背景:传统的下颌骨重建依赖于使用血管化和非血管化自体移植物。同种异体移植物和组织工程方式的使用已经成为一种替代方法。
目的:本研究的目的是确定由谱系定向骨形成细胞组成的同种异体骨基质(CBM)用于下颌组织工程和重建的成功。
■使用路易斯维尔大学2019年至2023年接受CBM治疗的受试者的数据进行了一项回顾性队列研究。如果没有使用CBM治疗,则排除受试者,数据不完整,或术后随访时间小于3个月。
方法:预测变量由分为以下几类的异质变量组成:人口统计学(年龄,sex),病史(青霉素[PCN]过敏史,糖尿病史[DM]和烟草使用),病因(良性肿瘤,弹道创伤,非弹道创伤,牙源性囊肿,骨髓炎/药物相关性颌骨坏死),下颌切除长度(cm)和类型(边缘,分段),延迟重建与立即重建,以及是否使用富含血小板纤维蛋白的自体移植物(胫骨近端)与CBM联合使用。
方法:主要结果变量是移植成功(是或否)。成功定义为骨愈合和缺损填充(在全景X光片上显示)和下颌稳定性(基于3个月的术后临床检查)。
■不适用。
方法:计算每个变量的描述性统计。为了衡量风险因素和移植成功之间的关联,使用分类变量的Fisher精确检验和数字数据的Wilcoxon秩和检验。P值<.05被认为是显著的。
结果:样本包括38名受试者。所有受试者的中位年龄为46(四分位距32.6)岁。总的来说,28例(73.7%)成功。与未报告PCN过敏或有DM病史的受试者相比,有PCN过敏或DM病史的受试者的成功率显着降低(2,7.1%的PCN过敏或DM)(P=.008,PCN过敏;P=.03,DM)。
结论:与现有的颌面外科文献相比,这是基于CBM的下颌骨重建的最大病例系列。临床医生应考虑确认PCN过敏,以便使用PCN型抗生素。CBM可能是自体移植的替代方案。
BACKGROUND: Traditional mandibular reconstruction has relied on the use of vascularized and non-vascularized autografts. The use of allografts and tissue engineering modalities has risen as an alternative.
OBJECTIVE: The purpose of this study was to determine the success of a cellular bone matrix (CBM) allograft composed of lineage committed bone forming cells for mandibular tissue engineering and reconstruction.
UNASSIGNED: A retrospective cohort study was implemented using data from subjects treated with a CBM at the University of Louisville from 2019 to 2023. Subjects were excluded if they were not treated with a CBM, data were not complete, or postoperative follow-up time was less than 3 months.
METHODS: The predictor variables were composed of heterogenous variables grouped into the following categories: demographics (age, sex), medical history (history of penicillin [PCN] allergy, history of diabetes mellitus [DM] and tobacco use), etiology (benign tumor, ballistic trauma, nonballistic trauma, odontogenic cyst, osteomyelitis/ medication-related osteonecrosis of the jaw), mandibular resection length (cm) and type (marginal, segmental), delayed versus immediate reconstruction, and whether an autograft (proximal tibia) with platelet-rich fibrin was used in combination with the CBM.
METHODS: The primary outcome variable was graft success (yes or no). Success was defined as bony union and defect fill (demonstrated on panoramic radiograph) and mandibular stability (based on postoperative clinical examination at 3 months).
UNASSIGNED: Not applicable.
METHODS: Descriptive statistics were calculated for each variable. To measure the associations between the risk factors and graft success, Fisher\'s exact test for categorical variables and the Wilcoxon rank sum test for numeric data were used. A P value of <.05 was considered significant.
RESULTS: The sample included 38 subjects. The median age of all subjects was 46 (interquartile range 32.6) years. Overall, 28 (73.7%) cases were successful. Subjects with a reported PCN allergy or a history of DM had significantly lower success (2, 7.1% with PCN allergy or DM) compared to those who did not (P = .008, PCN allergy; P = .03, DM).
CONCLUSIONS: This is the largest case series of CBM based mandibular reconstruction relative to the available maxillofacial surgery literature. The clinician should consider confirmation of PCN allergy so PCN-type antibiotics can be used. CBMs may be an alternative to autografts.