黏性骨与自体髂骨松质骨移植修复单侧牙槽突裂成骨效果的临床研究

doi:10.3969/j.issn.1674-8115.2025.08.009

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (8): 1017-1026.doi: 10.3969/j.issn.1674-8115.2025.08.009

黏性骨与自体髂骨松质骨移植修复单侧牙槽突裂成骨效果的临床研究

虞祖音, 刘逸云, 解嘉慧, 蔡鸣(), 沈国芳()

上海交通大学医学院附属第九人民医院口腔颅颌面科，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试验室，上海市口腔医学研究所，上海 200011

收稿日期:2025-02-26 接受日期:2025-05-22 出版日期:2025-08-28 发布日期:2025-08-14
通讯作者: 沈国芳，主任医师，博士；电子信箱：shengf1428@sjtu.edu.cn
蔡鸣，主任医师，博士；电子信箱：zidanecm500@126.com。
作者简介:第一联系人：为共同第一作者（co-first authors）。
基金资助:
上海市重中之重研究中心项目(NCRCO202328);上海交通大学医疗机器人研究院-第九人民医院临床联合研究中心项目(IMR-NPH202003);上海市科委地方院校能力建设项目(22010502600)

Clinical study on osteogenic effect of sticky bone and autologous iliac cancellous bone graft in repairing unilateral alveolar cleft

YU Zuyin, LIU Yiyun, XIE Jiahui, CAI Ming(), SHEN Guofang()

Department of Oral and Maxillofacial 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; Shanghai Research Institute of Stomatology, Shanghai 200011, China

Received:2025-02-26 Accepted:2025-05-22 Online:2025-08-28 Published:2025-08-14
Contact: SHEN Guofang, Email: shengf1428@sjtu.edu.cn
CAI Ming, Email: zidanecm500@126.com;
Supported by:
Project of Shanghai's Top Priority Research Center(NCRCO202328);Shanghai Jiao Tong University Medical Robotics Research Institute-Ninth People's Hospital Clinical Joint Research Center Project(IMR-NPH202003);Project of the Science and Technology Commission of Shanghai Municipality(22010502600)

摘要/Abstract

摘要：

目的·探索黏性骨［脱蛋白猪骨矿物颗粒联合高级富血小板纤维蛋白（advanced platelet-rich fibrin，A-PRF）与液态富血小板纤维蛋白（liquid platelet-rich fibrin，L-PRF）］在单侧牙槽突裂修复中的临床效果和安全性。方法·招募2023年12月1日—2024年8月31日确诊为单侧牙槽突裂且符合纳入标准的患者。将患者随机分为2组，分别采用黏性骨或自体髂骨松质骨移植进行牙槽突裂植骨术，黏性骨组设为试验组，髂骨组设为对照组。主要疗效指标为术后6个月的骨吸收率，通过收集患者术前、术后即刻及术后半年的计算机断层扫描数据，利用Simplant Pro 17.01软件测量术后即刻与术后半年的移植骨量以计算该指标。次要疗效指标包括术后6个月的骨密度、患者术后并发症发生情况以及口腔健康质量量表得分。运用Prism 10软件进行数据分析，采用t检验及Pearson相关性分析方法。结果·试验组纳入17名单侧牙槽突裂患者，对照组纳入15名患者。试验组术后6个月剩余骨量多于对照组，试验组骨吸收率为33.24%±17.16%，显著低于对照组的66.31%±17.98%（P<0.001）。试验组有1名患者在术后2周出现前庭侧黏膜裂开，并伴有骨粉排出；对照组有3名患者在术后1个月出现前庭侧黏膜裂开伴松质骨排出，其中1名患者在术后4个月出现移植骨坏死。试验组术后 6个月骨密度显著高于对照组（P<0.001），且口腔健康质量量表得分更低。结论·相较于髂骨松质骨，黏性骨用于单侧牙槽突裂患者的治疗时，展现出更低的骨吸收率与更高的骨密度，表明其成骨能力更佳。较少的并发症例数与更低的口腔健康量表得分，提示其安全性更高，因而具有较好的临床推广应用价值。

