From the University of California, Los Angeles, David Geffen School of Medicine; and University of Vermont Medical Center.
Plast Reconstr Surg. 2022 Aug 1;150(2):387e-395e. doi: 10.1097/PRS.0000000000009352. Epub 2022 Jun 8.
Alveolar bone grafting is an important component of cleft lip and palate treatment, with iliac crest as the most common donor site. Although studies have attempted to quantify alveolar bone graft resorption, few have directly compared the outcomes of graft techniques. This study compared the long-term success rates of corticocancellous block to trephine cancellous-only alveolar bone grafting from the iliac crest.
A retrospective review of all cleft lip and palate patients undergoing alveolar bone grafting over 14 years was performed. Power analysis was performed to determine sample size. Data including patient demographics, surgical technique, need for repeated grafting, complications, length of hospitalization, and follow-up were collected. Statistical analyses of outcomes were performed based on initial graft technique.
A total of 106 initial operations met criteria, with 73 using trephine technique, 30 using corticocancellous block, and three undergoing open cancellous harvest. The overall regraft rate was 40 percent, with an average follow-up of 43.5 months. Patients with corticocancellous block grafting had significantly lower rates of repeated grafting compared to trephine technique (16.7 percent versus 47.9 percent; p < 0.001). There was no significant difference in complication rates or length of admission between treatment groups.
The use of corticocancellous block alveolar bone grafting demonstrated significantly higher success rates when compared to cancellous-only trephine techniques, with no difference in complication rates. Although this must be weighed against the minor disadvantages of open iliac harvest, surgeons should consider incorporating en bloc corticocancellous bone to optimize outcomes in alveolar bone grafting.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
牙槽骨移植是唇腭裂治疗的重要组成部分，髂嵴是最常用的供体部位。尽管已有研究尝试量化牙槽骨移植吸收，但很少有研究直接比较移植技术的结果。本研究比较了皮质松质骨块与髂嵴单纯松质骨环钻牙槽骨移植的长期成功率。
对 14 年来接受牙槽骨移植的所有唇腭裂患者进行回顾性研究。进行了功效分析以确定样本量。收集的数据包括患者人口统计学、手术技术、重复移植的需求、并发症、住院时间和随访情况。根据初始移植技术对结果进行了统计学分析。
共有 106 例初始手术符合标准，其中 73 例采用环钻技术，30 例采用皮质松质骨块，3 例采用开放式松质骨采集。总体再移植率为 40%，平均随访时间为 43.5 个月。皮质松质骨块移植组的重复移植率明显低于环钻技术组（16.7%比 47.9%；p<0.001）。两组间并发症发生率和住院时间无显著差异。
与单纯的松质骨环钻技术相比，皮质松质骨块牙槽骨移植的成功率显著更高，且并发症发生率无差异。尽管这必须与开放式髂骨采集的轻微缺点相权衡，但外科医生应考虑将整块皮质松质骨纳入牙槽骨移植，以优化结果。
临床问题/证据水平：治疗，III 级。
