Early therapeutic effect of platelet-rich fibrin combined with allogeneic bone marrow-derived stem cells on rats’ critical-sized mandibular defects

BACKGROUND Critically sized bone defects represent a significant challenge to orthopaedic surgeons worldwide.These defects generally result from severe trauma or resection of a whole large tumour.Autologous bone grafts are the current gold standard for the reconstruction of such defects.However,due to increased patient morbidity and the need for a second operative site,other lines of treatment should be introduced.To find alternative unconventional therapies to manage such defects,bone tissue engineering using a combination of suitable bioactive factors,cells,and biocompatible scaffolds offers a promising new approach for bone regeneration.AIM To evaluate the healing capacity of platelet-rich fibrin(PRF)membranes seeded with allogeneic mesenchymal bone marrow-derived stem cells(BMSCs)on critically sized mandibular defects in a rat model.METHODS Sixty-three Sprague Dawley rats were subjected to bilateral bone defects of critical size in the mandibles created by a 5-mm diameter trephine bur.Rats were allocated to three equal groups of 21 rats each.Group I bone defects were irrigated with normal saline and designed as negative controls.Defects of group II were grafted with PRF membranes and served as positive controls,while defects of group III were grafted with PRF membranes seeded with allogeneic BMSCs.Seven rats from each group were killed at 1,2 and 4 wk.The mandibles were dissected and prepared for routine haematoxylin and eosin(HE)staining,Masson's trichrome staining and CD68 immunohistochemical staining.RESULTS Four weeks postoperatively,the percentage area of newly formed bone was significantly higher in group III(0.88±0.02)than in groups I(0.02±0.00)and II(0.60±0.02).The amount of granulation tissue formation was lower in group III(0.12±0.02)than in groups I(0.20±0.02)and II(0.40±0.02).The number of inflammatory cells was lower in group III(0.29±0.03)than in groups I(4.82±0.08)and II(3.09±0.07).CONCLUSION Bone regenerative quality of critically sized mandibular bone defects in rats was better promoted by PRF membranes seeded with BMSCs than with PRF membranes alone.

Healing Mechanism and Osteogenic Capacity of Bovine Bone Mineral—Human Amniotic Mesenchymal Stem Celland Autogenous Bone Graft in Critical Size Mandibular Defect

Experiments on maxillofacial bone tissue engineering showed the promising result;however, its healing mechanisms and effectiveness had not been fully understood. The aim of this study is to compare the bone healing mechanism and osteogenic capacity between bovine bone mineral loaded with hAMSC and autogenous bone graft in the reconstruction of critical size mandibular bone defect. Critical size defects were made at the mandible of 45 New Zealand white rabbits reconstructed with BBM-hAMSC, BBM alone, and ABG, respectively. At the end of first, second, and twelfth weeks, five rabbits from each experimental week were sacrificed for histology and immunohistochemistry staining. Expressions of vascular endothelial growth factor (VEGF), bone mor-phogenic proteins-2 (BMP2), Runx2 and the amount of angiogenesis were analyzed in the first and second week groups, while expressions of Runx2, osteocalcin, collagen type-I fibres, trabecular area and bone incorporation were analyzed in the twelfth week groups. The result showed that expressions of VEGF, BMP2 and Runx2 as well as the amount of angiogenesis were higher in ABG compared with BBM-hAMSC group in the first and second weeks of healing. The result of twelfth week of healing showed that expressions of Runx2 and osteocalcin as well as the thickness of collagen type-I fibres were significantly higher in BBM-hAMSC compared to ABG group, while there was no statistically difference in trabecular area and bone incorporation between BBM-hAMSC and ABG group. This study concluded that early healing activities were higher in auto-genous bone graft than in BBM-hAMSC, while osteogenic activities in the late stage of healing were higher in BBM-hAMSC compared to autogenous bone graft. It was also concluded that the osteo-genic capacity of BBM-hAMSC was comparable to autogenous bone graft in the reconstruction of critical size defect in the mandible.

