上海交通大学学报(医学版) ›› 2022, Vol. 42 ›› Issue (6): 768-777.doi: 10.3969/j.issn.1674-8115.2022.06.011

• 论著 · 临床研究 • 上一篇    

帐篷钉技术在牙槽骨重度缺损修复重建中的应用:30例临床病例回顾性分析与总结

吴靖1(), 赵正宜2, 邹多宏1(), 杨驰1, 张志愿1   

  1. 1.上海交通大学医学院附属第九人民医院口腔外科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,中国医学科学院口腔颌面再生医学创新单元,上海 200011
    2.安徽医科大学口腔医学院,合肥 230032
  • 收稿日期:2022-04-12 接受日期:2022-06-08 出版日期:2022-06-28 发布日期:2022-08-19
  • 通讯作者: 邹多宏 E-mail:wujingsjtu2021@163.com;zouduohongyy@163.com
  • 作者简介:吴靖(1994—),男,住院医师,硕士;电子信箱:wujingsjtu2021@163.com
  • 基金资助:
    国家自然科学基金(31870969);中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-037);上海交通大学医学院“双百人”人才计划(20191816)

Application of a tent-pole screw technology in reconstruction of severe alveolar bone defect: a retrospective study of 30 patients

WU Jing1(), ZHAO Zhengyi2, ZOU Duohong1(), YANG Chi1, ZHANG Zhiyuan1   

  1. 1.Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai 200011, China
    2.College of Stomatology, Anhui Medical University, Hefei, 230032, China
  • Received:2022-04-12 Accepted:2022-06-08 Online:2022-06-28 Published:2022-08-19
  • Contact: ZOU Duohong E-mail:wujingsjtu2021@163.com;zouduohongyy@163.com
  • Supported by:
    National Natural Science Foundation of China(31870969);CAMS Innovation Fund for Medical Sciences (CIFMS)(2019-I2M-5-037);Two Hundred-Talent Program of Shanghai Jiao Tong University School of Medicine(20191816)

摘要:

目的·探究帐篷钉技术在牙槽骨重度缺损修复重建中的作用。方法·选取2018年1月—2021年1月在上海交通大学医学院附属第九人民医院口腔外科接受帐篷钉技术完成牙槽骨重度缺损修复的30例患者作为研究对象,通过分析与重建患者术前以及术后8个月的锥形束计算机断层扫描(cone-beam computed tomography,CBCT)影像数据,统计患者牙槽骨水平、垂直以及混合型骨缺损的修复重建效果。术后8个月时,在患者接受二期种植手术过程中利用取骨环钻在待种植区域取一圆柱状骨组织样本,通过显微计算机断层扫描(micro-computed tomography,Micro-CT)数据分析样本骨小梁数量(trabecular bone number,Tb. N)、骨小梁厚度(trabecular bone thickness,Tb. Th)、骨体积分数(bone volume/total volume,BV/TV)以及骨骼矿物质密度(bone mineral density,BMD)以明确骨再生效果。通过硬组织切片观察术后组织样本内的新骨形成率及材料残留率以分析新骨形成情况。结果·术后8个月患者牙槽骨垂直骨增量为4.81(1.58,7.66)mm,水平骨增量为3.96(2.38,5.67)mm,骨增量区域的骨增量体积为2 157.22(776.59,2 831.63)mm3。术后8个月骨组织样本Micro-CT分析显示帐篷钉植骨区域Tb. N为(3.09±0.68)/mm,Tb. Th为(0.08±0.01)μm,BV/TV为(25.24±5.60)%,BMD为(0.24±0.05)g/cm3;硬组织切片显示新骨形成率为(16.30±3.57)%,材料残留率为34%(31.75%,38.25%)。上述研究数据表明骨修复与再生良好。患者术中、术后均未出现并发症以及严重不良事件。结论·基于以“稳定为核心”的牙槽骨骨增量理念,使用帐篷钉、膜钉及包袋结构,在规范化操作下,帐篷钉技术可以有效完成牙槽骨重度骨缺损的修复重建,并且术后并发症发生率低,骨增量效果可预测性高,有利于后期口腔种植修复治疗的顺利开展。

关键词: 稳定为核心, 牙槽骨, 骨增量, 引导骨再生, 帐篷技术, 帐篷钉, 包袋结构, 骨缺损

Abstract:

Objective·To explore the effect of a tent-pole screw technology on reconstruction of severe alveolar bone defect.

Methods·Thirty patients underwent tent-pole screw technology to reconstruct severe alveolar bone defects in the Department of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to January 2021 were enrolled. By analyzing and reconstructing the image data of cone-beam computed tomography (CBCT) before and 8 months after operation, the effects of repairing and reconstructing the horizontal, vertical and mixed alveolar bone defects were counted. The alveolar bone volumetric parameters were evaluated by micro-computed tomography (Micro-CT), and trabecular bone number (Tb. N), trabecular bone thickness (Tb. Th), bone volume/total volume (BV/TV) and bone mineral density (BMD) were calculated to assess the maturity of regenerated bone. The regeneration of alveolar bone and remanent scaffold were calculated by analyzing histological sections.

Results·Eight months after using the tent-pole screw, the vertical bone gain value was 4.81 (1.58, 7.66) mm, and the horizontal post-operative width was 3.96 (2.38, 5.67) mm. Additionally, the bone volume gain was 2 157.22 (776.59, 2 831.63) mm3. Micro-CT analysis of bone core, which was collected 8 months after the surgery, and Tb. N was (3.09±0.68)/mm, Tb. Th was (0.08±0.01) μm, BV/TV was (25.24±5.60)% and BMD was (0.24±0.05) g/cm3. Histological sections showed that the percentages of regenerated bone and remanent scaffold were (16.30±3.57)% and 34% (31.75%, 38.25%), respectively. These data suggested good new bone formation in targeted area. There were no complications or adverse events during surgery or post-operative healing.

Conclusions·Based on “stability-oriented” alveolar ridge augmentation, using tent-pole screw, membrane pins and packaging structure in a standard operation procedure can achieve beneficial results for bone augmentation, while complications seldom occurre. The tent-pole screw may offer predictable and exceptional outcomes for implantation site preparation, especially for large alveolar defects, which will provide advantages to subsequent implantation and restoration.

Key words: stability-oriented, alveolar bone, bone augmentation, guided bone regeneration, tenting technique, tent screw, package structure, bone defect

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