以真骨陶瓷骨移植體修復臨界大小骨缺損之探討

無論創傷、病理或手術性造成的骨缺損，我們都期盼其能迅速的恢復原有的功能與外形。故而能幫助骨缺損癒合及塑形的骨移植體，在醫療上佔有極重要的地位。本實驗研究使用緻密骨帶海綿骨真骨陶瓷骨移植體的效用，並和骨再生引導膜的效用作一比較。同時檢討以往認為只有具有骨生長誘發（Osteoinduction）的移植體，才有能力修復臨界大小的骨缺損這個理論。本研究利用36隻兔子，分別於額骨及頂骨製造15 mm直徑人造缺損共二個。第一組將真骨陶瓷骨（緻密骨帶海綿骨）置於頭骨其中之一人造缺損中，第二組置放真骨陶瓷骨（鑽孔緻密骨帶海綿骨），第三組置放骨引導再生膜（FRIOS® BoneShield），另外未置放材料的人造缺損是為控制組。術後二周、四周、八周、十六周，將之犧牲。並以放射學、組織學配合光學顯微鏡等影像分析，來觀察分析實驗結果。結果顯示控制組僅少量的不完整新生骨生成於人造缺損區。第一組有連續性的新生成木柵般的骨小樑與新骨形成，並完全修復臨界大小骨缺損。第二組表現類似第一組，惟新骨形成速度略慢於第一組。第三組亦可見連續性新骨與骨小樑生成，也是可以修復臨界大小骨缺損；植體緊密的嵌入在人造缺損區的範圍內，並且有良好的併合現象（incorporation）。不論使用骨引導再生膜或真骨陶瓷骨（緻密骨帶海綿骨）均能修復臨界大小的骨缺損；真骨陶瓷骨移植體在此不僅提供骨骼的空間架構，並具有引導新骨頭往內生長的效用。

關鍵字

真骨陶瓷；臨界大小骨缺損；引導組織再生；骨取代移植體

並列摘要

Objective: This study compares bone regeneration of critical sized defect（CSD）of cranial vault defects in rabbits using either nonresorbable membrane (FRIOS® BoneShield ) or true bone ceramic (TBC). Results are to identify the better material in repairing the CSD. Methods: Critical sized defects of 15 mm in diameter were created in the parietal and frontal bones of 36 rabbits. Group1 had membrane on one defect of the cranium, Group2 had TBC (cortical/sponge), and group3 had TBC (perforated cortical/sponge). The other defect of all 3 groups was unfilled. Three animals in each group were killed at 2,4,8 and 16 weeks post operation. Results: All unfilled defects healed with fibrous scar and minimal amounts of incomplete new bone formation. Defects treated with the titanium membrane healed with bone throughout the entire defect. There were definite of bony remodeling, with some areas showing characteristic lamellar-type bone. Defects treated with TBC (cortical/sponge) had markedly complete bony coverage of the defect giving a palisading appearance. Defects treated TBC (perforated cortical/sponge) seemed to lag behind that seen in TBC (cortical/sponge) implant. Conclusion: The utilization of TBC or titanium membrane seems to support complete closure of critical sized defects in rabbits with viable bone at 16 weeks. TBC may serve as a bony matrix and allow satisfactory bony ingrowth.

並列關鍵字

true bone ceramic ； critical sized defect ； guided tissue regeneration ； bone substitute

參考文獻

文獻

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