关键词: 单侧牙槽突裂, 黏性骨, 骨吸收率, 骨密度, 口腔健康质量, 植骨术

Abstract:

Objective ·To explore the clinical efficacy and safety of sticky bone [deproteinized porcine bone mineral granules combined with advanced platelet-rich fibrin (A-PRF) and liquid platelet-rich fibrin (L-PRF)] in the repair of unilateral alveolar cleft. Methods ·Patients diagnosed with unilateral alveolar cleft who met the inclusion and exclusion criteria were recruited from December 1,2023 to August 31,2024. The patients were randomly divided into 2 groups. The experimental group received sticky bone grafts, and the control group received autologous iliac cancellous bone grafts for alveolar cleft repair. The primary efficacy index was the bone resorption rate at 6 months post-surgery, calculated by measuring the grafted bone volume immediately after surgery and at 6 months using Simplant Pro 17.01 software based on patients' computed tomography data collected before surgery, immediately after surgery, and 6 months post-surgery. Secondary efficacy indices included bone density at 6 months after surgery, the occurrence of postoperative complications in patients, and the scores on the oral health-related quality of life scale. Prism 10 software was used for data analysis, and t-test and Pearson correlation analysis methods were adopted. Results ·Seventeen patients with unilateral alveolar cleft were included in the experimental group, and 15 in the control group. The remaining bone volume in the experimental group at 6 months after surgery was more than that in the control group. The bone resorption rate in the experimental group was 33.24%±17.16%, significantly lower than 66.31%±17.98% in the control group (P<0.001). One patient in the experimental group had vestibular mucosal dehiscence accompanied by bone powder discharge 2 weeks after surgery; 3 patients in the control group had vestibular mucosal dehiscence accompanied by cancellous bone discharge 1 month after surgery, with one case of grafted bone necrosis 4 months after surgery. The bone density in the experimental group at 6 months after surgery was significantly higher than that in the control group (P<0.001), and the scores on the oral health-related quality of life scale were lower. Conclusion ·Compared with iliac cancellous bone, when sticky bone is used in the treatment of patients with unilateral alveolar cleft, it shows a lower bone resorption rate and higher bone density, indicating better osteogenic ability. Fewer number of complications and lower scores on the oral health-related quality of life scale suggest greater safety, thereby supporting its strong potential for clinical promotion and application.

Key words: unilateral alveolar cleft, sticky bone, bone resorption rate, bone mineral density, oral health quality, bone grafting surgery

中图分类号:

R782.05

虞祖音, 刘逸云, 解嘉慧, 蔡鸣, 沈国芳. 黏性骨与自体髂骨松质骨移植修复单侧牙槽突裂成骨效果的临床研究[J]. 上海交通大学学报（医学版）, 2025, 45(8): 1017-1026.

YU Zuyin, LIU Yiyun, XIE Jiahui, CAI Ming, SHEN Guofang. Clinical study on osteogenic effect of sticky bone and autologous iliac cancellous bone graft in repairing unilateral alveolar cleft[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(8): 1017-1026.

图/表 9

图1 黏性骨修复牙槽突裂手术Note： A. Alveolar cleft before surgery. B. Preparation of sticky bone and A-PRF membrane. C. Preparation of the bone grafting area. D. The prepared sticky bone and A - PRF membrane were implanted into the cleft. E. Another Bio-Gide film was placed on the labial side. F. The bone grafting area was tightly closed with absorbable thread.

Fig 1 Surgery for repairing alveolar cleft with sticky bone

图2 术后移植骨量测定方法Note： A. Matching of 3D reconstruction: the cranio-maxillary complex, reconstructed in 3D before and after surgery, was aligned based on bone surface landmarks. B. 3D reconstruction registration: adjustment and alignment were carried out in the coronal, sagittal, and horizontal planes to ensure overlap of preoperative and postoperative alveolar bones at corresponding anatomical locations. C. Grafted bone extraction: after the alignment was completed, the preoperative alveolar bone contour was used as reference to separate the grafted bone from the surrounding bone in each plane, ultimately identifying the region of interest.

