【作者】 徐佳；

【导师】 归来；

【作者基本信息】 北京协和医学院 ， 外科学（专业学位）， 2014， 博士

【摘要】 研究目的1、探讨血管内皮生长因子、纤维蛋白胶及珊瑚人工骨复合物作为复合支架材料在体内的成骨效果以及下颌骨外板劈开联合血管内皮生长因子、纤维蛋白胶及珊瑚人工骨复合物充填用以增加下颌骨宽度的效果,评估该方法的可行性,为进一步的实验研究及以后的临床应用提供理论依据。2、运用下颌骨外板劈开颗粒状珊瑚羟基磷灰石充填矫治以Pruzansky-Kaban分型为Ⅰ型或者Ⅱa型的半侧颜面短小导致的下颌骨发育不良畸形,评估该方法的术后效果并分析该手术方法的优点及应用范围。方法1、本实验以小型猪为实验对象,A组5头小型猪,左侧行下颌骨外板劈开,颗粒状珊瑚羟基磷灰石、血管内皮生长因子及纤维蛋白胶(CHA+VEGF+FS)复合物植入术,右侧作为正常对照组。B组5头小型猪,左侧行下颌骨外板劈开,颗粒状珊瑚羟基磷灰石、血管内皮生长因子及纤维蛋白胶(CHA+VEGF+FS)复合物植入术；右侧行下颌骨外板劈开,颗粒状珊瑚羟基磷灰石及纤维蛋白胶(CHA+FS)复合物植入术。通过形态学、组织学、影像学观察及生物力学检测等手段研究VEGF对新骨形成过程的影响,通过骨质吸收率评估复合物材料的成骨效能,观察术后增加下颌骨宽度的效果。2、6例患者采用下颌骨外板劈开珊瑚羟基磷灰石人工骨植入术进行以Pruzansky-Kaban分型为Ⅰ型或者Ⅱa型的半侧颜面短小所致下颌骨发育不良畸形的矫治。对其中4名患者进行随访,随访时间6至24个月,通过术前、术后的摄像、头颅CT三维重建进行术后效果的评估。结果1、研究发现CHA+FS复合物及CHA+VEGF+FS复合物植入后均可有效对下颌骨的宽度进行扩展,但早期通过组织学观察发现CHA+VEGF+FS复合物植入后较CHA+FS复合物血管化程度高,更早地实现骨成熟。在骨质吸收率的检测上,CHA+VEGF+FS复合物植入后较CHA+FS复合物低从而实现更好的成骨效能。术后6个月两种植入物通过组织形态学、扫描电镜等超微结构观察与正常骨组织无明显差别,并且两者植入后对最大应力无明显影响。2、所有患者由于珊瑚人工骨的植入下颌骨相应部位厚度均不同程度的增加,术后患者面下部不对称畸形得到明显的改善,同时还有很好的美容效果。结论1、论证了下颌骨外板劈开联合珊瑚人工骨、血管内皮生长因子及纤维蛋白胶(CHA+VEGF+FS)复合物充填术是一种更为有效增加下颌骨宽度的方法,为其应用于临床打下理论基础。2、下颌骨外板劈开颗粒状珊瑚羟基磷灰石人工骨植入术是一种行之有效修复Pruzansky-Kaban分型为Ⅰ型或者Ⅱa型的半侧颜面短小导致的下颌骨发育不良畸形的方法,为解决下颌骨发育不良畸形临床治疗难题提供了一种有效的手段。更多还原

【Abstract】 Purpose:1. To evaluate the effect of the osteogenesis of the compound of CHA+VEGF+FS as composite scaffold materials and study the effect of this new method. Using osteotomy of the outer mandibular cortex combined with the compound of CHA+VEGF+FS in miniature pigs to treat mandibular hypoplasia caused by hemifacial microsomia, provide the necessary theoretical basis for clinical application in the future.2. To observe the clinical effect of osteotomy of the outer mandibular cortex combined with CHA implantation for mandibular hypoplasia caused by Pruzansky Kaban type I or type Ⅱa hemifacial microsomia. To evaluate the postoperative effect of the method and analyse the range of application and the advantage of the method of the surgery may exist.Method:1.10miniature pigs at age9-12months were selected as the experimental animals which were divided into2groups randomly:group A and group B. In group A, the outer cortex of mandibular body and angle was split in one side and the compound of CHA+VEGF+FS was implanted into the gap between the outer and inner cortex of mandible, with the other side as control. In group B, two kinds of compounds (leftside:the compound of CHA+VEGF+FS:the compound of CHA+FS) was implanted into the gaps with the same methods separately. The osteogenesis and effect of this method by morphological, histological, radiological observation and biomechanical testing.2. There were6patients of Pruzansky-Kaban type I or type Ⅱa hemifacial microsomia treated with the method of osteotomy of the outer mandibular cortex combined with coralline hydroxyapatite implantation. Follow-up visits were conducted for6to24months to monitor4of the patients. To observe the postoperative effect by the imaging, skull X-ray, CT three dimensional reconstruction.Result:1. Both of the compound of CHA+VEGF+FS and the compound of CHA+FS after implantation could increase the width of the mandible effectively. But the compound of CHA+VEGF+FS was higher than the compound of CHA+FS in the degree of vascularization in the early time, and achieved bone mature much earlier after implantation by histological observation. On the bone resorption rate of the test, the compound of CHA+VEGF+FS was lower than the compound of CHA+FS. After6months, the two implant materials showed that there was no evident difference with normal bone tissue by the histomorphology, scanning electron microscopy of ultrastructure observation and the implant had no obvious effect on maximum stress.2. With the thickness of mandibular increased significantly after6months, significant improvements in the asymmetry of the mandible as well as in the aesthetic appearance of all the patients were observed.Conclusion:1. The results of this pilot study indicate that the osteotomy of the outer mandibular cortex combined with the compound of CHA+VEGF+FS may be useful for the augumentation of width of mandible. This study provided a theoretical basis for clinical use of this new method.2. The osteotomy of the outer mandibular cortex combined with CHA implantation is a useful method for Pruzansky-Kaban type I or type Ha hemifacial microsomia in patients with mandibular hypoplasia.更多还原