Structural bone allografts with intramedullary vascularized fibular autografts for the treatment of massive bone defects in extremities

Objective:To report the clinical outcome of repairing massive bone defects biologically in limbs by homeochronous using structural bone allografts with intramedullary vascularized fibular autografts. Methods: From January 2001 to December 2005, large bone defects in 19 patients (11 men and 8 women, aged 6 to 35 years) were repaired by structural bone allografts with intramedullary vascularized fibular autografts in the homeochronous period. The range of the length of bone defects was 11 to 25 cm (mean 17.6 cm), length of vascularized free fibular was 15 to 29 cm (mean 19.2 cm), length of massive bone allografts was 11 to 24 cm (mean 17.1 cm). Location of massive bone defects was in humerus(n=1), in femur(n=9) and in tibia(n=9), respectively. Results: After 9 to 69 months (mean 38.2 months) follow-up, wounds of donor and recipient sites were healed inⅠstage, monitoring-flaps were alive, eject reaction of massive bone allografts were slight, no complications in donor limbs. Fifteen patients had the evidence of radiographic union 3 to 6 months after surgery, 3 cases united 8 months later, and the remained one case of malignant synovioma in distal femur recurred and amputated the leg 2.5 months, postoperatively. Five patients had been removed internal fixation, complete bone unions were found one year postoperatively. None of massive bone allografts were absorbed or collapsed at last follow-up. Conclusion: The homeochronous usage of structural bone allograft with an intramedullary vascularized fibular autograft can biologically obtain a structure with the immediate mechanical strength of the allograft, a potential result of revascularization through the vascularized fibula, and accelerate bone union not only between fibular autograft and the host but also between massive bone allograft and the host.

Bone Defect Reconstruction in a 2 Years Old Boy with Non-Vascularized Fibular Graft Using the Induced Membrane Technique in Country with Low-Income: A Case Report

Chronic osteomyelitis in children is frequent in the developing countries. Their complications and morbidity burden the functional prognosis. The reconstruction of diaphyseal bone loss after sequestrectomy in young children remains a difficult and expensive challenge in our context. The delay in care and the lack of social security for all, are risk factors for morbidity. The induced membrane technique described by Masquelet starts to be applied and showed satisfactory results. We report the results of a case of reconstruction of the proximal humerus by using a non-vascularized fibula and supplemental bone substitute in a boy of 2 years with sickle cell. No scarring occurred at the sampling site. The process of bone consolidation is underway.

Acellular allogeneic nerve grafting combined with bone marrow mesenchymal stem cell transplantation for the repair of long-segment sciatic nerve defects:biomechanics and validation of mathematical models

We hypothesized that a chemically extracted acellular allogeneic nerve graft used in combination with bone marrow mesenchymal stem cell transplantation would be an effective treatment for long-segment sciatic nerve defects.To test this,we established rabbit models of 30 mm sciatic nerve defects,and treated them using either an autograft or a chemically decellularized allogeneic nerve graft with or without simultaneous transplantation of bone marrow mesenchymal stem cells.We compared the tensile properties,electrophysiological function and morphology of the damaged nerve in each group.Sciatic nerves repaired by the allogeneic nerve graft combined with stem cell transplantation showed better recovery than those repaired by the acellular allogeneic nerve graft alone,and produced similar results to those observed with the autograft.These findings confirm that a chemically extracted acellular allogeneic nerve graft combined with transplantation of bone marrow mesenchymal stem cells is an effective method of repairing long-segment sciatic nerve defects.

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.

Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: Problems solved and unsolved

BACKGROUND Ilizarov non-free bone plasty is a method of distraction osteogenesis using the Ilizarov apparatus for external fixation which originated in Russia and was disseminated across the world. It has been used in long bone defect and nonunion management along with free vascularized grafting and induced membrane technique. However, the shortcomings and problems of these methods still remain the issues which restrict their overall use.AIM To study the recent available literature on the role of Ilizarov non-free bone plasty in long bone defect and nonunion management, its problems and the solutions to these problems in order to achieve better treatment outcomes.METHODS Three databases(Pub Med, Scopus, and Web of Science) were searched for literature sources on distraction osteogenesis, free vascularized grafting and induced membrane technique used in long bone defect and nonunion treatment within a five-year period(2015-2019). Full-text clinical articles in the English language were selected for analysis only if they contained treatment results,complications and described large patient samples(not less than ten cases for congenital, post-tumor resection cases or rare conditions, and more than 20 cases for the rest). Case reports were excluded.RESULTS Fifty full-text articles and reviews on distraction osteogenesis were chosen.Thirty-five clinical studies containing large series of patients treated with this method and problems with its outcome were analyzed. It was found that distraction osteogenesis techniques provide treatment for segmental bone defects and nonunion of the lower extremity in many clinical situations, especially in complex problems. The Ilizarov techniques treat the triad of problems simultaneously(bone loss, soft-tissue loss and infection). Management of tibial defects mostly utilizes the Ilizarov circular fixator. Monolateral fixators are preferable in the femur. The use of a ring fixator is recommended in patients with an infected tibial bone gap of more than 6 cm. High rates of successful treatment were reported by the authors that ranged from 77% to 100% and depended on the pathology and the type of Ilizarov technique used. Hybrid fixation and autogenous grafting are the most applicable solutions to avoid after-frame regenerate fracture or deformity and docking site nonunion.CONCLUSION The role of Ilizarov non-free bone plasty has not lost its significance in the treatment of segmental bone defects despite the shortcomings and treatment problems encountered.

Acetabular Reconstruction with Massive Allograft Shaped to the Cavity and Kerboull-Type Acetabular Reinforcement Device for Multiple Failures of Impaction Bone Graft: A Case Report

Acetabular component revision in the presence of severe bone loss is difficult for reconstructing an acetabular component in the anatomical hip center. Various treatment options are available, although often the acetabular defect cannot be corrected with a single option alone. Precise assessment of the bone loss and a suitable combination of methods are needed. Here we report a case of multiple failures with impaction bone grafting reconstruction for an acetabular bone defect of American Academy of Orthopedic Surgeons classification type III. We finally reconstructed the acetabulum with three femoral head allografts and a Kerboull-type acetabular reinforcement device. The allograft was a casted, jet-type helmet-like shape. A year later the patient was able to walk without a cane and perform light agricultural work. Accurate evaluation of the acetabular bone loss and appropriate reconstruction is important.

Recalcitrant distal humeral non-union following previous Leiomyosarcoma excision treated with retainment of a radiated non-angiogenic segment augmented with 20 cm free fibula composite graft: A case report

BACKGROUND Leiomyosacromas in the Extremities are rare malignant smooth muscle tumors.Adjuvant radiation therapy, in combination with wide surgical excision allows the best chance of treatment. During the follow up pathological fractures are common complications that can be accompanied by Implant failure and defect situations that are most challenging in their management.CASE SUMMARY We present a case of a 52-year-old female suffering from a pathological fracture of the humeral shaft 10 yr after resection of a Leiomyosarcoma and postoperative radiotherapy. She developed implant failure after retrograde nailing and another failure after revision to double plate fixation. In a two-stage revision, the implants were removed and the huge segmental defect created after debridement was bridged by a compound osteosynthesis with nancy nails and bone cement for formation of the induced membrane. Due to the previous radiotherapy treatment,20 cm of the humeral shaft were declared devascularized but were left in situ as a scaffold. In the second stage, a vascularized fibula graft was used in combination with a double plate fixation and autologous spongiosa grafts for final reconstruction.CONCLUSION This combinatory treatment approach led to a successful clinical outcome and can be considered in similar challenging cases.

Is there a connection between synthetic bone grafts and sisters chromatide exchange?

