异种脱细胞真皮基质在种植外科中应用初探

Short-term outcome of the acellular dermal matrix in dental implant surgical sites

目的 评估国产异种脱细胞真皮基质在骨劈开同期植入种植体引导骨组织再生的近期临床疗效.方法 选择上颌前牙种植区牙槽嵴顶、中部宽度1.5-3.5 mm（平均骨宽度3.0 mm）的患者64例.21例（空白对照组）采取超声骨刀行骨性切口、骨劈开同期植入25枚种植体,在种植体与骨壁之间植入人工骨代用品;43例（试验组）骨劈开同期植入50枚种植体,并植入人工骨代用品和覆盖国产异种脱细胞真皮基质.对两组的新骨生长情况进行临床及X线检查分析.结果 术后3个月,试验组种植体经X线检查显示,50枚种植体骨结合良好,种植体封闭螺帽上方有骨密度增高影像.Ⅱ期手术时试验组的生物膜已明显吸收较薄,新骨完全覆盖种植体;空白对照组种植体唇侧均有少量骨吸收,其中7例7枚种植体骨吸收较明显,种植体颈部唇侧部分暴露.对两组骨劈开术中、术后3个月行Ⅱ期手术时的牙槽嵴顶唇腭向骨宽度、垂直向骨高度的改建情况进行检测和统计学分析,试验组的新骨生成量（唇腭向骨宽度5.8±1.02 mm;垂直向骨高度0.8±0.39mm）均明显高于空白对照组（唇腭向骨宽度5.1±0.87 mm;垂直向骨高度增加-0.5±0.31mm,P〈0.05）.结论 国产异种脱细胞真皮基质能有效阻挡软组织的长入,屏障时间能满足临床需求,可有效引导骨劈开同期植入的种植体周围的骨组织再生.

Objective To evaluate the clinical short-term results of the acellular dermal matrix for guided bone regeneration.Methods Sixty-four patients with bone defect in anterior maxillary area（average bone width：3 ram） were included.Ridge-splitting technique with simultaneous placement of implants and artificial bone material implantation was performed in 21 patients（non-membrane group）.Forty-three patients received the same procedure but with acellular dermal matrix covering the surgical sites（ membrane group）. The patients were followed up for three months and the new bone formation was checked in clinic and by X- ray. Results Three months after operation, the membrane group showed good osseointegration and high bone density over the implant cover screws. In the second operation, the membranes became thinner and the new bone fully covered the implant in the membrane group. The labial bone exhibited slight absorption and labial surface of 7 implants in 7 patients was exposed in non-membrane group. The width and the height of the ridge in the second operation were greater in membrane group than in non-membrane group（ P 〈 0. 05 ）. Conclusions The acellular dermal matrix can effectively resist the growth of soft tissue to allow bone regeneration around the implant.