Grafting of iliac bone flap with deep iliac circumflex vessel in treatment of femoral head ischemic necrosis and long-dated hip joint function observation

Objective To retrospect the long-dated curative effect of grafting of iliac bone fl ap with deep iliac circumflex vessel in treatment of femoral head ischemic necrosis.Methods79cases of femoral head ischemic nec rosis treated by promoted Smith-Petersen incision,neck of femur notch,focus cleaning decompression,grafting of iliac bone flap with deep iliac circumflex vessel and screw fixation.13cases treated by transplanting granular bone after d ecompression.Results Grafting of iliac bone flap with deep iliac circumflex vessel treatment g roup were followed up from 3to 9years,the planting bone healed 3to 6months averagely.Two cases suffered femoral head i schemic necrosis continuous-ly.Other cases received good results.Transplanting granular bone afte r decompression group were followed up 3to 9years,3cases suffered femoral head ischemic necrosis cont inuously,hip joint function was lim ited,patients received hip replacement finally.Conclusion Place of iliac bone flap with deep iliac circumflex vessel is fixed,curative effects ar e credible,which can become the firs t-choice therapy to femoral head is-chemic necrosis of middle age and you ng people(Ficat I ～III stage).

Immediate iliac bone graft reconstruction of post ablative defect of benign mandibular pathology - a systematic review

Aim: Autogenous iliac crest bone graft is frequently used in immediate reconstruction of post ablation defect of benign mandibular pathologies. The aim of this study was to conduct a systematic literature review on the complication and failure rates with this technique and factors associated with failure. Methods: The initial literature search in PubMed and Cochrane databases identified 915 articles. Result: Of these, 7 were included in the final review. The majority of the studies were retrospective in nature. These articles encompassed 127 procedures with non-vascularized iliac crest bone graft;with complication rate of 13.3%and failure rate of 3.1%, most complications did not result in failure. All failures were due to infection with no main factor associated with failure. Conclusion: Use of non-vascularized iliac crest bone graft for immediate mandibular reconstruction appears to be associated with low complication and failure rates in carefully selected cases.

Three-dimensional printed tissue engineered bone for canine mandibular defects

Background:Three-dimensional(3D)printed tissue engineered bone was used to repair the bone tissue defects in the oral and maxillofacial(OMF)region of experimental dogs.Material and methods:Canine bone marrow stromal cells(BMSCs)were obtained from 9 male Beagle dogs and in vitro cultured for osteogenic differentiation.The OMF region was scanned for 3D printed surgical guide plate and mold by ProJet1200 high-precision printer using implant materials followed sintering at 1250℃.The tissue engineered bones was co-cultured with BASCs for 2 or 8 d.The cell scaffold composite was placed in the defects and fixed in 9 dogs in 3 groups.Postoperative CT and/or micro-CT scans were performed to observe the osteogenesis and material degradation.Results:BMSCs were cultured with osteogenic differentiation in the second generation(P2).The nanoporous hydroxyapatite implant was made using the 3D printing mold with the white porous structure and the hard texture.BMSCs with osteogenic induction were densely covered with the surface of the material after co-culture and ECM was secreted to form calcium-like crystal nodules.The effect of the tissue engineered bone on the in vivo osteogenesis ability was no significant difference between 2 d and 8 d of the compositing time.Conclusions:The tissue-engineered bone was constructed by 3D printing mold and hightemperature sintering to produce nanoporous hydroxyapatite scaffolds,which repair in situ bone defects in experimental dogs.The time of compositing for tissue engineered bone was reduced from 8 d to 2 d without the in vivo effect.

Treatment of tibial defect and bone nonunion with limb shortening with external fixator and reconstituted bone xenograft

Objective: To explore the effect of external fixator and reconstituted bone xenograft (RBX) in the treatment of tibial bone defect, tibial bone nonunion and congenital pseudarthrosis of the tibia with limb shortening. Methods: Twenty patients ( 13 males and 7 females) with tibial bone defect, tibial bone nonunion or congenital pseudarthrosis of the tibia with limb shortening were treated with external fixation. Two kinds of external fixators were used: a half ring sulcated external fixator used in 13 patients and a combined external fixator in 7 patients. Foot-drop was corrected at the same time with external fixation in 4 patients. The shortened length of the tibia was in the range of 2-9 cm, with an average of 4.8 cm. For bone grafting, RBX was used in 12 patients, autogenous ilium was used in 3 patients and autogenous fibula was implanted as a bone plug into the medullary canal in 1 case, and no bone graft was used in 4 patients. Results: All the 20 patients were followed-up for 8 months to 7 years, averaging 51 months. Satisfactory function of the affected extremities was obtained. All the shortened extremities were lengthened to the expected length. For all the lengthening area and the fracture sites, bone union was obtained at the last. The average healing time of 12 patients treated with RBX was 4.8 months. Conclusions: Both the half ring sulcated external fixator and the combined external fixator have the advantages of small trauma, simple operation, elastic fixation without stress shielding and non-limitation from local soft tissue conditions, and there is satisfactory functional recovery of affected extremities in the treatment of tibial bone defects, tibial bone nonunion and congenital pseudarthrosis of the tibia combined with limb shortening. RBX has good biocompatibility and does not cause immunological rejections. It can also be safely used in treatment of bone nonunion and has reliable effect to promote bone healing.

