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Taiwan Journal of Oral Medicine Sciences

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篇名 以真骨陶瓷骨移植體修復臨界大小骨缺損之探討
卷期 24:2
並列篇名 Critical Sized Defect Repaired with True Bone Ceramic
作者 莊富雄呂佩真陳正慧許栢仁沈領昌阮榮泰
頁次 119-134
關鍵字 真骨陶瓷臨界大小骨缺損骨移植體Bone ceramicsCritical size of bony defectBone graft
出刊日期 200808

中文摘要

無論創傷、病變或手術性造成的骨缺損,都期盼其能迅速的恢復原有的功能與外形,故能幫助骨
缺損癒合及塑形的骨移植體,在醫療上佔有極重要的地位。本研究探討使用緻密骨帶海綿骨真骨陶瓷骨移植體的生成效用,並和骨再生引導膜對骨生成的效用做比較,同時探討以往認為只具有骨生長誘發(osteoinduction)的移植體,才具有修復臨界大小骨缺損能力的理論真實性。本研究利用36隻週齡十週、頭蓋骨已生長完全之兔子,分別於額骨及頂骨製造兩個直徑15 mm,深度1.7 mm之人造缺損。製備完成之骨缺損隨機選入以下四組分組中的任二組植入,每一分組各包含18個骨缺損:第一組為置放緻密骨帶海綿骨的真骨陶瓷骨組;第二組為置放鑽孔緻密骨帶海
綿骨之真骨陶瓷骨組;第三組為置入骨引導再生膜(FRIOSR BoneShield);第四組為未放置任何材料的控制組。分別在術後二週、四週、八週、十六週犧牲後,以組織切片來觀察結果。結果顯示控制組於人造缺損區僅有少量且不完整新生骨生成。第一組有連續性新生成木柵般的骨小樑與新骨形成,並完全修復臨界大小骨缺損。第二組表現類似第一組,惟於第十六週的觀察,新骨形成速度略慢於第一組。第三組可見與第一組相同之新生成木柵般連續性新骨與骨小樑生成,且有良好的併合現象(incorporation)。緻密骨帶海綿骨的真骨陶瓷骨除了提供骨骼的空間架構,與鑽孔緻密骨帶海綿骨的真骨陶瓷骨相較,其完整的緻密骨有類似骨引導再生膜功能,具有引導新骨往內生長的效用,能修復臨界大小的骨缺損。

英文摘要

This study compared bone regeneration of critical sized defect(CSD)of cranial vault defects in rabbits using either nonresorbable membrane (FRIOSR BoneShield ) or true bone ceramic (TBC). Results are to identify the better material in repairing the CSD. Critical sized defects of 15 mm in diameter were created in the parietal and frontal bones of 36 rabbits. Group 1 had membrane on one defect of the cranium, group 2 had TBC (cortical/sponge), and group 3 had TBC (perforated cortical/sponge). The other defect of all 3 groups was unfilled. Three animals in each group were sacrificed at 2, 4, 8 and 16 weeks post operation, and excision biopsy
were performed for histological examination. Histological examination slowed, all unfilled defects healed with fibrous scar and minimal amounts of incomplete new bone formation. Defects treated with the titanium membrane healed with bone throughout the entire defect.
There were definite of bony remodeling, with some areas showing characteristic lamellar-type bone. Defects treated with TBC (cortical/sponge) had markedly complete bony coverage of the defect giving a palisade appearance. Defects treated TBC (perforated cortical/sponge) seemed to lag behind that seen in TBC (cortical/sponge) implant. The utilization of TBC or titanium membrane seems to support complete closure of critical sized defects in rabbits with viable bone at 16 weeks. TBC may serve as a bony matrix and allow satisfactory bony ingrowth.

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