Background: In oral and maxillofacial surgery, synthetic bone grafts are most widely used as bone substitutes, due to the limited sources of autologous bone. The aim of this study was to examine the influence of three different synthetic bone grafts (Cerasorb, Fortoss and Perioglass) on sisters chromatide exchanges (SCEs) in peripheral lymphocytes. Materials and Methods: Peripheral blood samples taken from 68 patients (45 females and 23 males), who underwent oral surgery procedures, such as apical resection, cyst enucleation or periodontal curretage, were obtained for SCE a day before and two months after the surgeries. A control group included 30 patients, while the study group was made of the patients who underwent bone grafting with Cerasorb? (11 patients), Fortoss? VITAL (10 patients) or Perioglass? (17 patients). Results: Comparing with the results of the study group before and after the treatment, it was concluded that the results were statistically significant (p = 0.001). In the Perioglass? subgroup, a greater statistical significance (p = 0.003) was noted, than that in either the Cerasorb? (p = 0.620) or Fortoss? (p = 0.210) subgroups, in which there was no statistical significance. Conclusions: Although further investigations may be necessary, our results suggest that the synthetic bone grafts might have an influence on SCE in peripheral lymphocytes.

自体骨移植联合生龙接骨方剂修复兔骨缺损实验研究

目的观察自体骨移植联合生龙接骨方剂对新西兰兔骨缺损模型修复效果的影响。方法选取54只SPF级6月龄雄性新西兰兔作为研究对象,随机分为单纯自体骨移植组(A组)、单纯生龙接骨方剂组(B组)、生龙接骨方剂联合自体骨移植组(C组),每组18只。各组均采用单侧桡骨中段临界尺寸法构建骨缺损模型,A、C组均予以自体骨移植,B、C组均灌胃生龙接骨方剂20 mg/(kg·d),A组灌胃等量生理盐水,持续干预1个月。于术后第1、2、3个月后分别分批处死实验兔,每组每次6只,收集桡骨组织,观察其损伤情况,采用苏木素-伊红(HE)染色、Masson染色检测桡骨愈合情况,经Micro-CT扫描测定各组实验兔骨组织体积(BV)、骨小梁数(Tb.N)、骨小梁厚度(Tb.Th)、骨小梁间距(Th.Sp)和骨密度(BMD)。结果术后各组大体观察到缺损断端骨痂形成至骨皮质连接的骨愈合过程,HE染色显示1~3个月各组炎性细胞浸润减少,C组较其他两组有较好的成骨作用。Masson染色结果显示,C组颜色对比鲜明,结构清晰,可以清晰地区分成熟骨质与新生骨质。Micro-CT检测结果显示,三组术后第2、3个月的BV、Tb.N、Tb.Th、BMD均高于本组术后1个月,B、C组术后3个月的BV、Tb.N、Tb.Th、BMD均高于本组术后2个月,差异有统计学意义(P<0.05)。术后第1、2、3个月,B、C组BV、Tb.N高于A组,C组BMD高于A组,BV、Tb.N、BMD高于B组,差异有统计学意义(P<0.05);术后第1、2、3个月,三组Tb.Th、Tb.Sp比较,差异无统计学意义(P>0.05)。结论自体骨移植联合生龙接骨方剂修复骨缺损效果明显,可提高新西兰兔成骨能力。

