犬上颌窦内提升动物模型的设计及评价

Modification and evaluation of an animal model for maxillary sinus floor elevation in Beagle dogs

目的 :介绍一种犬的上颌窦内提升动物模型,并利用CT和内镜对该模型进行评价。方法 :对2只成年Beagle犬尸体和4只成年Beagle活体犬行螺旋CT检查,将CT数据导入Simplant 11.04软件行三维重建,选择犬的第一磨牙远中牙尖的腭侧(即腭大孔的外侧)为上颌窦内提升的手术入路位点。对6只犬(共12侧上颌窦)行上颌窦内提升术。术中分别将内镜伸入种植窝和上颌窦外侧壁骨窗(5 mm×5 mm),观察上颌窦黏膜情况和该位点在上颌窦底的位置关系。术后即刻对所有动物行螺旋CT检查,测量该位点和上颌窦的关系。利用SAS 9.0软件包对测量数据进行配对t检验。结果:所有活体犬均存活至实验完成。术后行CT重建,在冠状位和矢状位测量11个相关参数,包括1DF和CE(该位点分别到腭大孔中点和腭侧牙槽嵴顶的水平距离)为(8.129±0.915)mm和(4.868±0.291)mm;2BC和CD(该位点分别到上颌窦底和腭黏膜的垂直距离)为(2.034±0.410)mm和(3.588±0.384)mm;3AB、MN和PQ(在该位点处上颌窦的上下径、内外径和前后径)分别为(17.341±0.651)mm、(7.899±0.984)mm和(18.424±1.131)mm;4MT和NT(该位点分别到上颌窦内、外侧骨壁的水平距离)为(3.961±0.421)mm和(3.845±0.562)mm;5OP和OQ(该位点分别到上颌窦前、后界的水平距离)为(9.248±1.256)mm和(9.368±1.161)mm。OP和OQ之间以及MT和NT之间均无显著差异(P>0.05)。术中将内镜分别伸入种植窝和外侧骨窗内,可见白色、完整、不透明的窦黏膜,该位点处于上颌窦底正中。结论:第一磨牙远中牙尖的腭侧是一个较为理想的犬上颌窦内提升手术入路,利用该位点设计的上颌窦内提升动物模型既简单又快捷,适用于相关上颌窦的动物实验研究。

PURPOSE： To modify a dog model for maxillary sinus floor elevation（MSFE） by selecting a new surgical approach and evaluate the process of the dog model with computed tomography（CT） scans and endoscope. METHODS：CT scans were performed for a total of 2 Beagle cadavers and 4 Beagles in healthy condition before surgery. The data from CT scans in Dicom（digital imaging and communications in medicine） format were input into an interactive Simplant software program to select a candidate site（CS） as a new surgical approach which was located on palatal to the distal dental cusp of the first molar, or buccal to the greater palatine foramen. Each sinus（12 sinuses in total） was treated with maxillary sinus-floor elevation（MSFE）, including a palatal gingival margin incision, bone window preparation, sinusmembrane elevation, and Bio-Oss grafts. During MSFE, an endoscope was put through the bone window and lateral puncture opening into the maxillary sinus to observe the Schneiderian membrane＇s condition and the CS＇s position,respectively. Postoperative CT scans for all animals were used to measure the CS＇s position, which were compared by paired t test using SAS 9.0 software package. RESULTS： All eleven parameters were measured in the CS＇s coronal and sagittal section. Eleven parameters were listed as follows： 1 DF and CE（the horizontal distance from CS to the midpoint of the greater palatine foramen and to the palatal alveolar ridge） were（8.129±0.915） mm and（4.868±0.291） mm; 2 BC（the residual bone height） was（2.034±0.410） mm; and 3 AB, MN and PQ（the height, width and length of maxillary sinus）were（17.341±0.651） mm,（7.899±0.984） mm and（18.424±1.131） mm; 4MT and NT（the horizontal distance from CS to the internal and external bone wall of the maxillary sinus） were（3.961±0.421） mm and（3.845±0.562） mm; 5OP and OQ（the horizontal distance from CS to the anterior and posterior bone edge of the maxillary sinus） were（9.248±1.256） mm and（9.368±1.161） mm. The most important two parameters were DF and BC. There was no significant difference between OP and OQ（the horizontal distance from CS to the anterior and posterior bone edge of the maxillary sinus）. There was also no significant difference between MT and NT（the horizontal distance from CS to the internal and external bone wall of the maxillary sinus）. Intraoperative views noted the intact, white and opaque sinus membrane in both the Beagle cadavers and Beagles after putting an endoscope through the bone window, and the membrane movement in the middle of the maxillary sinus floor after insertion of an endoscope into the maxillary sinus from the lateral puncture opening. CONCLUSIONS：The CS is an ideal surgical approach for MSFE, and the dog model is more suitable for maxillary sinus research.