生物活性玻璃陶瓷修复下颌骨缺损远期超微结构及元素含量分析

Ultramicroscopic Observation and Elements Analysis of Specimens Retrieved Long-Term After Bioactive Glass Ceramics Implantation

目的 :对2例下颌骨缺损区生物活性玻璃陶瓷 (bioactiveglassceramics,BGC)植入术后8、10年的临床疗效、植入BGC前后标本的超微结构进行观察及元素含量测定。方法 :将2例患者的BGC手术标本用戊二醛固定后 ,冷冻断裂形成自然断面 ,真空干燥条件下喷金 ,以10年前留下的BGC为对照 ,作断面的扫描电镜观察 ,同时X线探针测定植入前后元素含量变化。结果 :BGC在尚有少量下颌骨支架残存或与自体骨复合移植时骨替代效果良好 ,但存在不能随颌骨同步生长发育的缺点 ,因而术后可导致面部外形畸形或咬合紊乱。大体标本及超微结构观察发现 ,骨组织可以完全长入10mm厚度的材料中 ,材料与颌骨外侧的板状骨几乎无明显界限 ,多数板状骨以钉突形式长入材料中。X线能谱元素分析发现 ,SiMg原子百分含量由植入前27.7 %降至植入后0.43 %或更低,Ca、P的原子百分含量由植入前的54.66 %和9.89 %分别上升至60.44 %和31.87 %以上 ,Ca/P原子个数接近正常骨组织。结论 :BGC复合自体骨植入有良好的临床效果 ,克服其脆性后有较大的临床应用前景。

Objective: To investigate the long-term changes of microstructure and element of bioactive glass ceramics(BGC) specimens retrieved from two patients whose part of mandibles were dissected and BGC were implanted as bone substitutes because of their further esthetic or functional requirements. Methods: Scanning electromicroscope observation and elements analysis were performed after the specimens were fixed with 2.5% glutaldehyde solution. Non_implanted BGC sample kept from 10 years before was taken as control. Results: BGC can function as good bone substitute when there is a little remaining mandibular framework or co_transplanted with autogenous bone graf,but it cannot develop synchronously with the maxillary bone.During the operations we observed bioactive glass ceramics(BGC) present good fixation with the host bone gross.new bone could penetrate the full thickness (10mm) of the matrtial,at the bone_BGC interface the new bone fix with BGC by way of pin_like structure,the space between new bone and BGC was less than 10μm.Si,Mg atom percentage decrease while, Ca,P atom percentage increase thus Ca/p atom ratios reach almost to the leval of normal bone. Conclusion: BGC with autogenous bone or bone marrow complex implantation result in satisfactory clinical outcomes.