同种异体骨与异种骨对牙周骨下袋缺损再生治疗的疗效对比

目的对比同种异体的Bio-Gene和异种的Bio-Oss骨修复材料应用于引导组织再生术(GTR)联合植骨术在牙周骨下袋缺损的临床疗效。方法选取牙周基础治疗后仍有骨下袋缺损的牙周炎患者34例进行研究,行GTR联合植骨术的牙周再生手术,分为两组:Bio-Gene组(n=16)和Bio-Oss组(n=18)。比较两组牙周再生术前(T0)和术后12个月(T1)的探诊深度(PD)、临床附着水平(CAL)、牙龈退缩(GR)、探诊出血(BOP)、牙齿松动度(TM)、骨缺损深度(BD)、骨内缺损深度(IBD)、剩余牙槽骨高度(RBH)及骨缺损角度(α)。结果与T0相比,T1期两组的PD、CAL、BOP、TM、BD、IBD及RBH均有显著改善(P<0.05);T1期两组相比,Bio-Gene组的BD和RBH差异显著优于Bio-Oss组(P<0.05)。结论Bio-Gene和Bio-Oss骨移植材料在短时间内均能有效改善牙周骨内缺损。值得注意的是,在降低影像学骨缺损深度方面,Bio-Gene相较于Bio-Oss表现更为优越,为牙周骨内缺损的治疗及临床应用提供新的证据。

可降解锌基合金在骨缺损修复重建中的应用及研究热点和不足

背景:锌基合金医用植入材料有优异的力学性能、完全可降解性、良好的生物相容性,主要用于骨科植入物、心血管支架、胆管支架、气管支架、神经导管等。目的:综述可降解锌基合金应用于骨缺损修复的研究进展,展望锌基材料可期研究方向与成果。方法:检索PubMed、Web of Science、万方及中国知网数据库,选择各数据库建库至2023年6月收录的各类可降解锌基合金用于骨植入材料研究的相关文献,对生物可降解锌基合金的基本特性进行概述,对锌基合金促进骨组织修复作用进行梳理和归纳总结,讨论当前的研究热点与不足。结果与结论:①锌基合金具备良好的生物相容性,以锌基合金为基体材料,借助支架结构构建技术和涂层优化工艺将有效提高锌基合金的骨传导性,并且使其降解产物具备高效骨诱导性,以调控成骨、破骨细胞的基因表达,促进骨缺损后的修复重建;②然而在锌基合金优化的研究中,涂层工艺相对不足,增材负载技术尚缺乏;③锌基合金拥有良好的机械、生物特性,通过特殊工艺可增加材料的骨传导性、骨诱导性以有效提高其促进骨修复重建能力,并有望进一步实现个性化移植材料的研发。优化涂层与增材负载等技术融合于锌基合金的研究有待进一步探讨。

基于Mimics三维重建比较自体块状骨移植和GBR在水平骨增量中的临床效果

目的:比较自体块状骨移植与引导骨再生(guided bone regeneration,GBR)在水平骨增量中的临床效果。方法:选择2019年6月—2021年6月于合肥市口腔医院行种植修复伴水平骨缺损的患者42例,随机分为2组。A组20例,采用自体块状骨移植;B组22例,采用GBR进行水平骨增量。评价2组患者并发症发生率、疼痛度、二次植骨率、骨宽度增量、骨吸收率、修复1年的边缘骨吸收量和种植成功率。采用SPSS 26.0软件包对数据进行统计学分析。结果:2组种植成功率、并发症发生率和二次植骨率无显著差异,疼痛度A组显著高于B组(P<0.05)。术后6个月嵴顶下2 mm骨宽度增量A组显著高于B组(P<0.05),而在嵴顶下6 mm和10 mm处,2组无显著差异;A组在嵴顶下2mm吸收率显著低于B组(P<0.05),在嵴顶下6 mm和10 mm处差异无统计学意义。2组修复1年后的边缘骨吸收量无显著差异。结论:对于水平向骨缺损,自体块状骨移植较GBR在嵴顶处可获得更佳的骨轮廓,修复1年后2组边缘骨吸收量接近。