带血管蒂髂骨瓣移植在早期股骨头坏死患者临床治疗中的应用价值

目的探讨带血管蒂髂骨瓣移植在早期股骨头坏死患者临床治疗中的应用价值。方法将2019年8月~2022年8月南阳市中心医院收治的98例早期股骨头坏死患者,随机分为髂骨瓣组与髂骨块组各49例。髂骨块组患者采用髂骨块移植,髂骨瓣组患者采用带血管蒂髂骨瓣移植。手术前后,采用视觉模拟评分法(VAS)、Harris髋关节功能评价量表(HHS)、X线检查评估两组患者疼痛程度、髋关节功能和髋关节功能优良率、影像学指标评分。手术后,采用自制调查问卷评估两组患者治疗满意度。结果手术后,髂骨瓣组患者VAS评分、影像学指标评分均低于髂骨块组,HHS评分、髋关节功能优良率、治疗总满意度均高于髂骨块组(P<0.05或0.01)。结论带血管蒂髂骨瓣移植应用于早期股骨头坏死患者效果较好,可临床推广。

口内血管吻合髂骨瓣修复颌骨缺损的临床应用

目的:介绍数字外科引导下利用口内血管吻合技术联合血管化游离髂骨瓣移植在颌骨重建中的临床操作与优势,探讨口内血管吻合技术的临床应用。方法:选取2022年武汉大学口腔医学口腔颌面外科3例因颌骨良性肿瘤需行颌骨切除并同期修复的患者,术前对患者进行颌骨及髂骨CT扫描,制定虚拟手术计划,设计、制作取骨截骨导板,手术切除肿瘤,其中2例为口内入路切除,1例为口外入路切除。截取髂嵴部带血管蒂骨瓣,以面动静脉为受区吻合血管与髂骨瓣血管蒂进行吻合,从而完成髂骨瓣对颌面部缺损的重建修复。随访患者术后恢复情况并进行评估。结果:3例手术均成功完成,其中2例患者无口外切口,1例患者仅有一处原发灶切除为口外切口。术后患者恢复良好,颌面部结构基本对称且美观。结论:口内血管吻合技术与髂骨瓣及虚拟手术计划相结合可以取得良好的术后结果。口内吻合技术不仅可以完成口内颌骨病灶切除后重建,对于需经口外入路切除病灶的病例也有一定优势。

基于Micro-CT评价超声骨焊接技术PDLLA材料对骨愈合性能的影响

目的采用微焦点断层扫描(Micro-CT)评价超声骨焊接技术应用过程中超声震荡产热作用下PDLLA材料对骨愈合性能的影响。方法选择SPF级雄性新西兰大白兔36只,随机分为超声骨焊接技术辅助PDLLA材料组(A组)、拧入技术辅助PDLLA材料组(B组)、假手术组(C组)、空白对照组(D组),各9只。于术后4、8、12周取下颌骨标本,周围骨组织进行HE染色,观察各组植入钉周围情况。对术后4、8、12周的下颌骨大体标本拍摄Micro-CT图,使用VG Studio MAX软件进行三维重建,摆正数据样本,即颌骨颊侧造模处为轴向,动态分析植入钉体积、植入钉周围200μm环状区及骨缺损处的植入材料体积数、相对骨体积分数(BV/TV)、骨小梁厚度(Tb.Th)、骨小梁数(Tb.N)、骨小梁间隙(Tb.Sp)等骨愈合相关指标。结果HE染色结果显示,按3个时间可动态观察到A、B、C组骨缺损处骨性骨痂替代纤维性骨痂,形成类骨质,编织骨的过程符合正常骨损伤愈合的过程。Micro-CT结果显示,A、B组术后3个时间点的材料体积比较差异均无统计学意义(P>0.05);在3个时间点,4组植入钉周围200μm环状区中BV/TV、Tb.Th、Tb.N、Tb.Sp比较差异均无统计学意义(P>0.05);在骨缺损处,A、B、C组三个时间点BV/TV、Tb.Th、Tb.N、Tb.Sp比较差异无统计学意义(P>0.05);术后4周,与D组比较,A、B、C组BV/TV、Tb.Th、Tb.N、Tb.Sp差异有统计学意义(P<0.05);与C组比较,A、B组Tb.N差异有统计学意义(P<0.01)。术后8周,与D组比较,A、B、C组BV/TV、Tb.Th、Tb.N、Tb.Sp差异有统计学意义(P<0.05);术后12周,与D组比较,A、B、C组BV/TV、Tb.Th、Tb.Sp差异有统计学意义(P<0.05)。结论超声骨焊接技术其超声震荡产热作用下PDLLA材料对骨愈合性能无不良影响。

