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浙江大学学报（医学版）
浙江大学学报（医学版）  2017, Vol. 46 Issue (6): 630-636    DOI: 10.3785/j.issn.1008-9292.2017.12.09
原著     
改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者临床观察
陆薇1(),林梦娜2,赵士芳2,王慧明2,何福明2,*()
1. 浙江大学医学院附属口腔医院牙周科, 浙江 杭州 310006
2. 浙江大学医学院附属口腔医院种植科, 浙江 杭州 310006
Application of modified lateral window for maxillary sinus floor augmentation
LU Wei1(),LIN Mengna2,ZHAO Shifang2,WANG Huiming2,HE Fuming2,*()
1. Department of Periodontology, Stomatology Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, China
2. Department of Implantology, Stomatology Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou 310006, China
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摘要：

目的: 评估改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者的疗效。方法: 选择2012年6月至2014年10月于浙江大学医学院附属口腔医院就诊的上颌后牙区缺牙伴重度骨萎缩患者55例，均接受改良侧壁开窗式上颌窦底提升术。在上颌窦侧壁开窗操作中，将常规的6~8 mm垂直高度的卵圆形骨窗改良为4~5 mm的沟槽状骨窗，并通过改良骨窗建立的操作通道充分剥离上颌窦底黏膜，于黏膜下方置入适量大颗粒Bio-Oss骨粉。统计种植体存活率，测量骨粉垂直高度、体积并计算其吸收率，记录相关并发症。结果: 同期植入86颗种植体，种植体累计存活率为97.67%（基于种植体分析）和96.36%（基于患者分析）。术前剩余骨高度为（4.7±2.6）mm，宽度为（8.4±2.7）mm。术后即刻种植位点骨高度为（16.1±2.5）mm，修复时骨高度为（16.2±2.2）mm，术后1年和2年的骨高度分别为（14.9±2.5）mm和（13.6±2.6）mm。术后即刻骨粉高度为（10.6±2.8）mm，体积为（1569±745）mm3；术后半年内骨粉高度吸收率为3.79%，体积吸收率为7.87%；术后1年时骨粉高度累计吸收率为6.63%，体积累计吸收率为10.89%；术后2年时骨粉高度累计吸收率为7.58%，体积累计吸收率为15.26%。5例患者术中发生窦底黏膜小穿孔，均使用Bio-Gide胶原膜成功修复。结论: 改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者有较高的种植体存活率、良好的骨粉稳定性以及较低的并发症发生率，是一种安全可靠并且创伤较小的种植骨增量手段。
关键词： 上颌窦/外科学;  生物膜;  骨代用品/治疗应用;  明胶海绵, 吸收性/治疗应用;  骨移植/方法;  牙种植;  治疗结果;  随访研究    
Abstract:

Objective: To evaluate the clinical efficacy of modified lateral window for maxillary sinus floor augmentation (MSFA). Methods: Fifty-five patients who visited the Stomatology Hospital Affiliated to Zhejiang University School of Medicine between June 2012 and October 2014 were enrolled in the study. Patients underwent MSFA with Bio-Oss grafts based on modified access window. During the operation the vertical height of the bony window was reduced from 6-8 mm of conventional oval window to 4-5 mm of slot-shaped window. The sinus membrane was detached completely via the lateral access and large particle Bio-Oss graft was placed in the sub-mucosal space. The implant survival, graft height, graft volume and resorption rates were measured. Intra-op and post-op complications were recorded. Results: There were 86 implants inserted. The 2-4 year cumulative survival rates were 97.67% by implant-based analysis and 96.36% by patient-based analysis. The residual bone height was (4.7±2.6) mm and bone width was (8.4±2.7) mm. The bone height of implantation site immediately after operation was (16.1±2.5) mm and it was (16.2±2.2) mm at restoration. The bone heights at 1 and 2 years after operation were (14.9±2.5) mm and (13.6±2.6) mm, respectively. The graft height was (10.6±2.8) mm and the graft volume was (1569±745) mm3 immediately after operation. The resorption rate of graft height 6 months after operation was 3.79% and that of graft volume was 7.87%. The 1-year accumulative resorption rate of graft height was 6.63% and that of graft volume was 10.89%. The 2-year accumulative resorption rate of graft height was 7.58% and that of graft volume was 15.26%. Small membrane perforation during MSFA was observed in 5 cases and all were successfully repaired by a collagen Bio-Gide membrane. Conclusion: The modified lateral technique obtains high implant survival rate, excellent graft stability and low complication rate at 2-4 year clinical follow-up, indicating that it is a safe, predictable and minimally invasive surgical method for severe atrophic maxillary posterior dentition.
Key words: Maxillary sinus/surgery    Biofilms    Bone substitutes/therapeutic use    Gelatin sponge, absorbable/therapeutic use    Bone transplantation/methods    Dental implantation    Treatment outcome    Follow-up studies
收稿日期: 2017-06-15 出版日期: 2017-12-25
CLC:  R782.05  
基金资助: 国家自然科学基金(81470780, 31670970);国家卫生和计划生育委员会科研基金（浙江省部共建项目）(WKJ-ZJ-1524);浙江省科学技术厅公益技术应用研究计划(2015C33161)
通讯作者: 何福明     E-mail: jocelyn1016@zju.edu.cn;hfm@zju.edu.cn
作者简介: 陆薇(1989-), 女, 硕士, 住院医师, 主要从事牙周病学和口腔种植外科手术研究; E-mail:jocelyn1016@zju.edu.cn; https://orcid.org/0000-0002-5155-8851
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引用本文:

陆薇,林梦娜,赵士芳,王慧明,何福明. 改良侧壁开窗式上颌窦底提升术治疗上颌后牙区缺牙伴重度骨萎缩患者临床观察[J]. 浙江大学学报（医学版）, 2017, 46(6): 630-636.

LU Wei,LIN Mengna,ZHAO Shifang,WANG Huiming,HE Fuming. Application of modified lateral window for maxillary sinus floor augmentation. J Zhejiang Univ (Med Sci), 2017, 46(6): 630-636.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2017.12.09    或    http://www.zjujournals.com/med/CN/Y2017/V46/I6/630

图 1  制备改良式外侧壁骨窗
图 2  线性参数测量示意图
图 3  改良侧壁开窗式上颌窦底提升术典型病例锥形束CT图像
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