Rogers Gary F, Greene Arin K
Division of Plastic and Reconstructive Surgery, Children's National Medical Center, Washington, District of Columbia 22102, USA.
J Craniofac Surg. 2012 Jan;23(1):323-7. doi: 10.1097/SCS.0b013e318241dcba.
No single biomaterial is optimum for every craniomaxillofacial application. Instead, surgeons should consider the advantages and disadvantages of each alternative in a given clinical situation, and select the material with lowest overall cost and morbidity, and the highest likelihood of success. Autogenous bone is still considered the gold standard for most applications; it becomes vascularized and osseointegrates with surrounding bone, thus minimizing the risk of infection, dislodgement, or break-down. Limitations include added operative time for graft harvest, donor site morbidity, graft resorption, molding challenges, and limited availability, especially in the pediatric population. Numerous alternatives to bone graft have become available to address these limitations; unfortunately, most of these products are expensive, do not osseointegrate, and have unpredictable biologic activity. Understanding the physiologic behavior of autogenous bone graft can help clarify the indications for its use and provide a conceptual framework for achieving the best possible outcome when this alternative is chosen.
没有一种生物材料对每一种颅颌面应用都是最佳的。相反，外科医生应在特定临床情况下考虑每种替代材料的优缺点，并选择总体成本和发病率最低、成功可能性最高的材料。自体骨在大多数应用中仍被视为金标准；它会形成血管并与周围骨骼骨整合，从而将感染、移位或分解的风险降至最低。其局限性包括取骨增加手术时间、供区发病率、植骨吸收、塑形挑战以及可用性有限，尤其是在儿科人群中。为解决这些局限性，已有多种骨移植替代材料可供选择；不幸的是，这些产品大多价格昂贵，不能骨整合，且生物活性不可预测。了解自体骨移植的生理行为有助于明确其使用指征，并为选择这种替代方案时实现最佳可能结果提供概念框架。