诱导膜技术治疗下肢骨缺损的研究进展

骨缺损是指骨感染、骨肿瘤、先天性疾病或严重创伤导致的骨结构缺失。由于高能量损伤发生率增加和自身解剖结构特点,下肢骨缺损尤其常见,成为创伤骨科领域的研究难点。传统的治疗方案主要包括带血管蒂的腓骨移植技术、开放植骨技术和骨搬运技术等,但这些技术都存在固有的不足。近年来,诱导膜技术因其操作步骤标准化、简单高效而逐渐用于重建节段性骨缺损。诱导膜技术分为两个阶段:第一阶段是生成具有生物效应的诱导膜,第二阶段是将骨填充物(自体骨、异体骨、人工骨或生物活性物质等)填充到缺损区域,填充后,使用特定的固定方法将骨填充物固定在原有的骨骼结构中。本文对诱导膜技术的基础研究以及国内外治疗下肢骨缺损的相关研究进展进行了综述,旨在讨论其潜在的基础和临床发展方向。

下颌骨埋伏阻生第三磨牙拔除术后自然转归及对邻近第二磨牙的影响

目的:观察下颌阻生第三磨牙(impacted mandibular third molars,IM3Ms)拔除术后的自然转归及对邻近下颌第二磨牙(mandibular second molars,M2Ms)的影响。方法:选择下颌第三磨牙骨埋伏阻生的患者34例(51颗IM3Ms),使用超声骨刀、气动涡轮手机拔除患牙,分别于术前、术后1周及术后6个月随访,观察术后反应及M2Ms远中骨缺损情况。比较手术前后M2Ms远中骨缺损深度,并分析其影响因素。采用SPSS 29.0软件包对数据进行统计学分析。结果:术前M2Ms远中骨高度未见明显缺损,但拔除IM3Ms时,由于去骨拔牙等操作产生骨缺损。术后6个月,骨高度虽有所恢复,骨缺损率减少,但未达到术前水平。IM3Ms埋伏阻生深度是恢复率的主要影响因素。探诊深度较术前显著增加。术后24 h内患者疼痛感较重,术后1周缓解,但仍存在轻度开口受限及面部肿胀。拔除IM3Ms对患者日常生活、情绪、工作、睡眠影响较小。结论:下颌第三磨牙拔除术后,邻近第二磨牙远中骨高度部分恢复,但未达到术前水平。拔牙手术中需采取更加精细的手术技巧,以减少对邻近牙和骨组织的影响。同时,拔除IM3Ms后应给予镇痛药物,加强卫生宣教,提高患者术后舒适度。

Bio-Oss骨粉与CGF在自体牙移植游离端骨缺损中的修复重建

目的评估Bio-Oss骨粉和浓缩生长因子(concentrated growth factor,CGF)联合应用于自体牙移植游离端骨缺损修复的临床疗效。方法选取2018年7月至2022年6月就诊于合肥市口腔医院口腔外科患者共44例,观察组23例,术中应用Bio-Oss骨粉及CGF;对照组21例,不应用任何材料,术后定期随访,对比移植牙术后即刻初期稳定性、术后1周牙龈状况、术后3个月和6个月骨愈合情况以及术后1年成功率。结果观察组移植牙术后即刻初期稳定性较对照组有明显改善,差异有统计学意义(P<0.05);观察组术后1周牙龈肿胀度与对照组无明显改善,差异无统计学意义(P>0.05);术后3个月受牙区牙槽骨愈合情况较对照组好,差异有统计学意义(P<0.05);术后随访1年,观察组牙移植成功率100%;对照组牙移植成功率90.5%,留存率95.2%,失败率4.8%,差异有统计学意义(P<0.05)。结论Bio-Oss骨粉与CGF在自体牙移植游离端骨缺损中有较好的临床疗效,促进新骨形成,有利于移植牙早期稳定,提高自体牙移植成功率。

