Amir Lisa R, Becking Alfred G, Jovanovic Andreas, Perdijk Frits B T, Everts Vincent, Bronckers Antonius L J J
Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, and Department of Oral & Maxillofacial Surgery, Gelderse Vallei Hospital, Ede, The Netherlands.
Clin Oral Implants Res. 2006 Aug;17(4):410-6. doi: 10.1111/j.1600-0501.2006.01258.x.
We examined the effect of distraction rate on blood vessel growth in intramembraneous ossification after vertical distraction osteogenesis in the human mandible. Six edentulous patients (aged 60+/-9 years) with a severely atrophic mandible underwent bone augmentation with distraction osteogenesis. Two distraction rates (0.5 and 1 mm/day) were compared and for each group three patients were analyzed. Vascular histomorphometry was carried out in two different areas in the distraction gap: (1) in the first and (2) in the second 1 mm area from the osteotomy line, representing the oldest and younger new-bone area, respectively. Correlation analysis was performed between blood vessel parameters and the amount of new bone formed during distraction. Histological analysis demonstrated the presence of blood vessels throughout the soft connective tissue in the distraction gap. The volume density of blood vessels between the two investigated areas was significantly lower in the 1 mm/day groups, suggesting a delay in angiogenesis in this group of patients. A positive correlation between blood vessel volume and bone volume density was found in the younger new-bone area but not in the oldest new-bone area. This correlation was due to a higher number of blood vessels rather than to a larger size of the blood vessels. Our data suggest that the lower blood vessel density found in the patients with 1 mm/day distraction rate may be related to disruption of angiogenesis in the soft connective tissue of the gap or to a less optimal mechanical stimulation of cells involved in angiogenesis. This probably results in the slower rate of osteogenesis seen at the 1 mm/day distraction rate compared with the 0.5 mm/day distraction rate. The data support the concept that a positive relationship exists between the density of blood vessels and the formation of bone. For distraction of the human mandible in elderly patients, a distraction rate of 0.5 mm/day seems beneficial.
我们研究了牵张速率对人类下颌骨垂直牵张成骨术后膜内成骨过程中血管生长的影响。六名下颌骨严重萎缩的无牙患者（年龄60±9岁）接受了牵张成骨骨增量术。比较了两种牵张速率（0.5和1毫米/天），每组分析三名患者。在牵张间隙的两个不同区域进行血管组织形态计量学分析：（1）距截骨线的第一个1毫米区域和（2）距截骨线的第二个1毫米区域，分别代表最老和较新的新骨区域。对血管参数与牵张过程中形成的新骨量进行相关性分析。组织学分析显示牵张间隙的整个软结缔组织中均存在血管。1毫米/天组两个研究区域之间的血管体积密度显著较低，表明该组患者血管生成延迟。在较新的新骨区域发现血管体积与骨体积密度呈正相关，但在最老的新骨区域未发现。这种相关性是由于血管数量较多而非血管尺寸较大。我们的数据表明，牵张速率为1毫米/天的患者中发现的较低血管密度可能与间隙软结缔组织中血管生成的破坏或与参与血管生成的细胞的机械刺激不太理想有关。这可能导致与0.5毫米/天牵张速率相比，1毫米/天牵张速率下成骨速率较慢。这些数据支持血管密度与骨形成之间存在正相关的概念。对于老年患者的人类下颌骨牵张，0.5毫米/天的牵张速率似乎有益。
