de Ruiter Ad, Dik Eric, van Es Robert, van der Bilt Andries, Janssen Nard, Meijer Gert, Koole Ron, Rosenberg Antoine
Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. R. Koole), University Medical Centre Utrecht, Heidelberglaan 100, G.05.129, PO Box 85500, NL 3508 GA Utrecht, The Netherlands.
Department of Oral and Maxillofacial Surgery, (Head: Prof. Dr. R. Koole), University Medical Centre Utrecht, Heidelberglaan 100, G.05.129, PO Box 85500, NL 3508 GA Utrecht, The Netherlands.
J Craniomaxillofac Surg. 2014 Jul;42(5):460-8. doi: 10.1016/j.jcms.2013.05.042. Epub 2013 Jul 10.
The purpose of this study was to evaluate the use of synthetic bone graft material as a filling material at the mandibular symphysis donor site of autologous bone in children.
A blinded patient group comprised 20 patients with unilateral (UCLP) or bilateral (BCLP) cleft of lip and palate, all with an indication for alveolar cleft repair. The study took the form of a prospective randomized clinical trial. We used lateral cephalograms for the measurement of the symphyseal donor area defect both peroperatively and at 12 months postoperatively. The data obtained were digitalized and the treatment outcome expressed in numbers. Comparisons with a previous study were made. Histology of biopsies and CT scans were used for visualising bone formation.
This study demonstrates that the micro-structured, resorbable calcium phosphate ceramic provides good regeneration properties for the repair of a critical size bony defect in children. One year postoperatively, the measurements taken from lateral cephalograms show that there is scarcely any visible residual defect. Histological investigations of the bone biopsies show solid, induced bone formation and almost complete resorption of the micro-structured calcium phosphate.
The findings of this study (novel in children) indicate that micro-structured resorbable calcium phosphate is an excellent alternative to autologous bone. The digital findings showed a restored donor site defect significantly indicating the efficacy (i.e., osteoconductivity and resorbability) of this bone substitute. The biopsy histology demonstrated the overall presence of newly formed vital bone and the resorption of the bone substitute. Its use for grafting the alveolar cleft is currently researched and it may become the new standard.
As co-morbidity and prolonged operation time at the donor operation site are inherent to the alveolar cleft repair procedure, the use of the described bone substitute is winning progress.
本研究旨在评估合成骨移植材料作为儿童自体骨下颌骨联合供骨部位填充材料的应用情况。
一个盲法患者组包括20名单侧（UCLP）或双侧（BCLP）唇腭裂患者，均有牙槽嵴裂修复指征。本研究采用前瞻性随机临床试验形式。我们在手术中及术后12个月使用头颅侧位片测量联合供骨区缺损情况。获取的数据进行数字化处理，治疗结果以数字表示。与之前的一项研究进行了比较。活检组织学和CT扫描用于观察骨形成情况。
本研究表明，微结构可吸收磷酸钙陶瓷为修复儿童临界尺寸骨缺损提供了良好的再生性能。术后一年，头颅侧位片测量结果显示几乎没有可见的残余缺损。骨活检的组织学研究显示有坚实的诱导骨形成，微结构磷酸钙几乎完全吸收。
本研究（针对儿童的新研究）结果表明，微结构可吸收磷酸钙是自体骨的极佳替代品。数字化结果显示供骨部位缺损得到修复，显著表明了这种骨替代物的有效性（即骨传导性和可吸收性）。活检组织学证明总体上存在新形成的活性骨以及骨替代物的吸收。目前正在研究其用于牙槽嵴裂植骨的情况，它可能会成为新标准。
由于牙槽嵴裂修复手术本身存在供骨手术部位的合并症和手术时间延长的问题，所述骨替代物的应用正在取得进展。
