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臺灣口腔顎面外科學會雜誌

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篇名 運用富含血小板纖維蛋白輔助重建下顎骨缺損-病例報告
卷期 33:1
並列篇名 Reconstruction of Bony Defect of the Lower Jaw Using Platelet-rich Fibrin - A Case Report
作者 陳昕妤劉釗誌曾非凡陳元武
頁次 034-044
關鍵字 富含血小板纖維蛋白骨缺損下顎重建Platelet-rich fibrin Bony defectLower jawReconstruction
出刊日期 202203

中文摘要

顎骨常因創傷或病灶導致骨缺損,此缺損會造成病患失能,包括咬合、咀嚼、吞嚥、語言表達等不良後遺症。傳統治療骨缺損的方法大多使用自體、異體或合成骨粉填補。近年來伴隨再生醫學蓬勃發展,有大量臨床實驗證實富含血小板纖維蛋白可以加速傷口癒合、幫助缺損組織修復與再生。本病例爲71歲男性患者,主訴爲左侧下顎聯合旁區無痛之腫脹,經臨床與放射線檢查,發現大小约3 X 2公分的病灶。經手術移除後,於移植區同時施行皮質骨穿孔以提供血管新生、同時植入冷凍乾燥骨粉協助維持再生所需空間,以富含血小板纖維蛋白再生膜覆蓋增加傷口穩定性,並且完成初級缝合。許多研究顯示在骨缺損重建手術時合併使用骨粉與富含血小板纖維蛋白,可以促進骨頭生長。此次製備富含血小板纖維蛋白過程離心時間較長,推論因爲紅血球數量與平均體積有種族差異所致。本病例報告以富含血小板纖維蛋白重建骨缺損的案例以及文獻回顧,提供臨床醫師經驗分享。

英文摘要

Large jaw bone defect due to trauma or lesions in the oral and maxillofacial region leads to dysfunction, such as malocclusion, dysphagia, and dysarthria. Traditionally, this defect has been based on the use of autograft, allograft and synthetic bone graft substitutes. Several studies have shown that autologous platelet-rich fibrin (PRF) improves the properties of graft materials by providing bioactive factors. A 71-year-old Taiwanese man presented with painless swelling mass in the left parasymphyseal region of lower jaw. Both clinical examination and radiographic examination revealed a large cyst-like lesion measuring 3 X 2 cm in size. After the tumor was removed, the recipient site was decorticated to facilitate process of angiogenesis and grafted by freeze-dried bone allograft (FDBA) in order to provide space maintenance, and both the inner and outer layers were covered with a PRF gel membrane for blood clot stability followed by primary closure. The outcome of previous studies indicates that the use of PRF in the enhancement of bone defect regeneration promotes osteogenesis. In this case, the prolonged PRF centrifugation time suggests that red blood cell count and mean cell value may vary among ethnicities and should be considered during preparation. This case report provides clinical experience and the advantages of PRF in combination with FDBA in the treatment of bone defects.

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