第二章 研究材料與方法
2.8. 統計分析
經免疫組織化學染色之標本，以光學顯微鏡觀察並以數位影像檔 儲存，觀察 BMP-2 及 OC 之表現及其分布狀態，進而了解螺紋間骨組 織之生成及成熟程度，作為骨組織增生品質之分析參考。
2.8. 統計分析
以電子顯微鏡觀察及 Masson Goldner 染色觀察所獲得之數據以帄均 值 ± 標準差(SD)表示，並以 Microsoft Excel 2010 進行資料處理與 分析，統計分析以 P < 0.05 視為有統計上之差異。同時間點同螺紋 間距而不同螺紋外型，以及不同時間點同螺紋外型同螺紋間距者，均 以t檢定作統計，同時間點同螺紋外型而不同螺紋間距則以變異數分 析(one-way ANOVA)作比較。
32 觸百分比(BIC)依螺紋間距 1.6 mm、1.4 mm、1.0 mm、0.8 mm、0.6 mm 為 24.8 ± 9.8%、40.9 ± 10.3%、36.8 ± 8.9%、33.1 ± 14.2%、25.1
± 17.4%。而梯型螺紋則依序為 45.8 ± 15.0%、59.2 ± 7.8%、64.7 ± 13.6%、48.3 ± 12.0%、35.9 ± 7.6%(表 3-1)。在 Masson Goldner 染色組中，方型螺紋依序為 24.4 ± 13.6%、24.4 ± 15.7%、33.6 ± 13.6%、
25.2 ± 18.0%、14.3 ± 10.9%。梯型螺紋為 41.5 ± 10.3%、46.9 ± 15.1%、
33 顯微鏡或是 Masson Goldner 染色下，所有螺紋間距之組冸沒有任何 差異，意即方型螺紋於 8 週時，螺紋間距之差異對於骨整合並無顯著
34
35
36
現部分骨組織鈣化之現象。但方型螺紋之 OC 多出現在螺紋外緣，靠 植體表面處較少(圖 3-19)，顯示其骨組織鈣化位於植體外側，螺紋 間距內骨組織成熟較慢。而梯型螺紋其 OC 表現呈層狀之規則排列(圖 3-20)，顯示骨組織已經成熟，並且開始鈣化。
在 16 週之免疫化學組織學染色，方型螺紋與梯型螺紋皆有 BMP-2 之表現，並出現於排列規則之層狀骨中， 且兩者皆較少出現梭織骨 (圖 3-21，圖 3-22) ，顯示兩者其新生骨質已較成熟。在 OC 之標定，
發現方型有 OC 之表現，但在骨植體接觸面有較明顯之 OC 表現(圖 3-23)，表示在方型植體，其鈣化由植體表面開始。而梯型螺紋中，
OC 不只大量表現，更可以清楚看到其隨著骨元(osteon)外型排列(圖 3-24)，顯示此處之骨組織成熟並且癒合完成。
37 為 53.8% (Stadlinger et al. 2010)，近似本研究之梯型螺紋，1.0 mm 螺距於 16 週時之 BIC (53.1 ± 8.4%)。而在該研究中，其植體處 以噴砂及酸蝕處理，故在 4 週即與本研究之 16 週結果相似。而在 Traini et al.的研究中，其豬隻之犧牲時間同為 16 週，其螺紋同為 梯形(Xive plus)，螺紋間距為 0.75mm，其 BIC 為 78.0 ± 5.8%，高 於本研究結果。此研究中所使用之植體乃經過噴砂及酸蝕處理，而增
38
加了微表面積，可能是 BIC 較高的原因(Traini et al. 2008)。在其 他文獻上也發現，使用切削植體於狗之動物實驗(Bonfante et al., 2010)。在該研究中，其切削植體之螺紋間距約 1.0 mm，螺紋外型近 漸轉變為帄行排列整齊之層狀骨(lamellar bone)(Schenk et al.
1994)。在本研究的標本中，可以發現在 8 週方型螺紋中有較多的梭 織骨，而 8 週梯型螺紋含較少之梭織骨，取而代之的是多數之層狀骨。
在 16 週之梯型螺紋及方型螺紋則皆可見到多數之層狀骨，顯示梯型 螺紋內可使骨組織較快速成熟而形成層狀骨，而方型螺紋則需 16 週 才能達成多數之層狀骨，此標本也與其他學者之研究相近(圖
4-3)(Baas et al.,2006)。
而本研究同時利用 BMP-2 及 OC 作為骨成熟之比較。BMP-2 為 BMP
39
家族中之一員，其可引起骨母細胞之分裂與生成。在骨生成的初期，
骨母細胞分裂增生時，其 BMP-2 表現會增加，可以做為骨組織生成之 早期指標(von Wilmowsky et al. 2011)。而 OC 同為骨母細胞產生之 非膠原蛋白質，其在骨生成的過程中會與羥磷灰石(hydroxyapatite) 結合，故可做為一種偵測骨組織鈣化程度的蛋白質之一。當骨組織鈣 化後，其 OC 表現會相對增加，可代表骨較成熟時所產生的蛋白質 (Lian et al. 1998; von Wilmowsky et al. 2011)。本研究發現，8 週時方型螺紋之 BMP-2 表現呈現無規則排列，OC 則多位於螺紋外，
梯型螺紋則可發現呈層狀排列之 BMP-2 及 OC。顯示骨組織在方型螺 紋處生成較慢，其鈣化部分也較梯型螺紋慢。在 16 週中，BMP-2 皆 出現於梯型及方型螺紋，且排列方式皆呈現層狀。但在 OC 的表現中，
梯型螺紋比方型螺紋明顯，甚至出現骨元之外型，顯示梯型螺紋在 16 週時，其骨組織幾乎已成熟。在本研究之 Masson Goldner 染色中，
梯型螺紋於 16 週之 0.8 mm 螺距之骨組織呈現較成熟之層狀骨，符合
40
而在 Masson Goldner 染色下，梯型較方型螺紋多較成熟之層狀骨，
此與此學者的研究相似。 4-4)(Puleo et al., 1999)。故推測植體植入骨組織後，骨沿著植 體接觸面生長，因此本研究可觀察到，在 1.4 mm 及 1.2 mm 之方型螺
41
第五章 結論與展望
本研究結論支持利用梯形螺紋於 0.8 mm 螺距時，可以獲得較佳 的骨整合。同時也發現，梯形螺紋之設計在植入骨後，其達成骨整合 之速度快於方型螺紋。雖然方型螺紋在抵抗應力時有最佳之效果，但 因其螺紋面角關係，導致其在操作上之不便。加上文獻顯示，具有切 削力之 V 型螺紋雖然在操作上方便，但在植入受力時，其螺紋邊緣易 產生應力集中而造成骨吸收。因此，本研結果顯示，梯形螺紋在植入 骨時可提供比起方型螺紋較接近 V 形螺紋之楔型力量而幫助操作，同 時亦能較快速達到骨整合效果，顯然可提供未來在設計牙科植體時的 一種改良參考。
42
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表 2-1 甲基丙烯酸甲酯(methyl methacrylate)混和溶液配置方法 (100 ml)
1. Methyl methacrylate 60 ml
2. Butyl methacrylate 35 ml
3. Methyl benzoate 5 ml
4. Polyrthylene glycol 400 1.2 ml
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表 2-2 Weigert’s 蘇木紫溶液配置方法
溶液 A
Hematoxylin 1 gm
Ethanol 100 ml
溶液 B
Ferric Chloride 29% 4 ml
Distilled Water 95 ml
HCl 1 ml
使用時將溶液 A 及溶液 B 等量混和