数字化导板引导CGF联合Bio-Oss骨粉充填颌骨囊肿的临床研究

doi:10.13591/j.cnki.kqyx.2023.10.009

摘要/Abstract

摘要：

目的探讨数字化导板引导浓缩生长因子(concentrated growth factor,CGF)结合Bio-Oss骨粉充填颌骨囊肿术后骨缺损区的疗效。方法以2021年9月至2022年9月在徐州医科大学附属口腔医院口腔颌面外科就诊的60例行颌骨囊肿摘除术患者为研究对象,随机分为实验组、对照组1和对照组2。实验组术前制作数字化导板术中定位囊肿并填充CGF联合Bio-Oss骨粉至骨腔中,对照组1术前制作数字化导板术中定位囊肿并填充Bio-Oss骨粉至骨腔中,对照组2常规手术术中填充Bio-Oss骨粉至骨腔中。检测术前1 d、术后24 h、术后72 h血液CRP、WBC水平及手术时间,评估术后疼痛程度,测量术后3个月、6个月骨密度值。结果三组术后CRP、WBC均较术前显著上升,实验组和对照组1术后炎症反应、手术时间及疼痛程度均显著低于对照组2,且实验组术后炎症反应显著低于对照组1;术后3个月、6个月三组骨缺损区骨密度均高于术前,实验组显著高于其他两组。结论数字化导板引导CGF联合Bio-Oss骨粉充填颌骨囊肿摘除术后骨缺损区,可以缩短手术时间、减轻术后炎症反应及疼痛不适、促进骨愈合、提高成骨速度及成骨质量、更快恢复颌骨形态,值得在临床推广应用。

关键词: 浓缩生长因子, 数字化定位导板, 骨再生, 骨缺损

Abstract:

Objective To investigate the efficacy of digital guide plate guided concentrated growth factor(CGF)combined with Bio-Oss bone powder for filling bone cavity after jaw cyst surgery. Methods Sixty patients who attended the Department of Oral and Maxillofacial Surgery of the Affiliated Stomatological Hospital of Xuzhou Medical University from September 2021 to September 2022 for jaw cyst removal were randomly divided into experimental group, control group 1 and control group 2. In the experimental group, a digital guide was made intraoperatively to locate the cyst and CGF combined with Bio-Oss bone powder was filled into the bone cavity. In the control group 1, a digital guide was made intraoperatively to locate the cyst and Bio-Oss bone powder was filled into the bone cavity, and in the control group 2, Bio-Oss bone powder was filled into bone cavity during the conventional surgery. Preoperative, 24 h and 72 h postoperative blood CRP and WBC levels and the time of surgery were measured. Postoperative pain level was assessed and postoperative bone mineral density values were measured 3 and 6 months after surgery. Results The postoperative CRP and WBC of the three groups were significantly higher than those before surgery. The postoperative inflammatory reaction, operation time and pain level of the experimental group and control group 1 were lower than those of control group 2, and postoperative inflammatory reaction was significantly lower in the experimental group than in control group 1. The bone density of bone defect area of the three groups 3 and 6 months after surgerywas higher than that before surgery, and the experimental group was significantly higher than the other two groups. Conclusion Digital guide plate guided CGF combined with Bio-Oss bone powder to fill the bone defect area after jaw bone cyst removal can shorten operation time, reduce postoperative inflammatory reaction and pain and discomfort, promote bone healing, improve osteogenesis speed and quality, and restore jaw bone morphology faster, which is worth being promoted in clinical application.

Key words: concentrated growth factor, digital positioning guide plate, bone regeneration, bone defect

中图分类号:

R782.4

张浩, 张新风, 祁雨晨, 胥加斌, 司亚萌. 数字化导板引导CGF联合Bio-Oss骨粉充填颌骨囊肿的临床研究[J]. 口腔医学, 2023, 43(10): 910-914.

ZHANG Hao, ZHANG Xinfeng, QI Yuchen, XU Jiabin, SI Yameng. Clinical study on digital guide plate guided CGF combined with Bio-Oss bone powder for filling bone cavity after jaw cyst surgery[J]. Stomatology, 2023, 43(10): 910-914.

