中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (25): 4045-4050.doi: 10.12307/2023.461

• 组织工程口腔材料 tissue-engineered oral materials • 上一篇    下一篇

骨内型镁合金牵引器在犬牙槽骨垂直骨增量中的应用

王  舒1,赵贵然2,王  茹3,姚玉胜4,屈  直1   

  1. 1锦州医科大学附属第二医院,辽宁省锦州市  121000;2锦州医科大学附属第一医院口腔颌面外科,辽宁省锦州市  121000;3锦州医科大学,辽宁省锦州市  121000;4锦州医科大学附属第三医院口腔颌面外科,辽宁省锦州市  121000
  • 收稿日期:2022-06-21 接受日期:2022-07-27 出版日期:2023-09-08 发布日期:2023-01-18
  • 通讯作者: 姚玉胜,博士,主任医师,锦州医科大学附属第三医院口腔颌面外科,辽宁省锦州市 121000 屈直,博士,主任医师,锦州医科大学附属第二医院,辽宁省锦州市 121000
  • 作者简介:王舒,女,1991年生,辽宁省锦州市人,汉族,锦州医科大学在读硕士,医师,主要从事牙槽骨缺损修复方面的研究。
  • 基金资助:
    辽宁省重点研发计划指导计划(2018225031),项目负责人:屈直;辽宁省教育厅科学技术研究:垂直骨牵引对颌骨缺损咬合重建的实验研究,项目负责人:姚玉胜

Application of intraosseous magnesium alloy distractor in vertical bone augmentation of dog alveolar bone

Wang Shu1, Zhao Guiran2, Wang Ru3, Yao Yusheng4, Qu Zhi1   

  1. 1Second Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, Liaoning Province, China; 2Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, Liaoning Province, China; 3Jinzhou Medical University, Jinzhou 121000, Liaoning Province, China; 4Department of Oral and Maxillofacial Surgery, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, Liaoning Province, China
  • Received:2022-06-21 Accepted:2022-07-27 Online:2023-09-08 Published:2023-01-18
  • Contact: Yao Yusheng, MD, Chief physician, Department of Oral and Maxillofacial Surgery, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, Liaoning Province, China Qu Zhi, MD, Chief physician, Second Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, Liaoning Province, China
  • About author:Wang Shu, Master candidate, Physician, Second Affiliated Hospital of Jinzhou Medical University, Jinzhou 121000, Liaoning Province, China
  • Supported by:
    Liaoning Provincial key Research and Development Guidance Plan, No. 2018225031 (to QZ); Science and Technology Research of Liaoning Provincial Department of Education (to YYS)

摘要:

文题释义:

牵张成骨:是一种内源性骨组织工程技术,是通过将骨骼切开,在切骨线两侧安放特制的牵张器,经过一定的间歇期后(5-7 d),缓慢牵张切骨间隙(1-1.5 mm/d),使切骨间隙不断增宽,并激发机体组织再生的潜力,在牵张间隙内不断形成新生骨组织,同时使骨骼周围的肌肉、神经、血管、皮肤等同期延长,从而达到延长骨骼的目的。 
镁合金:作为一种骨科植入金属材料具有良好的可降解性,与人体骨组织相似的弹性模量以及良好的生物相容性和生物安全性。

背景:牙槽骨牵张成骨由于治疗周期长、二次手术创伤等限制了临床的广泛应用,镁合金作为可降解的生物金属材料可以制作成牵引器解决牙槽骨的软硬组织缺损问题。
目的:探讨运用自行研制的骨内型镁合金牵引器垂直牵引犬下颌牙槽骨的可行性。
方法:选取9只犬,拔除犬双侧下颌前磨牙,形成萎缩牙槽嵴模型。选取右侧下颌骨为实验侧,左侧为对照侧。3个月后选取右侧下颌骨行骨切开术形成输送盘,并植入1枚牵引器,1周后开始牵张,2次/d,每次0.5 mm,共6 d。固定期3个月后将犬麻醉处死并解剖下颌骨进行大体、X射线片、Micro-CT和组织学观察,并与对照侧进行比较。

结果与结论:①9只犬除1只中途死亡并补足后,均成功完成牙槽骨的垂直增高,游标卡尺测量实验侧较对照侧增高4.94 mm;②X射线片检查发现牵张间隙消失,新骨密度增加;取出牵引器可见表面出现腐蚀、降解;③组织学检查可见实验侧活跃的成骨细胞和骨小梁结构,以及部分成熟的骨组织;④Micro-CT检查可见实验侧比对照侧骨小梁与牵张方向更一致(P < 0.05);实验侧和对照侧相比骨小梁数目、厚度少量增加但无显著差异(P > 0.05),分离度减少(P < 0.05),新生骨的骨体积百分比(P < 0.05)和矿物质密度(P > 0.05)增加;⑤提示自行研制的骨内型镁合金牵引器可以成功增高萎缩的下颌骨,并且骨质愈合良好,可为将来牵引器的研制和临床应用提供参考。

https://orcid.org/0000-0001-9717-0927(王舒)

中国组织工程研究杂志出版内容重点:生物材料;骨生物材料口腔生物材料纳米材料缓释材料材料相容性组织工程

关键词: 牵张成骨, 牵引器, 镁合金, 降解,

Abstract: BACKGROUND: Long course of treatment and second operation limit the extensive application of alveolar distraction osteogenesis, and the distractor made by magnesium alloy as a biodegradable metal material can solve the problem of soft and hard tissue defects of alveolar bone. 
Objective: To explore the feasibility of establishing an experimental dog model of vertical alveolar distraction osteogenesis using the custom-made intraosseous distractor made by magnesium alloy. 
Methods: Nine adult mongrel dogs were provided. The bilateral mandibular premolars were extracted from experimental dogs to form models of atrophic alveolar ridge. The right mandible was selected as the experimental side and the left side as the control side. After 3 months, an alveolar segmental osteotomy was carried out in the right mandible and one intraosseous vertical distractor was placed. After a 7-day latency period, the alveolar bone was augmented at a rate of 0.5 mm per times, twice a day for 6 days. After a consolidation of 3 months, the dogs were sacrificed to dissect the mandibles for clinical, X-ray, micro-CT and histological examination. The experimental side was compared with the control side.
Results AND CONCLUSION: (1) Of the nine dogs, one dog died and was replaced. The rest of the experimental dogs obtained the predicted height and the average alveolar ridge was vertically increased for 4.94 mm measured by a vernier caliper as compared with the control side. (2) The X-ray showed that the distraction gap disappeared and the bone density increased. There were obvious cracks on surfaces of the distractor. (3) Histological examination revealed active osteoblasts and trabecular bone structures, as well as partially mature bone tissue. (4) Micro-CT showed that most of trabecular bone had the same distraction direction (P < 0.05); the trabecular thickness and trabecular number slightly increased (P > 0.05), trabecular separation decreased (P < 0.05) and percentage of bone volume (P < 0.05) and bone mineral density increased (P > 0.05) in the experimental side compared with the control side. (5) It is concluded that the custom-made intraosseous distractor made by magnesium alloy can increase the height of atrophy alveolar and obtain a mature new bone, which provides a good theoretical reference for development of alveolar distractor and clinical practice of the technique.

Key words: distraction osteogenesis, distractor, magnesium alloy, degradation, dog

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