3D打印个性化钛网辅助下的引导骨再生与块状自体骨移植在复杂牙槽骨缺损重建中的临床回顾性研究

目的拟采用临床回顾性研究的方法,对比3D打印个性化钛网(3D-PITM)辅助下的引导骨再生(guided bone regeneration,GBR)与块状自体骨移植在复杂牙槽骨缺损重建中的骨增量效果。方法纳入2018年5月至2022年1月就诊于重庆医科大学附属口腔医院种植科的39名牙槽骨缺损种植患者,根据其骨增量术式不同分为3D-PITM+GBR组(19名)和自体骨Onlay组(20名)。术前拍摄CBCT影像导入Mimics-Research和3-Matic软件进行三维重建与数字化设计,采用计算机辅助设计(CAD)/激光选区熔融(SLM)技术制作3D-PITM。术中固定3D-PITM或自体骨块完成相应的骨增量手术。收集患者术前、植骨术后、术后6~9个月、种植体植入后的CBCT影像资料。基于CBCT数字影像资料,分别测量两组患者在种植体中轴线上牙槽骨增加的高度,以及在种植体平台下方0 mm、2 mm、4 mm处牙槽骨增加的宽度,并计算其成骨率。结果3D-PITM+GBR组在骨增量前后和种植前后的垂直骨增量[2.68 mm(0.45,4.23)、2.27 mm(0.49,3.27)]均高于块状自体骨移植[1.60 mm(0.33,1.62)、1.74 mm(0.53,1.60)]。3D-PITM+GBR组在骨增量前后牙槽嵴顶下方0 mm、2 mm、4 mm平均骨宽度增量[(1.97±0.97)mm、(2.59±1.22)mm、(2.94±1.50)mm]高于块状自体骨移植[(1.06±0.99)mm、(1.45±1.25)mm、(2.32±1.23)mm]。3D-PITM+GBR组在种植前后种植体平台下方0 mm、2 mm、4mm平均骨宽度增量[(2.34±1.09)mm、(2.53±1.48)mm、(2.85±2.20)mm]反低于块状自体骨移植[(2.51±1.34)mm、(3.04±1.73)mm、(3.38±1.94)mm]。3D-PITM+GBR组在水平方向和垂直方向的成骨率(66.8%,68.8%)均高于块状自体骨Onlay移植组(64.6%,62.6%)。3D-PITM用于重建复杂牙槽骨缺损能够较块状自体骨移植明显提高牙槽骨重建的高度和宽度,但植入物暴露率(21%)仍高于自体骨Onlay组(5%)。结论3D-PITM+GBR技术可代替块状自体骨移植用于重建复杂牙槽骨缺损,获得理想的骨增量效果和稳定的骨轮廓,但钛网暴露仍是其应用的常见并发症。

组织工程骨移植物的血管化策略研究

利用骨组织工程修复大段骨缺损是一种富有前景的方法。骨骼是动态的高度血管化组织,在适当时间内形成血管组织是保证骨移植物存活、修复、重塑的关键,也是骨组织工程的主要挑战之一。本文将从血管化的意义,以及基于种子细胞、促血管生成因子、支架结构、免疫调控、体外预血管化等策略来综述组织工程骨移植物血管化的研究进展。

温敏性bFGF/Dex脂质体-水凝胶复合支架的神经化骨再生评价

目的:利用脂质体同时包载具有促进神经分化作用的碱性成纤维细胞生长因子(bFGF)和成骨诱导小分子(Dex),与海藻酸钠溶液混合,构建一种具有温敏性和可注射性的bFGF/Dex脂质体-水凝胶复合支架,评价复合支架促进神经分化和新骨再生的作用。方法:通过薄膜分散法制备bFGF/Dex脂质体,与RGD多肽活化后的海藻酸钠溶液混合,通过自由基聚合反应合成温敏性bFGF/Dex脂质体-水凝胶复合支架。使用Zeta粒径仪检测脂质体的粒径、多分散度和Zeta电位,扫描电镜观察支架的微观结构,利用万能材料试验机测定支架的机械强度,通过RT-PCR和免疫荧光染色检测bFGF促进hBMSCs成神经分化相关基因和蛋白的表达。构建兔颅骨缺损模型,通过micro-CT及免疫组织化学染色,评价复合支架在体内促进神经化骨再生的作用。采用SPSS 26.0软件包对数据进行统计学分析。结果:成功构建温敏性bFGF/Dex脂质体-水凝胶复合支架,该支架在常温下(25℃)呈溶液状态且具有流动性,大于临界温度(32℃)时可迅速转变为凝胶状态。支架表面呈疏松多孔的蜂窝状,能够承担一定应力。体外成神经相关基因和蛋白表达提示,bFGF在诱导hBMSCs成神经分化中具有重要作用。动物实验结果表明,复合支架具有高效促进神经化骨再生的作用。结论:具有温敏性、可注射性和突出生物功能的智能bFGF/Dex脂质体-水凝胶复合支架,为颌骨缺损修复提供了新的材料。

