Hönig J F, Merten H A, Wiltfang J
Department of Craniofacial & Plastic Surgery, University Hospital & Medical School, Göttingen, Germany.
J Craniofac Surg. 1998 May;9(3):260-6. doi: 10.1097/00001665-199805000-00016.
In the quest for bioinert, easily applicable, and individually adaptable alloplastic materials, hydroxyapatite (HA) has gained a new application in onlay craniofacial augmentation. On the basis of clinical and experimental proof that intraosseous translocation of HA occurs after HA onlay augmentation, we conducted an animal study on 16 adult Goettingen minipigs in which HA, as blocks or granular, was implanted for a maximum time of 72 weeks. Our aim was to study the difference between periosteal and subperiosteal onlay augmentation of two different HA forms by comparing HA-bone interface on the intact frontal bone treated with a block form of HA versus granular HA, with special emphasis on the periosteum. Within a few weeks after subperiosteal augmentation, subimplant changes in the grafted bone became evident to such an extent that within 72 weeks the granules migrated into the frontal sinus. In contrast, in epiperiosteal HA onlay augmentation, no intraosseous migration of HA particles was observed, regardless of the type of HA implants. The HA particles were integrated within the connective tissue, and the connective tissue infiltrated the interstitial spaces. For the most part, the location and the shape of the implant remained stable. The periosteum assumed the function of a limiting membrane. We recommend that epiperiosteal onlay augmentation with HA be performed only if previous studies have proven that shape and location are stable. The periosteum should be preserved because it functions as a limiting membrane, retaining the HA and preventing it from migrating into the subimplant bone.
在寻求生物惰性、易于应用且可个体适配的异质材料的过程中，羟基磷灰石（HA）在颅骨表面增强术方面获得了新的应用。基于临床和实验证据表明，HA植入颅骨表面后会发生骨内移位，我们对16只成年哥廷根小型猪进行了一项动物研究，将块状或颗粒状的HA植入，最长时间为72周。我们的目的是通过比较用块状HA与颗粒状HA处理完整额骨上的HA - 骨界面，研究两种不同HA形式的骨膜下和骨膜上表面增强术之间的差异，特别强调骨膜。骨膜下增强术后几周内，移植骨的植入物下方变化明显，以至于在72周内颗粒迁移到额窦。相比之下，在骨膜上HA表面增强术中，无论HA植入物的类型如何，均未观察到HA颗粒的骨内迁移。HA颗粒整合在结缔组织内，结缔组织浸润到间隙空间。在大多数情况下，植入物的位置和形状保持稳定。骨膜起到了限制膜的作用。我们建议仅在先前研究证明形状和位置稳定的情况下，才进行HA骨膜上表面增强术。应保留骨膜，因为它作为限制膜，可保留HA并防止其迁移到植入物下方的骨中。