带旋髂深血管髂骨瓣移植治疗股骨头缺血性坏死

目的探讨带旋髂深血管髂骨瓣移植治疗股骨头缺血性坏死(ischemicnecrosisofthefemoralhead,INFH)的方法及疗效。方法1996年2月～2003年9月对46例58髋INFH,其中采用带旋髂深血管的髂骨瓣移植治疗44例56髋,2例2髋采用缝匠肌骨瓣治疗。左侧34髋,右侧24髋;期16髋,期39髋,期3髋。结果术后37例40髋获随访6个月～10年,平均3.1年。根据范启申的评定方法:优19例21髋;良11例12髋;中5例5髋;差2例2髋,优良率81%。结论带旋髂深血管的髂骨瓣手术治疗INFH具有重建股骨头血运、髓腔减压、清除坏死骨和支撑股骨头软骨的特点。带旋髂深血管的髂骨瓣手术是治疗INFH的有效方法。

硫酸钙人工骨联合同种异体骨与单纯人工骨治疗下肢良性骨肿瘤的对比研究

目的评价硫酸钙颗粒人工骨联合同种异体骨与单纯使用硫酸钙颗粒人工骨植骨治疗下肢良性骨肿瘤的效果。方法回顾性分析第二军医大学长海医院关节骨病外科2010年6月至2015年6月收治的符合研究条件的97例下肢良性骨肿瘤患者的临床资料,其中32例患者接受硫酸钙颗粒人工骨联合同种异体骨植骨治疗(联用组),另65例患者接受单纯硫酸钙颗粒人工骨植骨治疗(单用组)。比较并分析两组患者术后的切口不良事件、人工骨完全吸收后的骨质愈合情况等。结果联用组和单用组患者术后切口不良事件的发生率分别为15.6%(5/32)和26.2%(17/65),两组差异无统计学意义(P>0.05)。联用组和单用组患者在硫酸钙颗粒人工骨完全吸收后,遗留明确或可疑骨缺损的发生率分别为9.4%(3/32)和29.2%(19/65),两组差异有统计学意义(P=0.028)。结论硫酸钙颗粒人工骨联合同种异体骨植骨治疗下肢良性骨肿瘤具有良好的效果,两者的联合使用不会增加切口不良事件的发生风险,并且可能降低人工骨被完全吸收后遗留骨缺损的风险。

应用细胞片层技术构建组织工程骨修复犬下颌骨缺损的实验研究

目的应用骨髓间充质干细胞(BMSCs)细胞片层构建组织工程骨修复犬下颌骨缺损,探讨细胞片层在成骨中的作用。方法采用密度梯度离心法分离和培养BMSCs,将BMSCs向成骨细胞诱导培养后,制备细胞片层。将细胞片层包裹到聚乳酸羟基乙酸共聚物(PLGA)支架表面,将其植入犬左侧下颌骨全层缺损中,对侧下颌骨植入无细胞片层包裹的支架复合体作同体对照。将16只犬分为4组,每组4只。术后4、8、12、16周分别处死1组,取材行大体及组织学观察。结果实验侧成骨好于对照侧,术后16周,实验侧骨缺损大部分被新生骨替代,舌侧形成与正常骨相似的密质骨,与正常骨断端骨性愈合。实验侧新生骨光密度值大于对照侧,两者差异有统计学意义(P<0.05)。实验侧可见较多哈弗氏系统及红骨髓,大量板层骨;对照侧哈弗氏系统较少。结论利用细胞片层技术可以构建出含板层骨结构的组织工程骨。

髂骨块植骨结合内固定治疗跟骨严重骨折

目的评价髂骨块植骨结合内固定治疗跟骨严重骨折的疗效。方法2000年5月～2007年4月收治54例57足跟骨骨折,行髂骨块植骨结合内固定治疗,对患者术后骨折复位、并发症进行随访。结果平均随访时间为50.4个月,术后Gissane角及Bohler角均恢复,骨折全部骨性愈合。按Maryland评定标准,优39足,良14足,可3足,差1足,优良率为92.98%。结论选择髂骨块植骨治疗跟骨骨折能达到解剖复位或近似解剖复位,直接恢复跟骨的Gissane角及Bohler角,可减少外固定时间,降低术后并发症的发生率。