卯榫样植骨修复重度膝关节骨性关节炎胫骨缺损的疗效观察

目的:探讨卯榫样植骨修复重度膝关节骨性关节炎胫骨缺损的疗效及技术优化。方法:对2012年1月至2023年1月内蒙古科技大学包头医学院第一附属医院骨科收治的50例重度膝关节骨性关节炎胫骨平台缺损患者使用卯榫样植骨进行修复,于2023年12月集中对患者进行一次随访。结果:全部患者顺利完成手术,无严重并发症。随访时间为半年至11年,平均为9.3年,所有患者末次随访时膝关节活动度良好,术后KSS评分84~92分,平均88分,较术前有显著改善。末次随访时影像学检查结果显示,胫骨平台骨缺损处均得到有效修复,膝关节假体的位置良好并且承载功能可靠,所有植骨块均与胫骨完全融合,无骨吸收、骨坏死等并发症的出现。末次随访时,对于胫骨平台存在较大缺损的患者,通过增加截骨的角度配合打压植骨修复胫骨平台缺损,所有患者移植的自体骨均完全融入宿主骨,无任何临床症状。结论:卯榫样植骨修复重度胫骨平台缺损植入骨块更加紧实,早期稳定性好,通过进一步改进手术细节,骨块与主体骨接触间隙更小,适应范围更广,值得临床推广。

抗生素骨水泥柱占位联合植骨治疗股骨远端开放骨折骨缺损的疗效分析

目的:探讨抗生素骨水泥柱占位联合髂骨植骨在股骨远端开放骨折骨缺损治疗中的有效性及初步疗效。方法:回顾性分析2014年10月至2021年3月采用抗生素骨水泥柱占位联合髂骨植骨技术治疗股骨远端开放骨折骨缺损16例,其中男12例,女4例;年龄28~68岁。车祸伤11例,高处坠落伤5例,Gustilo分型Ⅰ型3例,Ⅱ型5例,ⅢA型8例。采用AO分型:C2型9例,C3型7例。从受伤至接受最终植骨手术时间为4~119 d。骨缺长损度2~10 cm。记录患者骨折愈合时间、并发症、膝关节功能Merchan评分。结果:本组16例患者均获得随访,随访时间9~29个月。16例患者切口均Ⅰ期愈合,无术后感染、钢板断裂、肢体短缩及膝内外翻畸形等并发症。骨折愈合时间为4~10个月。膝关节功能根据Merchan评分标准评估,优8例,良4例,可3例,差1例。结论:采用抗生素骨水泥柱占位联合髂骨植骨治疗股骨远端开放复杂骨折骨缺损有助于预防感染、协助骨折复位,增加固定强度,减少植骨量,是一种有效的手术方式。

