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):417-25. doi: 10.1111/j.1600-0501.2005.01231.x.
Vertical distraction osteogenesis has received considerable interest as a way to augment bone prior to implant placement. However, very little is known regarding the appropriate distraction protocols in the human mandible. In this study, we evaluate the effect of the distraction rate and the duration of neutrofixation on bone formation and closure of the gap in the human mandible. Vertical distraction was performed in the atrophic mandible of 16 edentulous patients, aged 62+/-6 years. The bone was distracted for approximately 10 mm at a rate of either 0.5 or 1 mm/day. Bone biopsies were taken after 7-20 weeks of neutrofixation. Histological analysis demonstrated newly formed bone in the distraction gap in all biopsies. The bone was predominantly of the woven type. After 10 weeks of neutrofixation, the gap was bridged by new bone in two out of three intact samples in the 0.5 mm/day group, but not in two intact samples of the 1 mm/day group. Histomorphometry revealed longer bone trabeculae (P=0.02) and a somewhat increased bone volume in the area where new bone formation started (P=0.07) in the group of patients having the 0.5 mm/day of distraction rate than in the 1 mm/day group. We conclude that in elderly patients, a distraction rate of 0.5 mm/day results in faster osteogenesis in the distraction gap than a rate of 1 mm/day. A minimum of 10 weeks of neutrofixation seems to be needed to close a 10 mm gap after cessation of distraction.
垂直牵张成骨作为一种在种植体植入前增加骨量的方法已引起了广泛关注。然而，关于人类下颌骨合适的牵张方案却知之甚少。在本研究中，我们评估了牵张速率和中性固定持续时间对人类下颌骨骨形成及间隙闭合的影响。对16例年龄为62±6岁的无牙颌患者的萎缩下颌骨进行垂直牵张。以0.5或1mm/天的速率将骨牵张约10mm。在中性固定7 - 20周后进行骨活检。组织学分析显示，所有活检标本的牵张间隙内均有新形成的骨。新形成的骨主要为编织骨。在中性固定10周后，0.5mm/天组的三个完整样本中有两个样本的间隙被新骨桥接，而1mm/天组的两个完整样本中则未出现这种情况。组织形态计量学显示，牵张速率为0.5mm/天的患者组与1mm/天组相比，新骨形成起始区域的骨小梁更长（P = 0.02），骨体积也略有增加（P = 0.07）。我们得出结论，在老年患者中，0.5mm/天的牵张速率比1mm/天的速率能使牵张间隙内的成骨更快。牵张停止后，似乎至少需要10周的中性固定才能闭合10mm的间隙。
