富血小板纤维蛋白联合胶原膜修复颅顶骨缺损

摘要

BACKGROUND: At present, there are some studies on applying platelet-rich fibrin (PRF) or collagen membrane in guided bone regeneration to promote the bone defect repair, while there is no report about their combined use versus single use in the bone defect repair. OBJECTIVE: To compare the bone regeneration ability of PRF, collagen membrane and their combined membrane in the bone defect repair.METHODS: Twenty-two Japanese big ear rabbits were selected to establish three bone defects in the calvarial bone, and then PRF, collagen membrane and PRF/collagen membrane composite were respectively implanted into the three defect regions. At 2, 4, 8, 12 weeks after implantation, tissue repair and regeneration in the bone defect regions were observed by X-ray and hematoxylin-eosin staining. RESULTS AND CONCLUSION: (1) Postoperative 2-week X-ray showed blurred density increase in the margin of bone defect in the composite membrane group, as well as increased density in the PRF group, while it was rarely seen in the collagen membrane group. At 12 weeks after implantation, in the composite membrane group, the bone density in the defect area was similar to the surrounding bone tissue; in the collagen membrane group, annulus-shaped density was enlarged, but the density in the defect region was still lower than that in the surrounding bone tissues; and in the PRF group, the lower density was seen in the individual parts of bone defect region compared with the surrounding bone tissues. (2) Histological observation: At 2 weeks after implantation, new fibrous connective tissues and newborn capillaries were seen around the defect area in the composite membrane group, while less fibrous connective tissues and capillaries were found in the other two groups. At 12 weeks after implantation, in the composite membrane group, a great amount of bone cells arranged regularly in the bone defect area with the presence of thickened trabecular bone and mature bone formation; in the PRF group, there were visible bone cells and increased number of trabecular bone, but less bone formation than the composite membrane group; in the collagen membrane group, there were few bone tissues formed with osteoblasts, osteoclasts and obvious bone lacuna. In conclusion, the PRF/collagen composite membrane shows better osteogenic effects than their use alone.%背景:目前有部分关于富血小板纤维蛋白、胶原膜应用于引导骨再生技术中促进骨缺损修复的研究,但将二者联合使用与单纯使用胶原膜或富血小板纤维蛋白膜修复骨缺损的对比研究尚未被报道.目的:比较富血小板纤维蛋白与胶原复合膜、单纯富血小板纤维蛋白膜、单纯胶原膜3种膜的引导骨再生能力.方法:取日本大耳兔24只,在颅顶骨建立3个骨缺损区,分别植入复合膜(自体富血小板纤维蛋白膜与胶原膜)、单纯自体富血小板纤维蛋白膜及单纯胶原膜,植入后2,4,8,12周,进行颅顶骨缺损区X射线及组织学观察.结果与结论:①X射线观察:植入后2周:复合膜组缺损区见边缘模糊的密度增高影;胶原膜组见极少量密度增高影像;富血小板纤维蛋白膜组边缘区出现密度增高影像.植入后12周,复合膜组整个缺损区与周围正常骨密度接近;胶原膜组环形密度增高影像区域较植入后8周扩大,但中心的密度较周边正常骨组织密度低;富血小板纤维蛋白膜组缺损区可见个别部位的密度低于周围正常骨;②组织学观察:植入后2周,复合膜组见缺损区周围出现纤维结缔组织、新生毛细血管;富血小板纤维蛋白膜膜组、胶原膜组纤维结缔组织和新生血管均少于复合膜组.植入后12周,复合膜组缺损区出现大量骨细胞,排列整齐,有骨小梁变粗变大,可见成熟骨组织形成,骨质较好;富血小板纤维蛋白膜组可见骨细胞,骨小梁数目增多,但骨形成量较复合膜组少;胶原膜组可见少量新骨形成,有成骨细胞、破骨细胞,有明显骨陷凹;③结果表明:富血小板纤维蛋白与胶原复合膜具有更好的成骨效果.