Heberer Susanne, Rühe Bärbel, Krekeler Leif, Schink Tania, Nelson John J, Nelson Katja
Department of Oral and Maxillofacial Surgery, Clinical Navigation and Robotics, Charité-Campus Virchow Clinic, Berlin, Germany.
Clin Oral Implants Res. 2009 Mar;20(3):319-26. doi: 10.1111/j.1600-0501.2008.01638.x.
In this prospective study, solid monocortical iliac onlay grafts of the maxilla were randomly covered with a bioresorbable membrane and periosteum within the maxilla. Histologic specimens were analyzed by light microscopy after a healing period of three months and the rate of resorption of the grafts were measured.
Fourteen patients (9 females and 5 males), with a mean age of 56 years (range 25-72) underwent augmentation with avascular iliac onlay bone grafts. The grafts were randomly covered either with a bioresorbable membrane (MC) or periosteum (PC). Resorption was measured with a digital caliper at the microscrews (slashed circle 1.5 mm) used to fixate the graft. Histologic evaluation of the specimens derived from the graft with a trephine bur (slashed circle 2 mm) from the implant site at implant placement after a 3-month healing period. Statistical evaluation of the data was performed using Analysis of variance and the Wilcoxon signed rank test.
Clinical appearance of the augmented bone after 3 months showed a dense cortical layer with good vascular perfusion. Thirty-three sites in 13 patients (one dropped put) were analyzed histomorphometrically and showed an average of 46% newly formed bone with no significant difference between the groups (P=0.46). The mean resorption rate at 56 measured sites was 1.2 mm (range 0.3-3.4 mm) after 3 months, with no significant difference between the MC sites and the PC sites (P=0.38).
Histomorphometry of new bone formation after 3 months demonstrates no significant difference between the PC and MC groups. Initialization of graft resorption can be seen after 3 months with no significant difference as to whether the graft was covered with a membrane or the periosteum.
This study provides evidence that after avascular iliac bone grafting, the revascularization of the graft was sufficient after 3 months regardless of the graft coverage with no effect on the amount of initial resorption of the graft.
在这项前瞻性研究中，对上颌骨的实体单皮质髂骨贴附移植片在颌骨内随机覆盖生物可吸收膜和骨膜。在三个月的愈合期后，通过光学显微镜分析组织学标本，并测量移植片的吸收速率。
14名患者（9名女性和5名男性），平均年龄56岁（范围25 - 72岁）接受了无血管髂骨贴附骨移植的增容手术。移植片随机覆盖生物可吸收膜（MC）或骨膜（PC）。使用数字卡尺在用于固定移植片的微螺钉处（直径1.5毫米的斜线圆）测量吸收情况。在植入物植入后3个月的愈合期，用环钻（直径2毫米的斜线圆）从植入部位获取移植片的组织学标本进行评估。使用方差分析和威尔科克森符号秩检验对数据进行统计学评估。
3个月后增容骨的临床表现显示为致密的皮质层，血管灌注良好。对13名患者（1名退出）的33个部位进行组织形态计量学分析，平均有46%的新形成骨，两组之间无显著差异（P = 0.46）。3个月后，在56个测量部位的平均吸收速率为1.2毫米（范围0.3 - 3.4毫米），MC组和PC组之间无显著差异（P = 0.38）。
3个月后新骨形成的组织形态计量学显示PC组和MC组之间无显著差异。3个月后可见移植片吸收开始，无论移植片是被膜还是骨膜覆盖，均无显著差异。
本研究提供的证据表明，在无血管髂骨移植后，无论移植片的覆盖情况如何，3个月后移植片的再血管化已足够，且对移植片的初始吸收量无影响。