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参考文献 22

[1]	熊贤斌, 吴元元, 郑旸, 等. 颌骨囊性病变囊内压对开窗术后不同时间段体积缩小速度的影响[J]. 口腔医学, 2020, 40(5):411-415.
[2]	Berretta LM, Melo G, Mello FW, et al. Effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions:A systematic review[J]. Br J Oral MaxillofacSurg, 2021, 59(10):E17-E42.
[3]	王松松, 张云涛, 刘珂珂, 等. 高度浓缩生长因子对MC3T3-E1成骨细胞生物学性能的影响[J]. 上海口腔医学, 2020, 29(5):482-486.
[4]	Lei LH, Yu YY, Han JY, et al. Quantification of growth factors in advanced platelet-rich fibrin and concentrated growth factors and their clinical efficacy as adjunctive to the GTR procedure in periodontal intrabony defects[J]. J Periodontol, 2020, 91(4):462-472. doi: 10.1002/JPER.19-0290 pmid: 31471902
[5]	Stanca E, Calabriso N, Giannotti L, et al. Analysis of CGF biomolecules, structure and cell population:Characterization of the stemness features of CGF cells and osteogenic potential[J]. Int J MolSci, 2021, 22(16):8867.
[6]	Ku JK, Han M, Yongvikul A, et al. Volumetric analysis of spontaneous bone healing after jaw cyst enucleation[J]. Sci Rep, 2022, 12(1):14953. doi: 10.1038/s41598-022-16921-w
[7]	Soluk-Tekkesin M, Wright JM. The World Health Organization Classification of Odontogenic Lesions:A Summary of the Changes of the 2022 (5th) Edition[J]. Turk Patoloji Derg, 2022, 38(2):168-184. doi: 10.5146/tjpath.2022.01573 pmid: 35578902
[8]	Melo G, Mello FW, Mesquita RA, et al. Cell-block as ancillary tool for the diagnosis of cystic and cyst-like jaw lesions[J]. Diagn Cytopathol, 2020, 48( 8):717-723. doi: 10.1002/dc.24400 pmid: 32112624
[9]	Koçak E, Yıldız A, Acartürk F, et al. Three dimensional bioprinting technology:Applications in pharmaceutical and biomedical area[J]. Colloids Surf B Biointerfaces, 2021, 197:111396. doi: 10.1016/j.colsurfb.2020.111396
[10]	Tellisi N, Ashammakhi NA, Billi F, et al. Three dimensional printed bone implants in the clinic[J]. J Craniofac Surg, 2018, 29(8):2363-2367. doi: 10.1097/SCS.0000000000004829 pmid: 30277956
[11]	Shi J, Zhou JH, Liu CX, et al. Radiographic bone volume alteration after jaw cyst enucleation with or without simultaneous bone grafts:A prospective randomized study[J]. Clin Implant Dent Relat Res, 2022, 24(4):468-474. doi: 10.1111/cid.v24.4
[12]	Sacher C, Holzinger D, Grogger P, et al. Calculation of postoperative bone healing of cystic lesions of the jaw-A retrospective study[J]. Clin Oral Investig, 2019, 23(11):3951-3957. doi: 10.1007/s00784-019-02826-y
[13]	Stoor P, Apajalahti S, Kontio R. Regeneration of cystic bone cavities and bone defects with bioactive glass S53P4 in the upper and lower jaws[J]. J Craniofac Surg, 2017, 28(5):1197-1205. doi: 10.1097/SCS.0000000000003649 pmid: 28538076
[14]	Raţiu CA, Raţiu IA, Cavalu S, et al. Successful management of spontaneous bone regeneration after jaws cystectomy using PRGF approach; case series[J]. Rom J Morphol Embryol, 2020, 61(3):833-840. doi: 10.47162/RJME.61.3.21 pmid: 33817724
[15]	Feng YJ, Guo WW, Hu L, et al. Application of hydrogels as sustained-release drug carriers in bone defect repair[J]. Polymers, 2022, 14(22):4906. doi: 10.3390/polym14224906
[16]	Dong K, Zhou WJ, Liu ZH, et al. The extract of concentrated growth factor enhances osteogenic activity of osteoblast through PI3K/AKT pathway and promotes bone regeneration in vivo[J]. Int J Implant Dent, 2021, 7(1):70. doi: 10.1186/s40729-021-00357-4 pmid: 34345951
[17]	Qiao J, An N. Effect of concentrated growth factors on function and Wnt3a expression of human periodontal ligament cells in vitro[J]. Platelets, 2017, 28(3):281-286. doi: 10.1080/09537104.2016.1213381
[18]	Qi L, Liu L, Hu Y, et al. Concentrated growth factor promotes gingival regeneration through the AKT/Wnt/β-catenin and YAP signaling pathways[J]. Artif Cells Nanomed Biotechnol, 2020, 48(1):920-932. doi: 10.1080/21691401.2020.1773482 pmid: 32496895
[19]	Firouzi N, Yavari HR, Rahimi S, et al. Concentrated growth factors combined with lipopolysaccharide stimulate the in vitro regenerative and osteogenic activities of human dental pulp stem cells by balancing inflammation[J]. Int J Dent, 2022, 2022:2316666.
[20]	Luo HY, Liu WJ, Zhou YC, et al. Concentrated growth factor regulates the macrophage-mediated immune response[J]. Regen Biomater, 2021, 8(6):rbab049. doi: 10.1093/rb/rbab049
[21]	Nasirzade J, Kargarpour Z, Hasannia S, et al. Platelet-rich fibrin elicits an anti-inflammatory response in macrophages in vitro[J]. J Periodontol, 2020, 91(2):244-252. doi: 10.1002/JPER.19-0216 pmid: 31376159
[22]	Kargarpour Z, Nasirzade J, Panahipour L, et al. Liquid PRF reduces the inflammatory response and osteoclastogenesis in murine macrophages[J]. Front Immunol, 2021, 12:636427. doi: 10.3389/fimmu.2021.636427

