Nkenke Emeka, Neukam Friedrich W
Eur J Oral Implantol. 2014 Summer;7 Suppl 2:S203-17.
To analyse the morbidity arising from autogenous bone graft harvesting, graft resorption and implant survival in grafted sites.
Only comparative clinical trials on the harvest of autogenous bone grafts were selected. Studies were excluded if they compared autogenous bone grafts to bone substitutes or vascularised free bone grafts.
A total of 24 studies were included in the review. Six intraoral or distant donor sites were identified. The highest level of evidence was reached by a randomised controlled trial. The mandibular ramus was the source of bone that was preferred by the patients. From this intraoral donor site bone was harvested under local anaesthesia on an outpatient basis. Patients' acceptance of chin bone harvesting was low. It led to a considerable morbidity that included pain, superficial skin sensitivity disorders and wound healing problems at the donor site. Patients even preferred iliac crest bone harvesting over bone harvesting from the chin, although this distant donor site required general anaesthesia and a hospital stay. The harvest of posterior iliac crest block led to less morbidity than the harvest of anterior iliac crest block grafts. When only cancellous bone was needed, percutaneous bone harvesting from the iliac crest led to less morbidity than an open approach to the iliac crest.
Dependent on the required graft structure and amount of bone needed, ramus grafts, block bone grafts from the posterior iliac crest and cancellous bone grafts harvested with a trephine from the anterior iliac crest should be chosen.
分析取自体骨移植、移植物吸收以及移植部位种植体存活所引发的发病率。
仅选择关于取自体骨移植的比较性临床试验。若研究将自体骨移植与骨替代物或带血管游离骨移植进行比较，则将其排除。
本综述共纳入24项研究。确定了6个口腔内或远处供区。随机对照试验达到了最高证据水平。下颌支是患者首选的骨源。在局部麻醉下于门诊从该口腔内供区获取骨。患者对颏部取骨的接受度较低。这导致了相当高的发病率，包括供区疼痛、皮肤浅感觉障碍及伤口愈合问题。尽管该远处供区需要全身麻醉和住院，但患者甚至更倾向于髂嵴取骨而非颏部取骨。髂后嵴块状骨移植的发病率低于髂前嵴块状骨移植。仅需松质骨时，经皮从髂嵴获取骨的发病率低于切开髂嵴取骨。
应根据所需移植物结构和骨量，选择下颌支移植物、髂后嵴块状骨移植物以及用环钻从髂前嵴获取的松质骨移植物。