自体骨与富血小板纤维蛋白修复牙槽骨重度缺损

背景:有研究将富血小板纤维蛋白与自体骨联合应用于牙周骨缺损治疗取得了良好效果,但二者联合治疗牙槽骨重度缺损的研究目前较为匮乏。目的:观察自体骨移植与富血小板纤维蛋白联合修复牙槽骨重度缺损的效果。方法:选择2022年4月至2023年2月衡水市人民医院收治的102例牙槽骨重度缺损患者,采取随机数字表法分为对照组(n=51)与观察组(n=51),两组患者均进行引导性组织再生手术,对照组术中采用自体骨填充骨缺损,观察组术中采用自体富血小板纤维蛋白与自体骨填充骨缺损。观察两组临床疗效、手术前后牙齿松动度、牙周微生态环境(探诊深度、临床附着丧失、出血指数)、牙槽骨高度及密度、龈沟液指标(转化生长因子β、丝氨酸蛋白酶抑制剂、基质金属蛋白酶3)变化及不良反应情况。结果与结论:术后6个月,两组治疗有效率比较差异无显著性意义(P> 0.05);观察组患者术后3,6个月的牙齿松动度及牙周探诊深度、临床附着丧失、出血指数均低于对照组(P <0.05),术后6个月的牙槽骨高度高于对照组(P <0.05),术后3,6个月的龈沟液转化生长因子β水平高于对照组(P <0.05),术后3,6个月的龈沟液丝氨酸蛋白酶抑制剂、基质金属蛋白酶3水平均低于对照组(P <0.05)。结果提示:在引导性组织再生手术中,采用自体富血小板纤维蛋白与自体骨联合填充可改善牙槽骨重度缺损患者的牙周微生态环境、减轻牙龈组织炎症、促进牙槽骨组织再生与修复、降低牙齿松动度。

煅烧骨与羧甲基壳聚糖修复兔下颌骨缺损的体内研究

目的观察煅烧骨(CB)与羧甲基壳聚糖(CMC)复合材料(CB/CMC)在新西兰兔下颌骨缺损区的成骨情况。方法36只新西兰兔均分为实验组、对照组和空白组,制作一侧下颌骨缺损模型,实验组兔在骨缺损区植入CB/CMC复合材料、对照兔组植入Bio-Oss、空白组兔不植入任何材料,于术后的第4周、第8周、第12周时分别处死4只新西兰兔,观察骨缺损区情况,HE染色、Masson染色及骨涎蛋白免疫组化染色观察各组动物骨缺损区骨形成情况。结果实验组和对照组兔随植入时间的增加,下颌骨缺损区植入的材料逐渐融合,在第12周时对照组可见少量的骨颗粒残留,空白组未见骨组织形成;HE染色及Masson染色可见实验组和对照组兔随时间的增加缺损区新生骨组织逐渐产生并成熟,残留材料逐渐减少,而空白组未见骨组织形成;实验组和对照组兔骨涎蛋白随植入时间的增加,骨涎蛋白表达由强阳性逐渐呈弱阳性表达;空白组在第4、8、12周时均未见骨组织形成,骨涎蛋白表达阴性。结论CB/CMC复合材料具有与Bio-Oss骨粉相似甚至更优的成骨效果,同时材料降解速度与新骨形成速度更加适宜。

富含血小板血浆联合自体骨移植治疗骨缺损的临床研究

目的探讨富含血小板血浆(PRP)联合自体骨移植治疗骨缺损的疗效及其影响因素。方法选择2023-01至2023-12在火箭军特色医学中心骨科门诊及住院的骨缺损患者60例作为研究对象,依据随机数字表法分为试验组(30例)和对照组(30例)。试验组采用PRP联合自体骨移植治疗,对照组采用单纯自体骨移植治疗,比较两组患者的骨愈合时间、骨愈合率、骨密度、骨强度、骨形态评分、美国下肢功能评分(LEFS评分)和疼痛视觉模拟评分(VAS评分),采用多元线性回归和多元logistic回归分析影响骨愈合的因素。结果试验组的骨愈合时间、骨愈合率、骨密度、骨强度和骨形态评分均明显优于对照组,差异均有统计学意义(P<0.05),且无严重的术后并发症发生。多元回归分析显示,PRP治疗是骨愈合时间和骨愈合率的独立影响因素(P<0.05)。结论PRP联合自体骨移植是一种安全、有效、可行的治疗骨缺损的方法,能够促进骨缺损的愈合和修复,提高骨愈合质量和患者的生活质量。