應(yīng)用富血小板纖維蛋白修復(fù)頜骨缺損的臨床觀察
發(fā)布時間：2018-08-26 07:20
【摘要】：目的：將自體富血小板纖維蛋白(PRF)單獨作為骨移植材料應(yīng)用于骨量不足的種植區(qū)及頜骨缺損中，初步觀察PRF促進骨組織修復(fù)的臨床效果。 方法：選擇骨量不足的即刻種植修復(fù)患者5例，上頜竇提升病例5例，頜骨囊腫患者4例。術(shù)前抽取肘靜脈血10-40ml于不含抗凝劑的試管中，立即以3500轉(zhuǎn)/分，離心15分鐘制成PRF。常規(guī)口內(nèi)及口周頜面部消毒、鋪手術(shù)巾，術(shù)區(qū)使用阿替卡因腎上腺素液行局部浸潤麻醉，牙槽嵴頂做梯形切口，沿切口剝離牙齦，全層翻起黏骨膜瓣，暴露牙槽嵴頂和頰側(cè)骨面，去凈骨面粘連的軟組織和肉芽組織。球鉆定位后用先鋒鉆沿預(yù)定方向鉆入，根據(jù)種植體直徑情況逐級擴大，植入種植體。于骨缺損處放入PRF。如果種植體初期穩(wěn)定性達到25Ncm以上，就放入愈合基臺；如果初期穩(wěn)定性不足25Ncm，則放入覆蓋螺絲。囊腫摘除術(shù)后，將PRF植入骨缺損區(qū)。術(shù)后1周、3個月、6個月進行復(fù)查，記錄軟組織瓣的愈合情況，有無感染；拍攝牙片以了解填入PRF部位的骨改建情況及與種植體骨結(jié)合情況，以術(shù)后即刻拍攝的X線片為觀察基點，將術(shù)后3個月和6個月的X線片與之對比，觀察PRF植入?yún)^(qū)骨質(zhì)的變化。檢查種植體及上部修復(fù)體的穩(wěn)定性、種植體周圍牙齦情況、患者對修復(fù)體的咀嚼功能及美觀的滿意度。 結(jié)果：種植體無一例松動脫落，留存率為100%。術(shù)后未出現(xiàn)明顯疼痛癥狀者5例，僅有輕微疼痛者最多，達8例，1例囊腫伴感染者疼痛較重；術(shù)后7天口腔粘膜瓣顏色無異常，無明顯水腫，達到初期愈合者共13例，僅1例上頜竇提升的患者術(shù)后眶下區(qū)腫脹，2周后恢復(fù)正常。隨診6月，患者均完成上部修復(fù)，對修復(fù)效果滿意，其中單冠4例，，固定橋7例。種植體均可承受35Ncm扭矩，行使功能皆良好。未發(fā)現(xiàn)術(shù)后并發(fā)癥。與術(shù)前X線對比顯示：種植體周圍骨密度增高，所有種植體均獲得良好的骨結(jié)合。對于種植體周圍較小的骨缺損和上頜竇提升病例，新生骨均能充滿腔隙且種植體穩(wěn)定；對于頜骨囊腫刮治后殘留的較大的骨腔，單純使用PRF可以促進新骨從四周向中央生長，但短期內(nèi)不能完全充滿骨腔。術(shù)后3個月的影像學(xué)分析顯示，新生骨充填原骨缺損區(qū)，但此時新生骨質(zhì)密度低于周圍骨質(zhì)；術(shù)后6個月骨密度進一步增高。 結(jié)論：本臨床觀察證實了PRF促進組織再生的效果。單純應(yīng)用PRF作植骨材料，不僅可以加快種植體周圍較小骨缺損的修復(fù)，對較大骨缺損中的骨再生也能起到促進作用。因此，PRF作為一種簡便、安全、價廉的骨移植材料，在頜骨缺損修復(fù)再生中的效果可靠。PRF的應(yīng)用避免了取自體骨的痛苦和使用人造骨的弊端，擴大了種植手術(shù)的適應(yīng)癥。但PRF促進骨再生的遠期效果及與其他材料的聯(lián)合應(yīng)用的效果還有待研究。
[Abstract]:Objective: to investigate the clinical effect of autogenous platelet-rich fibrin (PRF) (PRF) on bone tissue repair in bone defects and grafts with insufficient bone mass using autologous platelet-rich fibrin (PRF) alone as bone graft material. Methods: 5 cases of immediate implant repair, 5 cases of maxillary sinus lifting and 4 cases of maxillary cyst were selected. Before operation, 10-40ml was extracted from elbow vein blood in a test tube without anticoagulant. PRF. was made by centrifugation for 15 minutes at 3500 rpm immediately. Routine intraoral and perioral maxillofacial disinfecting, spreading surgical towels, using Atevacaine epinephrine solution to perform local infiltration anesthesia, alveolar ridge top trapezoid incision, along the incision to remove the gingiva, the whole layer turned over the mucoperiosteal flap, The alveolar crest and buccal bone surface were exposed, and the soft tissue and granulation tissue were removed. After the ball is positioned, the pioneer drill is used to drill in along the predetermined direction and expand step by step according to the diameter of the implant to implant the implant. Place PRF. at bone defect If the initial stability of the implant is above 25Ncm, put in the healing base; if the initial stability is less than 25 Ncm, put in the cover screw. After cystectomy, PRF was implanted into the bone defect area. 1 week, 3 months and 6 months after operation, the healing of soft tissue flap was recorded, and any infection was recorded. X-ray films taken immediately after operation were compared with X-ray films taken at 3 and 6 months after operation to observe the changes of bone in PRF implantation area. Check the stability of implants and upper prostheses, gingiva around implants, patients' satisfaction with prosthetic masticatory function and beauty. Results: none of the implants loosened and shed, and the retention rate was 100%. There were no obvious pain symptoms in 5 cases, only slight pain occurred in 5 cases, and there were 8 cases of cyst with severe pain in infected persons, 7 days after operation, there was no abnormal color of oral mucosal flap, no obvious edema, and 13 cases reached initial healing. Only one patient with maxillary sinus elevation returned to normal after 2 weeks of suborbital swelling. After 6 months of follow-up, all the patients completed the upper repair, and the results were satisfactory, including 4 cases with single crown and 7 cases with fixed bridge. Implants can withstand 35Ncm torque and function well. No postoperative complications were found. Compared with preoperative X-ray, the bone density around implants increased and all implants had good bone bonding. For the patients with small bone defect around implant and maxillary sinus lifting, the new bone could be filled with space and the implant was stable. For the larger bone cavity left after curettage of maxillary cyst, the use of PRF alone could promote the growth of new bone from four sides to the center. But the bone cavity cannot be completely filled in the short term. Imaging analysis at 3 months after operation showed that the new bone filled the original bone defect area, but the density of the new bone was lower than that of the surrounding bone, and the bone density increased further 6 months after operation. Conclusion: this clinical observation confirmed the effect of PRF on tissue regeneration. Simply using PRF as bone graft material can not only accelerate the repair of small bone defects around implants, but also promote bone regeneration in larger bone defects. Therefore, as a simple, safe and inexpensive bone graft material, PRF has a reliable effect in the reconstruction of mandibular defects. The application of PRF avoids the pain from body bone and the malpractice of using artificial bone, and expands the indication of implant operation. However, the long-term effect of PRF on bone regeneration and the effect of combined application with other materials need to be studied.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R782.4
