CAJ | 학술논문

目的评价多孔磷酸三钙(β-tricalcium phosphate,β-TCP)修复腔隙性骨缺损的临床效果,探讨其成骨愈合机制.方法 2003年1月至2008年12月,随机选择应用多孔β-TCP人工骨颗粒材料修复孤立性骨囊肿刮除术后骨缺损55例(实验组),或应用异体骨颗粒材料修复40例(对照组).术后1周、1、2、3、6、12、24及48个月摄X线片,采用自定的X线影像学半定量方法观察植骨材料的降解和成骨情况,计算植骨材料降解率,分析不同年龄组、不同随访时间段、不同植骨方式的材料降解率.组织病理学检查观察β-TCP人工骨降解成骨过程.结果全部病例随访7～48个月,平均28.4个月.终末随访X线片示β-TCP人工骨和异体骨均能修复骨缺损.实验组(81.5%±23.2%)与对照组(77.9%±19.4%)材料降解率无统计学差异(t=0.803,P=0.424).实验组与对照组均表现出年龄越小植骨降解率越高的趋势;术后3年以上,实验组降解率高于对照组(t=29.893,P=0.04);采用打压植骨法时对照组降解率高于实验组(t=39.233,P=0.00),实验组组内比较疏松植骨法降解率高于打压植骨法(t=8.342,P=0.03).组织病理学结果显示β-TCP降解与成骨同时进行,新骨内可见骨细胞和骨陷窝.结论多孔β-TCP人工骨修复腔隙性骨缺损的临床效果和异体骨相似,随时间延长降解效果逐渐优于异体骨.
목적 평개다공린산삼개(β-tricalcium phosphate,β-TCP)수복강극성골결손적림상효과,탐토기성골유합궤제.방법 2003년1월지2008년12월,수궤선택응용다공β-TCP인공골과립재료수복고립성골낭종괄제술후골결손55례(실험조),혹응용이체골과립재료수복40례(대조조).술후1주、1、2、3、6、12、24급48개월섭X선편,채용자정적X선영상학반정량방법관찰식골재료적강해화성골정황,계산식골재료강해솔,분석불동년령조、불동수방시간단、불동식골방식적재료강해솔.조직병이학검사관찰β-TCP인공골강해성골과정.결과 전부병례수방7～48개월,평균28.4개월.종말수방X선편시β-TCP인공골화이체골균능수복골결손.실험조(81.5%±23.2%)여대조조(77.9%±19.4%)재료강해솔무통계학차이(t=0.803,P=0.424).실험조여대조조균표현출년령월소식골강해솔월고적추세;술후3년이상,실험조강해솔고우대조조(t=29.893,P=0.04);채용타압식골법시대조조강해솔고우실험조(t=39.233,P=0.00),실험조조내비교소송식골법강해솔고우타압식골법(t=8.342,P=0.03).조직병이학결과현시β-TCP강해여성골동시진행,신골내가견골세포화골함와.결론 다공β-TCP인공골수복강극성골결손적림상효과화이체골상사,수시간연장강해효과축점우우이체골.
Objective To evaluate the clinical outcomes of a hovel porous β-tricalcium phosphate (β-TCP)and control allograft for the repair of lacunar bone defects caused by solitary bone cyst curettage.Methods From January 2003 to December 2008,the patients with solitary bone cyst were randomized into an experimental(55 cases)and a control(40 cases)group.The control group received particulate allograft bone as the graft material,and the experimental group received β-TCP.At 1 week,1,2,3,6,12,24,48months after surgery,a new radiographic scoring system was employed to calculate the biodegradation of bone graft and evaluate the influence of multiple factors.Histologic characteristic of the degradation process of β-TCP were also evaluated.Results All the cases were followed up for average 28.4 months.Radiographic semi-quantitative analysis revealed that the biodegradation effieiencies were not significantly difierent between β-TCP and allografts(P=0.424).Degradation percentage of the implanted β-TCP or allograft was higher in younger patients than those in the older ones.Degradation of β-TCP was significantly higher than that of allografts over 3 years after surgery(P=0.04).In the experimental group,β-TCP degradation was greater in the loose packing treatment than that in the dense packing treatment (P=0.03).Histological observation demonstrated that the process of new bone formation accompanied the degradation of β-TCP.Conclusion The interporous β-TCP could be an advantageous alternative to allografts for repair bone defects caused by bone cyst.The clinical application of β-TCP is safe and reliable,which shows better biodegradation and osteogenesis than allografts in long-term follow-up.