone, without obvious fibrous tissue involvement. A small amount of blood vessels in the center of the cylinder and a small amount of new bone formed. It is made up of smaller knitted bones.
At the 12 week, the coralline hydroxyapatite was degraded obviously on the edge of the cylinder, and the newborn bone mass was further increased at the edge of the cylinder. The plate shaped bone was formed in a considerable scale, and a small amount of bone marrow cavity formed. The cylinder was closely connected with the surrounding host bone, and no fibrous tissue intervened. There were more blood vessels in the center of the cylinder. At the.12 week of small Liang Zengcu fusion, only a small number of new bone formation on the edge of the cylindrical bone defect in the control group was formed. The defect was mainly composed of inflammatory cells and fibroblasts, the defect center was a blank area, and no obvious bone tissue was found.
(4) statistical analysis of new bone metrology in the experimental group: the percentage of new bone area in the experimental group was 4 weeks, 8 weeks and 12 weeks, the percentage of new bone area was One-Way ANOVA, and 22 compared between each time period. The 4 and 8 weeks were compared, and 4 weeks were obviously less than 8 weeks. The difference was statistically significant (P=0.02); 4 weeks and 12 weeks were significantly less than 12 weeks, the difference has unification. Academic significance (P=0.001); 8 weeks was significantly less than 12 weeks (P=0.03).
2. clinical trial section
(1) the success rate and statistical analysis of bone graft in group A and B: 19 patients in group A were implanted with 39 coralline hydroxyapatite, 4 of two patients failed to increase the height of bone hydroxyapatite, one case of bone grafting area was poor, bone graft area was loose, and the success rate of coral hydroxyapatite in group CHA ungood.A group was 90%.B group success rate 18 patients, one of the patients were split open, bone graft failure, B group bone graft success rate was 94%.A, group B transplantation success rate of four lattice data of the chi square test, the difference between the two groups was not statistically significant (P0.05).
(2) A, B two groups through the vertical onlay bone graft, after bone graft after 6 months implant implantation at this stage, the absorption value of the vertical bone height (H1-H2), A group B group, the difference is significant (P0.01); after the bone mass implantation to the superstructure completion of this stage, the vertical bone height absorption value (H1-H3), A group B group, the difference is significant (P0.01); bone mass implantation In the 12 months after the completion of the upper structure, the vertical bone height absorption (H1-H4) in group A was significantly less than that in group B (P0.01).
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R783.6

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