牙槽突裂髂骨松质骨植骨术的效果及影响因素分析

doi:10.7518/hxkq.2023.2022446

摘要/Abstract

摘要：

目的回顾采用髂骨松质骨的单侧完全性牙槽突裂植骨术的效果并探究其影响因素。方法回顾性研究就诊于四川大学华西口腔医院唇腭裂外科行髂骨松质骨植骨修复的单侧完全性牙槽突裂患者160例，其中小年龄组（6~12岁）和大年龄（≥13岁）组各80例，收集术前、术后3 d内、术后6个月以上的锥形束CT（CBCT）影像，借助Mimics软件判断有无骨桥形成，并测量体积计算髂骨植入率、剩余骨充填率和吸收率，并研究两亚组的植骨影响因素。结果以骨桥形成为临床成功标准，总人群的成功率为71.25%，小年龄组和大年龄组分别为78.75%和63.75%，差异有统计学意义（P=0.036），同时后者的裂隙体积显著大于前者（P<0.001），小年龄组的植骨影响因素为腭侧骨壁（P=0.006）和腭裂手术史（P=0.012），大年龄组仅腭侧骨壁对植骨效果有显著影响（P=0.036）。结论大年龄组的植骨效果差于小年龄组，腭侧骨壁是牙槽突裂植骨的重要影响因素，小年龄患者的植骨效果也受腭裂手术史影响。

关键词: 牙槽突裂, 髂骨松质骨, 骨壁, 瘢痕, 锥形束CT

Abstract:

Objective To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it. Methods A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated. Results Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036). Conclusion The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

Key words: alveolar cleft, iliac cancellous bone, bone wall, scars, cone beam CT

中图分类号:

R 782.2⁺2

景兵帅, 石冰, 郑谦, 李承浩. 牙槽突裂髂骨松质骨植骨术的效果及影响因素分析[J]. 华西口腔医学杂志, 2023, 41(3): 284-289.

Jing Bingshuai, Shi Bing, Zheng Qian, Li Chenghao.. Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it[J]. West China Journal of Stomatology, 2023, 41(3): 284-289.

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特征	分类	所有患者	小年龄组	大年龄组	P值
年龄/岁		12.5（9.0，16.0）	9.0（9.0，11.0）	16.0（13.0，18.0）	<0.001
性别	男	107	56	51	0.401
	女	53	24	29	0.401
患侧	左	99	53	46	0.255
	右	61	27	34	0.255
腭侧骨壁	有	91	51	40	0.079
	无	69	29	40	0.079
腭裂手术史	有	125	62	63	0.848
	无	35	18	17	0.848
裂隙体积/mm³		1 204.88（1 000.45，1 145.06）	1 117.43（907.35，1 314.77）	1 268.41（1 125.10，1 702.60）	<0.001
髂骨植入率/%		81.93（69.27，91.13）	81.14（68.88，91.23）	82.90（70.34，91.11）	0.364
复查间隔/d		363.50（221.75，615.75）	368.00（221.25，628.00）	355.50（221.75，571.50）	0.828

指标	分类	所有患者	小年龄组	大年龄组	P值
骨桥形成结果	有	114	63	51	0.036
	无	46	17	29	0.036
剩余骨充填率/%		22.57（7.59，40.92）	23.65（8.46，39.62）	21.55（6.66，41.76）	0.947
吸收率/%		69.42（49.76，89.33）	67.03（51.18，88.15）	72.09（47.45，90.20）	0.792

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