重组人骨形态发生蛋白-2与脱矿骨基质对比髂嵴骨移植用于唇腭裂患者二期牙槽骨植骨的比较分析：501例病例回顾
A Comparative Analysis of Recombinant Human Bone Morphogenetic Protein-2 with a Demineralized Bone Matrix versus Iliac Crest Bone Graft for Secondary Alveolar Bone Grafts in Patients with Cleft Lip and Palate: Review of 501 Cases.
作者信息
Hammoudeh Jeffrey A, Fahradyan Artur, Gould Daniel J, Liang Fan, Imahiyerobo Thomas, Urbinelli Leo, Nguyen JoAnna T, Magee William, Yen Stephen, Urata Mark M
机构信息
Los Angeles, Calif.; Ann Arbor, Mich.; New York, N.Y.; and Portland, Ore.
From the Divisions of Plastic and Maxillofacial Surgery and Dentistry and Orthodontics, Children's Hospital Los Angeles; the Division of Plastic and Reconstructive Surgery and the Ostrow School of Dentistry, University of Southern California; the Department of Oral and Maxillofacial Surgery, University of Southern California, School of Dentistry; the Division of Plastic Surgery, University of Michigan; the Division of Plastic Surgery of New York-Presbyterian/Columbia, New York-Presbyterian/Morgan Stanley Children's Hospital; and Oregon Health & Science University.
出版信息
Plast Reconstr Surg. 2017 Aug;140(2):318e-325e. doi: 10.1097/PRS.0000000000003519.
BACKGROUND
Alveolar cleft reconstruction using iliac crest bone graft is considered standard of care for children with complete cleft lip and palate at the time of mixed dentition. Harvesting bone may result in donor-site morbidity and additional operating time and length of hospitalization. Recombinant human bone morphogenetic protein (rhBMP)-2 with a demineralized bone matrix is an alternative bone source for alveolar cleft reconstruction. The authors investigated the outcomes of rhBMP-2/demineralized bone matrix versus iliac crest bone graft for alveolar cleft reconstruction by reviewing postoperative surgical complications and cleft closure.
METHODS
A retrospective chart review was conducted for 258 rhBMP-2/demineralized bone matrix procedures (mean follow-up, 2.9 years) and 243 iliac crest bone graft procedures (mean follow-up, 4.1 years) on 414 patients over a 12-year period. The authors compared complications, canine eruption, and alveolar cleft closure between the two groups.
RESULTS
In the rhBMP-2/demineralized bone matrix group, one patient required prolonged intubation because of intraoperative airway swelling not thought to be caused by rhBMP-2, 36 reported facial swelling and one required outpatient steroids as treatment, and 12 had dehiscence; however, half of these complications resolved without intervention. Twenty-three of the 228 rhBMP-2/demineralized bone matrix patients and 28 of the 242 iliac crest bone graft patients required repeated surgery for alveolar cleft repair. Findings for canine tooth eruption into the cleft site through the graft were similar between the groups.
CONCLUSIONS
The rhBMP-2/demineralized bone matrix appears to be an acceptable alternative for alveolar cleft repair. The authors found no increase in serious adverse events with the use of this material. Local complications, such as swelling and minor wound dehiscence, predominantly improved without intervention.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
背景
在混合牙列期，使用髂嵴骨移植进行牙槽嵴裂修复被认为是完全性唇腭裂患儿的标准治疗方法。取骨可能导致供区发病，以及额外的手术时间和住院时间。重组人骨形态发生蛋白（rhBMP）-2与脱矿骨基质是牙槽嵴裂修复的一种替代骨源。作者通过回顾术后手术并发症和腭裂闭合情况，研究了rhBMP-2/脱矿骨基质与髂嵴骨移植用于牙槽嵴裂修复的效果。
方法
对414例患者在12年期间进行的258例rhBMP-2/脱矿骨基质手术（平均随访2.9年）和243例髂嵴骨移植手术（平均随访4.1年）进行回顾性病历审查。作者比较了两组之间的并发症、尖牙萌出和牙槽嵴裂闭合情况。
结果
在rhBMP-2/脱矿骨基质组中，1例患者因术中气道肿胀需要延长插管时间，肿胀原因被认为不是由rhBMP-2引起的；36例报告有面部肿胀，1例需要门诊使用类固醇进行治疗，12例出现裂开；然而，这些并发症中有一半未经干预即得到缓解。228例接受rhBMP-2/脱矿骨基质治疗的患者中有23例，242例接受髂嵴骨移植的患者中有28例需要再次进行牙槽嵴裂修复手术。两组中尖牙通过移植骨进入腭裂部位的萌出情况相似。
结论
rhBMP-2/脱矿骨基质似乎是牙槽嵴裂修复可接受的替代方法。作者发现使用这种材料不会增加严重不良事件。局部并发症，如肿胀和轻微伤口裂开，大多未经干预即得到改善。
临床问题/证据水平：治疗性，III级。
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