改良小骨窗在上颌窦外提升术中的应用

Clinical application of modified minimally invasive incision in maxillary sinus lift and dental implantation surgery

目的:比较两种不同大小的上颌窦外提升术入路窗口结合同期植入种植体临床疗效。方法:采用2种不同尺寸窗口行上颌窦外提升术,对29例(共32颗)垂直骨量不足的上颌后牙区种植病例行上颌窦底提升及种植体同期植入手术。术前将患者随机分为小骨窗组(6 mm×6 mm,n=15)和常规骨窗组(15 mm×10 mm,n=14),两种窗口均同期植入人工骨粉和种植体。分别于术后10 d和30 d评价患者舒适感。在手术前、手术当天、术后6个月分别进行口腔锥形束CT(CBCT)扫描,检查种植体周围上颌窦底部剩余牙槽骨和植入骨粉的总厚度和所植骨粉在窦底的宽度。结果:全部32颗种植体CBCT检查骨结合良好,窦内种植体周围骨量有明显增加。小骨窗组与常规骨窗组的植入骨粉成骨能力无明显差异。小骨窗组患者总手术时间与常规骨窗组无明显差异,术后10 d和30 d随访中患者对手术不适反应明显减轻。结论:微创小窗口上颌窦底外提升术较常规窗口损伤更小,技术适应证更广泛,可减少患者手术痛苦,提升治疗满意度。

Objective：To compare two invasive incision sizes in maxillary sinus floor elevation surgery for increasing the height of sinus floor and reducing the discomfort and complications of patients.Methods：Two different size of windows（6 mm ×6 mm and 10 mm ×15 mm）for maxillary sinus lift surgery were adopted in 29 cases（32 implants）with vertical bone mass defect in maxillary posterior,who would accept maxillary sinus floor elevation and implant placement surgery.The experimental（n =15）and control groups （n =14）were implanted artificial bone and implants simultaneouly.The evaluation of the discomfort of patients after surgery was evaluated at day 10 and 30 after surgery respectively.The height and width of alveolar bone at the bottom of the maxillary sinus floor were examined by CBCT scan at day 180 after opera-tion.Results：All the implants examined were shown with wonderful bone integration and the height and width of the maxillary sinus floor were significantly improved.Compared with the control group [（41.34 ± 6.54）minutes],the operation time in the experimental group [（40.23 ±5.42）minutes]had no signifi-cantly prolonged.The discomfort feeling of patients in the experimental group was better than that of control group at day 10 and day 30 after surgery.Conclusion：Small window approach with minimally invasive incision in the treatment of maxillary sinus floor is less invasive than the traditional approach.