rhBMP-2 联合脱矿骨基质支架与自体髂嵴骨移植在牙槽裂重建中的比较。
rhBMP-2 with a demineralized bone matrix scaffold versus autologous iliac crest bone graft for alveolar cleft reconstruction.
机构信息
Los Angeles, Calif.; and Houston, Texas From the Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles; Division of Plastic and Reconstructive Surgery, University of Southern California, Keck School of Medicine; Division of Plastic and Reconstructive Surgery, University of Texas Health Science Center; and Department of Oral and Maxillofacial Surgery, University of Southern California, School of Dentistry.
出版信息
Plast Reconstr Surg. 2013 May;131(5):1107-1115. doi: 10.1097/PRS.0b013e3182865dfb.
BACKGROUND
Secondary alveolar cleft reconstruction using autologous iliac crest bone graft is currently the standard treatment for alveolar clefts. Although effective, harvesting autologous bone may result in considerable donor-site morbidity, most commonly pain and the potential for long-term sensory disturbances. In an effort to decrease patient morbidity, a novel technique using recombinant human bone morphogenetic protein (rhBMP)-2 encased in a demineralized bone matrix scaffold was developed as an alternative to autografting for secondary alveolar cleft reconstruction.
METHODS
A chart review was conducted for the 55 patients who underwent secondary alveolar cleft reconstruction over a 2-year period with a mean follow-up of 21 months. Of these, 36 patients received rhBMP-2/demineralized bone matrix scaffold (including 10 patients with previously failed repairs using iliac crest bone grafting) and 19 patients underwent iliac crest bone grafting. Postoperatively, bone stock was evaluated using occlusal radiographs rated according to the Bergland and Chelsea scales.
RESULTS
Alveolar clefts repaired using rhBMP-2/demineralized bone matrix scaffold were 97.2 percent successful compared with 84.2 percent with iliac crest bone grafting. Radiographically, initial repairs with rhBMP-2/demineralized bone matrix scaffold were superior to iliac crest bone grafting according to both Bergland and Chelsea scales, and significantly more patients in the rhBMP-2/demineralized bone matrix scaffold group had coronal bridging. The postoperative intraoral infection rate following iliac crest bone grafting was significantly greater than for rhBMP-2/demineralized bone matrix scaffold. The cost of rhBMP-2/demineralized bone matrix scaffold products was offset by cost savings associated with a reduction in operative time averaging 102 minutes.
CONCLUSIONS
rhBMP-2 encased in a demineralized bone matrix scaffold appears to be a viable alternative for secondary alveolar cleft repair. Patients are spared donor-site morbidity and achieve excellent results, decreasing operative time, and increasing operating room use.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
使用自体髂嵴骨移植进行二次牙槽裂重建目前是牙槽裂的标准治疗方法。虽然有效，但采集自体骨可能会导致相当大的供区发病率，最常见的是疼痛和长期感觉障碍的潜在风险。为了降低患者的发病率，开发了一种新的技术，使用包裹在脱矿骨基质支架中的重组人骨形态发生蛋白（rhBMP）-2 作为自体移植的替代物，用于二次牙槽裂重建。
方法
对 55 例在 2 年内接受二次牙槽裂重建的患者进行了图表回顾，平均随访 21 个月。其中，36 例患者接受 rhBMP-2/脱矿骨基质支架治疗（包括 10 例先前使用髂嵴骨移植修复失败的患者），19 例患者接受髂嵴骨移植。术后，根据 Bergland 和 Chelsea 量表对咬合片上的骨量进行评估。
结果
使用 rhBMP-2/脱矿骨基质支架修复的牙槽裂成功率为 97.2%，而使用髂嵴骨移植的成功率为 84.2%。根据 Bergland 和 Chelsea 量表，rhBMP-2/脱矿骨基质支架的初始修复效果优于髂嵴骨移植，rhBMP-2/脱矿骨基质支架组中更多的患者有冠状桥接。髂嵴骨移植术后的口腔内感染率明显高于 rhBMP-2/脱矿骨基质支架组。rhBMP-2/脱矿骨基质支架产品的成本被手术时间缩短带来的成本节约所抵消，平均缩短了 102 分钟。
结论
包裹在脱矿骨基质支架中的 rhBMP-2 似乎是二次牙槽裂修复的一种可行替代方法。患者避免了供区发病率，并获得了良好的效果，缩短了手术时间，增加了手术室的使用。
临床问题/证据水平：治疗，III 级。
Zotero 插件