牙槽突裂植骨术后移植骨桥的三维纵向变化研究  

Three-dimensional longitudinal evaluation of bone bridge after alveolar bone grafting

作　　者：张柯佳 严斌[1] 刘璐玮[1] 王译雪 卞晶晶 黄路梅 王子添 Zhang Kejia;Yan Bin;Liu Luwei;Wang Yixue;Bian Jingjing;Huang Lumei;Wang Zitian(Nanjing Medical University,Department of Orthodontics,Affiliated Hospital of Stomatology,Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学口腔疾病研究江苏省重点实验室,南京医科大学附属口腔医院正畸科,210029

出　　处：《中华口腔正畸学杂志》2020年第4期216-221,共6页Chinese Journal of Orthodontics

基　　金：江苏省高等学校大学生实践创新训练计划项目(201810312004X);江苏省高等学校自然科学研究项目(19KJB320015);江苏省高校优势学科建设工程项目(2018-87)。

摘　　要：目的利用锥形束CT对唇腭裂患者行牙槽突裂植骨术后的移植骨体积变化情况和吸收区域三维分布情况进行纵向评价。方法选择2018年1~7月在南京医科大学附属口腔医院行牙槽突裂植骨术的唇腭裂患者作为本研究对象,分别于牙槽突裂植骨术前即刻、术后3个月和9个月时拍摄牙槽突局部CBCT,并进行植骨区三维模型重建。通过惯性轴配准对不同时期的颅面部结构进行三维重叠,比较移植骨桥随时间的形态变化特征,同时测量各时间点移植骨体积,计算移植骨吸收率。结果 37例唇腭裂患者(男性22例,女性15例;平均年龄10.53岁),其中双侧完全性唇腭裂6例、单侧完全性唇腭裂19例、单侧不完全性唇腭裂12例,裂隙区共计43侧。受试者牙槽突裂植骨术后3个月和9个月时的移植骨吸收率分别为44.37%±19.17%和57.68%±18.53%。其中,双侧完全性唇腭裂组、单侧完全性唇腭裂组、单侧不完全性唇腭裂组的术后移植骨吸收率分别为61.46%±12.42%、42.80%±15.84%、29.78%±16.03%(术后3个月)和72.71%±13.00%、58.20%±15.59%、41.83%±14.08%(术后9个月),组间差异具有统计学意义(P<0.05)。在移植骨桥吸收区域分布上,牙槽嵴顶侧和腭侧的移植骨吸收率明显高于鼻腔侧和唇侧。结论双侧完全性唇腭裂患者行牙槽突裂植骨术后3个月和9个月时的移植骨吸收率显著高于单侧完全性唇腭裂,而单侧完全性唇腭裂高于单侧不完全性唇腭裂。不同类型唇腭裂患者的术后移植骨吸收程度均在术后前三个月较为明显,之后开始减慢趋于稳定,且移植骨桥吸收区域主要集中在腭侧区和牙槽嵴顶区。Objective The aim of this study was to assess the longitudinal changes of bone volume after secondary alveolar bone grafting and three-dimensional distribution of bone graft resorption area in patients with cleft lip and palate(CLP)based on cone beam computed tomography(CBCT).Methods This prospective study consisted of patients with CLP who underwent secondary alveolar bone grafting from January 2018 to July 2018 in Affiliated Hospital of Stomatology,Nanjing Medical University.CBCT was taken immediately before alveolar bone grafting,and at 3 and 9 months after bone grafting.The reconstructed cranial-facial 3D images were matched and superimposed by inertial navigation system.The volume and morphologic changes of the grafted bone were measured,and the resorption rated were calculated.Results The sample consisted of 37 patients with CLP(22 males and 15 females;mean age 10.53 years)who underwent secondary alveolar bone grafting.Among them,6 patients have bilateral complete cleft lip and palate(BCLP),and 19 patients have unilateral complete cleft lip and palate(UCLP),and 12 patients have unilateral incomplete cleft lip and palate(UILP),with a total of 43 cleft sides.The mean bone resorption rates of 3 and 9 months postoperatively were 44.37%and 57.68%,respectively.The resorption rates of BCLP,UCLP and UILP were 61.46±12.42%,42.80±15.84%,29.78±16.03%(3 months postoperatively)and 72.71±13.00%,58.20±15.59%,41.83±14.08%(9 months postoperatively),respectively.The difference among three types was statistically significant(P<0.05).The bone resorption rates of palate and alveolar ridge crest of the grafted bone bridge were significantly higher than those of the nasal and labial sides.Conclusions The bone resorption rate of BCLP was significantly higher than that of UCLP at 3 and 9 months postoperatively,while the rate of UCLP was higher than that of UILP.The grafted bone resorption was obvious in the first three months after alveolar bone grafting,and then slowed down from 3 to 9 months postoperatively.The main resorpt

关 键 词：唇腭裂 牙槽突裂植骨 纵向评价 骨吸收 

分 类 号：R782.21[医药卫生—口腔医学]