Fig 2 Method for measuring post operative grafted bone volume

图3 牙槽骨骨密度的测量Note： A 2-mm² circular ROI was drawn. Using the root tips of adjacent teeth in the mesial-distal direction of the fracture area and the canines on the normal side as references, gray values were measured from 3 mm below the enamel-bone junction down to the root tip.

Fig 3 measurement of alveolar bone density

表1 2组患者的一般资料情况

Tab 1 General information of patients in the two groups

Indicator	Test group	Control group	P value
Gender (male)/n(%)	11 (64.7)	8 (53.3)	0.513
Age/year	15.47±6.00	13.93±4.85	0.518
Side (left)/n(%)	9 (52.9)	9 (60.0)	0.688
Hospital day/d	3.20±2.34	5.30±1.16	0.033
Patients receiving orthodontic treatment/n(%)	5 (29.41)	4 (26.67)	0.999
Width of piriform aperture on cleft side/mm	14.87±2.54	14.01±3.48	0.480
Width of alveolar crest of cleft side/mm	5.23±1.87	5.76±1.65	0.574

表2 术后即刻的移植骨量相关性分析

Tab 2 Correlation analysis of the grafted bone volume immediately after surgery

Influence factor	Test group		Control group
Influence factor	r	P	r	P
Width of apertura piriformis	0.427	0.146	0.516	0.086
Width of alveolar crest	0.493	0.087	0.825	0.001
Gender	0.327	0.254	0.564	0.089
Age	0.040	0.890	0.519	0.084
Cleft side	0.354	0.195	0.003	0.992
Orthodontic treatment	-0.200	0.474	0.287	0.367

表3 术后6个月移植骨量的相关性分析

Tab 3 Correlation analysis of the grafted bone volume at 6 months post-operation

Influence factor	Test group			Control group
Influence factor	r	P		r	P
Width of apertura piriformis	0.184		0.547	0.184	0.547
Width of alveolar crest	0.256		0.398	0.256	0.547
Gender	0.514		0.050	0.009	0.977
Age	0.080		0.778	-0.048	0.883
Cleft side	0.259		0.352	-0.369	0.238
Orthodontic treatment	-0.145		0.621	0.390	0.203

图4 试验组术后植骨效果Note： A. Effect immediately after surgery. B. Effect at 6 months post-operation.

Fig 4 Postoperative bone grafting effect in the test group

表4 术后6个月的骨吸收率相关性分析

Tab 4 Correlation analysis of bone resorption rate at 6 months post-operation

Influence factor	Test group		Control group
Influence factor	r	P	r		P
Width of apertura piriformis	0.337	0.260	0.265	0.406
Width of alveolar crest	0.283	0.348	0.207	0.519
Gender	-0.393	0.165	0.249	0.434
Age	0.056	0.842	0.549	0.067
Cleft side	-0.002	0.993	0.379	0.224
Orthodontic treatment	0.086	0.770	-0.276	0.386

表5 术后6个月的骨密度相关性检验

Tab 5 Correlation analysis of BMD at 6 months post-operation

Analytical dimension	Test group	Control group
Cleft side
Postoperative BMD at 6m of the cleft side/HU	889.8±258.2	455.4±84.9
Immediate postoperative BMD of the cleft side/HU	692.9±123.6	420.8±57.5
Correlation analysis	r=0.576, P=0.025	r=0.348, P=0.269
Normal side
Postoperative BMD at 6m of the normal side/ HU	350.3±14.8	358.5±28.4
Immediate postoperative BMD of the normal side/ HU	355.2±19.5	368.4±27.4
Correlation analysis	r=0.235, P=0.440	r=0.272, P=0.390

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黏性骨与自体髂骨松质骨移植修复单侧牙槽突裂成骨效果的临床研究

Clinical study on osteogenic effect of sticky bone and autologous iliac cancellous bone graft in repairing unilateral alveolar cleft

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