【摘要】 目的比较富血小板血浆(PRP)联合同种异体骨骨粉与自体髂骨移植治疗老年患者上颌骨骨缺损的效果。方法选取上颌骨牙缺失、骨缺损,需要行骨增量手术为牙种植术提供骨床的老年患者20例,其中采用PRP联合同种异体骨骨粉治疗骨缺损的10例(A组),采用自体髂骨移植治疗骨缺损的10例(B组)。比较两组患者术后1、3个月随访时骨缺损填充区域CT值以反映骨愈合情况;比较种植体植入后的稳定性参数(ISQ值),以观察新生骨组织对种植体的初始把持力;以术后半年、1年、2年随访为观察时间点,比较种植体边缘骨吸收程度、周围龈沟探诊深度、周围龈沟出血指数。结果两组组内各时间点骨缺损填充区域CT值比较均无统计学差异(均P>0.05),A组CT值高于正常骨质(P<0.05),而B组CT值与正常骨质比较无统计学差异(P>0.05)。两组患者牙种植术后ISQ值比较无统计学差异(P>0.05)。两组患者种植体边缘骨吸收程度均属正常范围,A组在1年内出现明显的骨吸收(P<0.05),B组不明显(P>0.05)。两组患者种植体周围龈沟探诊深度、周围龈沟出血指数比较差异均无统计学意义(均P>0.05)。结论PRP联合同种异体骨骨粉填充骨缺损可以避免额外有创操作和手术切口,容易被临床接受,而自体髂骨移植有更好的组织相容性和骨生长,两种方法均能满足老年患者牙种植术前的骨增量,均体现出良好的生物力学性质,不影响种植体稳定,不会造成种植体周围炎,可根据适应证和临床实际需要作出选择。更多还原

【Abstract】 Objective To compare the curative effect of platelet-rich plasma(PRP)combined allograft bone powder and autogenous iliac bone graft in the treatment of maxillofacial bone defect in the elderly. Methods Twenty elderly patients with missing teeth and maxillofacial bone defect were randomly divided into two groups with 10 cases in each. The patients in group A were treated by PRP combined with allograft bone powder and patients in group B were treated by PRP with autogenous iliac bone graft for the maxillofacial bone defect. CT scans of the original defect area were performed at 1, 2 and 3 months after operation, the bone growth in the filling area was measured. During the dental implant operation, the bone was taken for pathological analysis, the bone quality was evaluated. The implant stability quotient(ISQ) of the implant was determined to evaluate the grasping ability and biomechanics of the new bone to the implant. The marginal bone losing,sulcus bleeding index and periodontal probing depth was assessed at the first and the second year after the implant surgery. Results The baseline data were comparable in two groups. There was no significant difference in the CT value of filling areas between two groups at all time points after bone grafting operation(P >0.05). The new bone CT value of group A was higher than that of the normal bone(P<0.05), while that of the group B had no difference to the normal bone(P >0.05). There was no significant difference in ISQ value, means initial stability of implants between the two groups. The biopsy showed bone and fibrous tissue complex with granular calcification in group A, but good quality cancellous bone in group B. After dental implant surgery, the marginal bone losingof the two groups was normal. The group A had significant bone losing in the first year(P<0.05), but not that in group B was not statistically significant. There was no difference between the two groups in sulcus bleeding index and periodontal probing depth in the two years follow-up. Conclusion PRP combined with allograft bone filling bone defects can avoid extra invasive operation,which is more accepted by the patients, while the autogenous iliac bone graft has better biocompatibility and bone growth.The study shows that two methods both can provide good quality bones for the stability of implants in elderly patients with maxillofacia bone defect.更多还原