本文編號：2204136
[Abstract]:Objective: to investigate the clinical effect of autogenous platelet-rich fibrin (PRF) (PRF) on bone tissue repair in bone defects and grafts with insufficient bone mass using autologous platelet-rich fibrin (PRF) alone as bone graft material. Methods: 5 cases of immediate implant repair, 5 cases of maxillary sinus lifting and 4 cases of maxillary cyst were selected. Before operation, 10-40ml was extracted from elbow vein blood in a test tube without anticoagulant. PRF. was made by centrifugation for 15 minutes at 3500 rpm immediately. Routine intraoral and perioral maxillofacial disinfecting, spreading surgical towels, using Atevacaine epinephrine solution to perform local infiltration anesthesia, alveolar ridge top trapezoid incision, along the incision to remove the gingiva, the whole layer turned over the mucoperiosteal flap, The alveolar crest and buccal bone surface were exposed, and the soft tissue and granulation tissue were removed. After the ball is positioned, the pioneer drill is used to drill in along the predetermined direction and expand step by step according to the diameter of the implant to implant the implant. Place PRF. at bone defect If the initial stability of the implant is above 25Ncm, put in the healing base; if the initial stability is less than 25 Ncm, put in the cover screw. After cystectomy, PRF was implanted into the bone defect area. 1 week, 3 months and 6 months after operation, the healing of soft tissue flap was recorded, and any infection was recorded. X-ray films taken immediately after operation were compared with X-ray films taken at 3 and 6 months after operation to observe the changes of bone in PRF implantation area. Check the stability of implants and upper prostheses, gingiva around implants, patients' satisfaction with prosthetic masticatory function and beauty. Results: none of the implants loosened and shed, and the retention rate was 100%. There were no obvious pain symptoms in 5 cases, only slight pain occurred in 5 cases, and there were 8 cases of cyst with severe pain in infected persons, 7 days after operation, there was no abnormal color of oral mucosal flap, no obvious edema, and 13 cases reached initial healing. Only one patient with maxillary sinus elevation returned to normal after 2 weeks of suborbital swelling. After 6 months of follow-up, all the patients completed the upper repair, and the results were satisfactory, including 4 cases with single crown and 7 cases with fixed bridge. Implants can withstand 35Ncm torque and function well. No postoperative complications were found. Compared with preoperative X-ray, the bone density around implants increased and all implants had good bone bonding. For the patients with small bone defect around implant and maxillary sinus lifting, the new bone could be filled with space and the implant was stable. For the larger bone cavity left after curettage of maxillary cyst, the use of PRF alone could promote the growth of new bone from four sides to the center. But the bone cavity cannot be completely filled in the short term. Imaging analysis at 3 months after operation showed that the new bone filled the original bone defect area, but the density of the new bone was lower than that of the surrounding bone, and the bone density increased further 6 months after operation. Conclusion: this clinical observation confirmed the effect of PRF on tissue regeneration. Simply using PRF as bone graft material can not only accelerate the repair of small bone defects around implants, but also promote bone regeneration in larger bone defects. Therefore, as a simple, safe and inexpensive bone graft material, PRF has a reliable effect in the reconstruction of mandibular defects. The application of PRF avoids the pain from body bone and the malpractice of using artificial bone, and expands the indication of implant operation. However, the long-term effect of PRF on bone regeneration and the effect of combined application with other materials need to be studied.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R782.4
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