消旋聚乳酸/羟基磷灰石/脱钙骨基质人工骨修复兔桡骨大段骨缺损的实验研究

目的研制理想的,能够修复大段骨缺损的人工骨材料。方法采用乳液共混法将消旋聚乳酸(PDLLA)、羟基磷灰石(HA)、脱钙骨基质(DBM)结合,制成PDLLA/HA/DBM人工骨,并将PDLLA/HA/DBM和PDLLA进行兔桡骨大段骨缺损修复的对比研究。术后2、4、8和12周时摄X片及病理形态学观察及新骨形成定量分析。结果PDLLA/HA/DBM人工骨内新骨形成量明显多于PDLLA及空白对照组(P<0.01),且能够有效修复骨缺损。结论PDLLA/HA/DBM人工骨能促进长骨大段骨缺损的修复,是一种较理想的骨修复材料。

同种异体骨关节移植修复骨肿瘤切除后骨缺损

目的 探讨骨肿瘤切除后大块骨缺损的修复重建方法。 方法 1998年 5月～ 2 0 0 2年 5月 ,根据肢体骨肿瘤切除后造成骨缺损的部位及大小形状 ,选择深低温冷冻同种异体骨制备成与之大体匹配的骨半关节、骨干段或骨条、骨粒修复骨缺损 ,辅以交锁髓内钉或加压钢板螺钉行坚强内固定。 结果 本组 2 2例 ,术后随访 3～ 4 2个月 ,无瘤存活 2 0例 ,死亡 2例。其中 1例行半膝关节移植者出现排异反应 ,伤口不愈合 ,经皮瓣修复仍不愈合而截肢 ;其余 2 1例患者摄 X线片和 /或 99m Tc SPECT检查提示均有不等量骨痂生成和 /或核素浓集 ,提示有骨愈合。患肢术后功能恢复以Markin骨移植结果评定标准评定 ,优良率达 81.8%。 结论 应用同种异体骨、关节移植修复骨肿瘤切除后骨缺损是一种理想有效的修复方法 ,值得进一步研究和推广应用。

游离腓骨复合组织移植修复胫骨及周围软组织缺损

目的改进切取带血管腓骨及其复合组织瓣游离移植修复胫骨缺损合并胫前及周围皮肤软组织缺损的方法。方法采用改进法行带血管腓骨及复合组织皮瓣的切取，术中先锯断两端腓骨，再切取带肌袖腓骨和显露腓动、静脉血管蒂。为确保游离移植腓骨的血运，腓动脉两断端均与受区胫前动脉吻合。结果术中无一例损伤腓动、静脉，切取腓骨时间为２０～４０分钟。术后１６例移植腓骨均Ⅰ期愈合，骨愈合时间为２～３个月。随访６个月～９年３个月，１４例患肢功能恢复正常，１６例供腓骨侧均无踝关节不稳定发生。结论该改进法切取腓骨具有手术出血量少、解剖清晰及手术时间较常规方法明显缩短的优点。腓骨复合组织瓣移植法行植骨的同时修复胫前皮肤软组织缺损，并可对移植腓骨的血运情况进行监测。

下颌骨缺损自体游离髂骨移植后骨吸收及其影响因素的临床分析

研究下颌骨部分缺损自体游离髂骨移植修复后植骨块的吸收情况。方法 对 2 6例下颌骨部分缺损植骨修复的病人进行回顾性分析。描记术后不同时期的下颌曲面体层片 ,测量并比较植骨块近远中及中点附近骨高度的变化 ;比较保留与摘除髁突后 ,以植骨块重建升支的高度变化。结果 髂骨植入 3个月内已发生吸收改建 ,术后 6个月内吸收较快 ,植骨 1年以后骨块高度基本稳定 ;骨块远中端吸收程度重于近中端 ;对于下颌骨缺损包括升支的病例 ,摘除髁突者比保留髁突者的升支高度明显降低。结论 下颌骨缺损自体游离髂骨移植术后骨块的吸收重建 ,术后 6个月为活跃期 ,6～ 12个月后吸收与重建趋向平稳 ;下颌骨缺损涉及升支区域时 ,应尽量保留髁突再行植骨 ,以避免升支高度的严重降低。