From Nantes University, Nantes University Hospital; INSERM UMR-S 1229, RMeS; the Department of Plastic and Reconstructive Surgery, Sir Charles Gairdner Hospital; the Dental Department, the Plastic and Reconstructive Surgery Department, and the Cleft Lip and Palate and Craniomaxillofacial Units, The Princess Margaret Hospital for Children.
Nantes, France; and Perth, Western Australia, Australia.
Plast Reconstr Surg. 2020 Feb;145(2):391e-400e. doi: 10.1097/PRS.0000000000006494.
Outcomes for a continuously applied alveolar bone grafting protocol, established in 1982, are reported and compared to previously published outcomes from the authors' unit and elsewhere.
A descriptive, retrospective cohort study of alveolar bone grafting outcomes at a tertiary referral cleft center was performed. Records of all alveolar bone grafts between 2002 and 2014 were reviewed (224 grafts). Three-year postoperative periapical radiographs were evaluated using the Bergland, Kindelan, and standardized way to assess graft scores by an external rater. Incomplete records, a syndromic diagnosis, or primary surgery performed elsewhere resulted in 123 grafts being excluded, leaving 101 grafts for assessment. The distribution of scores was compared to the authors' previous studies and international reports. The authors also tested for any impact on the outcome based on cleft type, laterality, timing for incisor or canine eruption, and surgeon experience.
A total of 95.6 percent of applicable grafts (66 of 69) were considered "successful" by Bergland scores and 96 percent by Kindelan scores. Eighty-nine percent of grafts were "very good" based on standardized way to assess graft score. No significant differences were detected in outcomes based on timing, cleft type, or laterality. Surgeon experience had a significant impact (p < 0.05) on outcome for Bergland and Kindelan scores. Distribution of Bergland scores did not differ from the authors' earlier studies demonstrating consistent outcomes for over 30 years.
The Western Australian alveolar bone grafting protocol has consistently achieved a very high success rate (96 percent) for over 30 years despite multiple staff changes. These results compared well with best-reported outcomes from worldwide cleft centers. Surgeon training and experience were significant in achieving these outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
报告了 1982 年建立的连续应用牙槽骨移植方案的结果，并将其与作者所在单位和其他地方以前发表的结果进行比较。
对三级转诊腭裂中心牙槽骨移植结果进行描述性、回顾性队列研究。回顾了 2002 年至 2014 年间所有牙槽骨移植的记录（224 例移植）。3 年后对根尖周射线照片进行评估，使用 Bergland、Kindelan 和标准化方法由外部评分者评估移植评分。由于记录不完整、综合征诊断或在其他地方进行的初次手术，123 例移植被排除在外，留下 101 例进行评估。评分分布与作者以前的研究和国际报告进行了比较。作者还测试了基于裂隙类型、侧别、切牙或尖牙萌出时间以及外科医生经验对结果的任何影响。
根据 Bergland 评分，66 例（95.6%）可应用的移植被认为是“成功”的，根据 Kindelan 评分，96%是“成功”的。根据标准化方法评估移植评分，89%的移植被认为是“非常好”的。根据时机、裂隙类型或侧别，结果无显著差异。外科医生经验对 Bergland 和 Kindelan 评分的结果有显著影响（p<0.05）。Bergland 评分的分布与作者之前的研究不同，这些研究显示 30 多年来结果一致。
尽管人员多次变动，西澳大利亚牙槽骨移植方案在 30 多年来一直保持非常高的成功率（96%）。这些结果与全球腭裂中心的最佳报告结果相当。外科医生的培训和经验对实现这些结果至关重要。
临床问题/证据水平：治疗，IV。
