富血小板纤维蛋白诱导口腔缺损软组织的修复与再生

Platelet-rich fibrin for repair of oral soft tissue defects

背景:口腔种植术区软组织量不足可能对创面愈合和后期美学修复带来不利影响。富血小板纤维蛋白能促进软组织缺损创面的愈合进程,但目前尚缺乏深入探讨其促进口腔软组织缺损修复的动物实验。目的:对比观察富血小板纤维蛋白和胶原生物膜修复新西兰兔硬腭软组织缺损的效果。方法:将54只新西兰兔随机分为3组,分别为富血小板纤维蛋白组、胶原膜组和空白对照组,每组18只。每只实验兔均于硬腭前部中份,分别距上颌后排门齿、左右硬腭黏膜边缘2 mm处以直径为5 mm的组织环切钻制备圆形软组织全层缺损区。富血小板纤维蛋白膜组、胶原膜组分别于缺损处植入自体富血小板纤维蛋白膜和胶原生物膜,空白对照组创面不予任何处理。在术后3,7,14,21,28,56 d对创面进行大体观察并作创面愈合率分析;术区取材后行苏木精-伊红染色、CD31免疫组织化学染色和Masson染色分别观察术区炎性反应、血管生成和胶原形成情况。结果与结论:(1)创面愈合率:富血小板纤维蛋白组创面愈合速度最快,且无明显瘢痕形成。术后3 d各组的创面愈合率无显著差异。术后7 d富血小板纤维蛋白组创面愈合率大于胶原膜组和空白对照组(P<0.05)。(2)炎性反应:术后3,7 d,富血小板纤维蛋白组炎性反应均小于胶原膜组和空白对照组(P<0.05);术后14,21,28,56 d,3组炎症情况差异无显著性意义。(3)新生血管评价以CD31平均吸光度值分析:术后7,14,21 d,富血小板纤维蛋白组CD31平均吸光度值高于胶原膜组和空白对照组(P<0.05)。(4)胶原纤维形成以平均吸光度值分析:术后7 d,富血小板纤维蛋白组胶原纤维平均吸光度值高于胶原膜组和空白对照组(P<0.05);术后14 d,富血小板纤维蛋白组胶原纤维平均吸光度值高于空白对照组(P<0.05);术后21,28,56 d,富血小板纤维蛋白组胶原纤维平均吸光度值低于其他2组(P<0.05)。结果证实,富血小板纤维蛋白能减轻创面愈合过程中的炎性反应,加快血管化进程,调节胶原代谢,减少瘢痕形成,改善创面愈合质量,促进口腔软组织缺损修复。

BACKGROUND： Insufficient oral soft tissues in the implant zone may have a negative effect on the wound healing and the aesthetic restoration in the late stage. Platelet-rich fibrin can promote the wound healing of soft tissue defects. But there is still a lack of in-depth studies on the promotion of oral soft tissue defects in animal experiments. OBJECTIVE： To compare the repairing effects of platelet-rich fibrin and collagen membrane on soft tissue defects of the hard palate in New Zealand rabbits. METHODS： Fifty-four New Zealand rabbits were randomly divided into three groups（n=14 per group）： platelet-rich fibrin group, collagen membrane group and blank control group. A 5 mm-diameter circular full-thickness soft tissue defect was made in the front of the hard palate, 2 mm distant to the rear maxillary incisors and mucosal edge of the bilateral hard palates. Autologous platelet-rich fibrin membrane or collagen membrane were implanted into the defect in the platelet-rich fibrin group and collagen membrane group, respectively. No treatment was given in the blank control group. General observation of the wound and wound healing analysis were performed at days 3, 7, 14, 21, 28, 56 post operation. Hematoxylin-eosin staining, CD31 immunohistochemical staining and Masson staining were used to observe inflammatory reaction, angiogenesis and collagen formation in the surgical site. RESULTS AND CONCLUSION： The wound healing rate was fastest in the platelet-rich fibrin group, and no obvious scar formed. At 3 days post operation, there was no difference in the wound healing rates among the three groups; at 7 days, the wound healing rate in the platelet-rich fibrin group was significantly higher than that in the collagen membrane group and blank control group（P 0.05）. At 3 and 7 days after operation, the inflammatory reaction in the platelet-rich fibrin group was less than that in the collagen membrane and blank control groups（P 0.05）; at 14, 21, 28 and 56 days, there was no significant difference between the three groups. At 7, 14, 21 days after operation, the average absorbance value of CD31 in the platelet-rich fibrin group was significantly higher than that in the collagen membrane and blank control groups（P 0.05）. The average absorbance value of collagen formation in the platelet-rich fibrin group was significantly higher than that in the collagen membrane and blank control groups at 7 days after operation（P 0.05）, significantly higher than that in the blank control group at 14 days（P 0.05）, but lower than that in the collagen membrane and blank control groups at 21, 28 and 56 days after operation（P 0.05）. These findings show that platelet-rich fibrin can reduce inflammatory reactions in the process of wound healing, accelerate the angiogenesis, regulate the metabolism of collagen, reduce the formation of scar and improve the quality of wound healing, thereby promoting the repair of oral soft tissue defects.