【作者】 邹锋；

【导师】 邢树忠；

【作者基本信息】 南京医科大学 ， 口腔临床医学， 2004， 硕士

【摘要】 目的：本研究在兔下颌升支建立骨膜牵张成骨模型，观察牵张骨膜后，在骨膜下新骨的形成，以及新骨在各个阶段的结构，同时观察了骨膜受到牵张力后的改变，研究骨膜牵张在口腔颌面部成骨的可能，为牙槽骨缺损及其他口腔颌面部骨组织缺损探讨新的重建方法。 材料与方法： 本研究分为两个部分： 1、下颌升支骨膜牵张成骨模型的建立与新骨形成研究： 1．1、20只成年新西兰大耳白兔，以手术方法将自制钛合金骨膜牵张装置和钛网植入下颌升支外侧面，并以钛钉固定，从术后第7天开始牵张骨膜，第一次牵拉2mm，后每3天牵拉1mm，共牵拉15天，至手术后第22天，最终将钛网牵拉离开骨面7mm。 1．2、于术后第28、35、42和56天分别处死5只动物，进行新生骨的X线检查和组织计量，每组5只动物标本中，随机选取3只进行苏木精-伊红(HE)染色观察，每组2只行苦味酸-品红染色组织学观察。 2、下颌升支骨膜牵张后骨膜的组织学改变： 2．1、20只成年新西兰大耳白兔，手术及术后牵拉方法同第一部分。 2．2、术后第28、35、42和56天分别处死5只实验兔，每组随机选其中2只取实验侧和对照侧的下颌升支骨膜进行HE染色观察；每组3只实验兔取实验侧和对照侧的下颌升支骨膜进行增殖细胞核抗原(PCNA)免疫组织化学染色观察。 结果：骨膜牵张成骨的实验研究南京医科大学硕{学位论文l、骨膜牵张后，可见下领升支外侧的骨皮质上有新骨形成，新骨呈 山峰状凸起，术后第28天的新生骨较低平，多孔隙，随着固定时 间的延长，新骨逐渐成熟;下领升支前后向切线位X线投照显示 新骨呈山峰样隆起;经测量，术后第28、35、42和56天组平均新生 骨厚度分别为x.86士0.15mm、2.29士0.29mm、3.19士0.13mm和4.70 土0.45mm;脱钙骨组织的HE染色和不脱钙骨组织的苦味酸一品 红染色的组织学观察均显示了新生骨在成骨细胞数量上的增长，以 及胶原纤维和骨小梁排列方向上的变化，术后第56天的新生骨在 组织学上与原升支骨组织已无明显区别。2、HE染色显示，与对照组相比较，实验侧骨膜增生明显，细胞间 排列紧密，单位面积内骨膜细胞数增多，细胞核饱满;骨膜PCNA 免疫组化染色显示，与对照侧相比较，实验侧骨膜在牵张后出现了 明显的增生迹象，PCNA阳性细胞分布紧密，单位面积内阳性细胞 数较对照组多，靠近骨表面的骨膜中的阳性细胞数更多而且分布更 为紧密。随着稳定期的延长，阳性细胞密度有所减少。结论: 本研究通过在成年兔下领升支外侧面植入骨膜牵张装置和钦 网，经过缓慢而有规律的牵张，最终在骨膜下形成了新骨，表明骨 膜牵张能够在口腔领面部形成一定量的新骨。牵张后骨膜增生明 显，骨膜细胞保持了较长时间的增殖活性，显示了明显的成骨倾向。 我们认为，新生骨可能来源于牵张后骨膜的增殖和分化，其临床应 用前景值得进一步研究。更多还原

【Abstract】 Objective: The purpose of this study is to establish a periosteal distraction model on rabbit mandiblar ramus, to observe the formation of newly formed bone and its structure in each phase after distraction of periostea, to observe the changes of periostea after being secondary to distraction forces, to investigate the possibility of osteogenesis by periosteal distraction in oral and maxillofacial region, and to study the possibility of a new restoration method of clincal alveolar and other bony defect.Material and methods:The experiment included two sections:1. The establishment of model of osteogenesis by periosteal distraction and the research of formation of newly formed bone 1.1 A self-made titanium periosteal distraction device and titanium mesh were surgically implanted onto the lateral aspect of the mandibular ramus and fixed through titanium pins in 20 adult New Zealand rabbits. The periosteal distraction was begun 7 days after the placement of the distraction device. The titanium mesh placed under the periosteum was distracted 2mm from the surface of the mandible for the first time. During the following 15 days, the mesh was further distracted 1 mm every 3 days. Finally the periosteum was distracted 7mm from the surface of mandibular ramus 22 days after the operation.1.2 Every 5 animals were killed postoperatively at days 28,35,42 and 56 respectively. All the specimens were subjected to X-ray andhistomorphometric examination. The 3 of each 5 specimens were subjected to hematoxylin-eosin stain (HE stain) examination, and 2 were subjected to picricacid-fuchsin stain examination. 2, Histological changes of periostea on the mandibular ramus after the periosteal distraction:2.1 20 adult New Zealand rabbits were operated and distracted with the same methods mentioned above.2.2 Every 5 animals were killed postoperatively at days 28,35,42 and 56 respectively. The periostea of both experimental and control side of the mandibular ramus were taken and prepared, 2 of each 5 rabbits in a group were prepared for HE stain detection and 3 for proliferating cell nuclear antigen (PCNA) immunohistochemical detection.Results:1, The newly formed bone was detected on the lateral aspect of mandibular ramus after periosteal distraction. The bone was shaped like a hill. It looked very low and was full of holes at postoperative day 28. With the time of consolidation period lengthened, the newly formed bone matured gradually. X-ray examination showed the new bone shaped like a hill. The average values of new bone height at postoperative days 28,35,42 and 56 were 1.86 + 0.15mm, 2.29 + 0.29mm,3.19 + 0.13mm and 4.70 + 0.45mm. Histological examination of both HE stain and picricacid-fuchsin stain showed the increase in the number of osteoblasts and the change in the orientation of collagen fibers and bone trabecula. There were no significant differences between newly formed bone and original bone on the lateral aspect of mandibular ramus at postoperative day 56 histologically.2 Compared with the control side, the distracted periostea proliferated obviously under the microscope, and the number of periostealcells increased with satiation of cellular nuclear per unit area. The images of PCNA immunohistochemical stain of periosteum showed that the experimental periosteum proliferated obviously after distraction compared with the control side. The PCNA positive cells were densely, and the number of PCNA positive cells was more than that of the control side per unit area. Positive cells in periosteum adjacent to the surface of bone were much more in number and much denser in density. With the time of consolidation period lengthened, the number of positive cells gradually decreased.Conclusions:The results of this study that newly formed bone was detected on the lateral aspect of mandibular ramus at skeletally matured rabbits after gradual and regular distraction of periosteum indicate that osteogenesis by periosteal distraction is feasible in the oral and maxillofacial region. Periosteum proliferated obviousl更多还原