分组	年龄/岁	性别		部位		分类
分组	年龄/岁	男	女	上颌骨	下颌骨	根尖囊肿	含牙囊肿	鼻腭囊肿
实验组(n=20)	24.25±3.093	12	8	9	11	16	2	2
对照组1(n=20)	25.00±3.325	10	10	12	8	15	4	1
对照组2(n=20)	25.20±3.071	9	11	13	7	15	2	3
P	0.609	0.627		0.414		0.780

组别	术前1 d	术后24 h	术后72 h
实验组	0.794±0.226	1.068±0.349^ab	3.178±0.281^ab
对照组1	0.778±0.234	1.609±0.768^a	3.495±0.412^a
对照组2	0.780±0.247	2.246±0.538	3.802±0.319
F	0.016	12.515	9.990
P	0.984	<0.001	<0.001

组别	术前1 d	术后24 h	术后72 h
实验组	5.625±0.993	10.724±2.299^ab	6.760±1.614^ab
对照组1	6.198±1.499	13.480±2.167^a	8.887±1.726
对照组2	6.020±1.414	15.563±2.451	9.221±1.260
F	0.592	13.266	8.938
P	0.509	<0.001	0.001

组别	手术时间/min	术后1 d疼痛VAS值	术后3 d疼痛VAS值	术后5 d疼痛VAS值
实验组	54.250±4.070^a	3.583±1.084^ab	1.583±0.793^ab	0.167±0.389
对照组1	52.333±5.123^a	4.667±0.888^a	2.333±0.779	0.417±0.669
对照组2	68.833±5.798	5.500±0.674	2.917±0.669	0.583±0.669
F	38.363	13.759	9.536	1.514
P	<0.001	<0.001	0.001	0.175

组别	术后即刻	术后3个月	术后6个月
实验组	459.89±23.29	659.13±34.76^ab	752.53±40.73^ab
对照组1	458.74±26.64	635.88±31.20	729.03±31.15
对照组2	462.74±21.94	636.97±28.60	726.08±29.20
F	0.147	3.443	3.620
P	0.863	0.039	0.033