上颌窦前外侧壁骨内血管孔道位置锥形束CT影像判断分析及其临床应对措施

发布时间：2018-04-19 05:31

本文选题：牙种植 + 上颌窦　；参考：《北京大学学报(医学版)》2017年03期

【摘要】：目的:回顾临床病例资料,分析上颌窦前外侧壁骨内血管孔道的锥形束CT(cone beam computer tomography,CBCT)定位方法及其在上颌窦侧壁开窗提升手术中的临床应对措施。方法:回顾分析71例(81侧)上颌窦侧壁开窗植骨术(上颌窦外提升)病例的临床及影像学检查资料,通过CBCT影像资料测量分析上颌第一磨牙缺失位点相对上颌窦前外侧壁骨内血管孔道的位置及其临床应对措施。结果:71例(81侧)上颌窦外提升病例中,术前CBCT曲面断层模拟功能可以判断上颌窦前外侧壁近远中区域骨内存在血管孔道77侧(95.1%)。应用CBCT冠状面断层功能局部可观察到上颌第一磨牙缺失位点相对上颌窦外侧骨壁血管孔道54侧(66.7%),其中3侧(3.7%)可见两条水平向大致平行走行的血管,另外27侧(33.3%)未见明显血管孔道。81侧的影像资料中有6侧两位医师的诊断不一致,CBCT诊断的一致性kappa值为0.842(P0.001)。54侧检出第一磨牙缺失位点上颌窦外侧骨壁内存在血管孔道的病例中,最低位置血管孔道距离牙槽嵴顶水平的平均距离为(13.0±4.7)mm(最小3 mm、最大28 mm),距离上颌窦底水平的平均距离为(9.3±4.8)mm,其中1侧检出上颌窦底骨壁内血管孔道。根据手术记录,上颌窦侧壁开窗术中解剖骨壁内血管4侧,开窗有意识避开血管3侧,1侧因出血而中断手术,73侧手术记录中未见血管相关记录。结论:上颌窦前外侧骨壁血管孔道CBCT检出率较高,术前CBCT检查具有较高的可靠性,有助于完善手术设计、降低术中损伤上颌窦前外侧骨壁内血管的风险。
[Abstract]:Objective: to review the clinical data of patients with maxillary sinus and to analyze the localization of conical bundle CT(cone beam computer tomographyCT-CTs in the anterolateral wall of maxillary sinus and the clinical countermeasures in the operation of maxillary sinus lateral wall fenestration.Methods: the clinical and imaging data of 71 cases (81 sides of maxillary sinus) undergoing lateral wall fenestration and bone grafting (extranasal lifting of maxillary sinus) were retrospectively analyzed.The location of the missing site of maxillary first molar relative to the intraosseous vascular orifice in the anterolateral wall of maxillary sinus and its clinical countermeasures were analyzed by CBCT imaging data.Results in 71 cases of extramaxillary sinus elevation (71 cases with 81 sides of maxillary sinus), the function of CBCT curved surface tomographic simulation before operation could be used to judge the presence of vascular foramen in the proximal and distal region of the anterior and lateral wall of maxillary sinus in 77 sides of the maxillary sinus.Using CBCT coronal tomographic function, we can observe that the missing site of maxillary first molar is about 66.7% in 54 sides of vascular canal of lateral bone wall of maxillary sinus, of which 3 sides are 3. 7%) there are two vessels that walk roughly parallel horizontally.In the other 27 sides (33. 3%), there were no obvious imaging data of vascular orifice. 81 sides. There were 6 sides whose diagnosis was inconsistent. The consistent kappa value of CBCT was that the first molar defect site was found in the 0.842(P0.001).54 side, and the vascular orifice was found in the lateral wall of maxillary sinus.The average distance from the lowest position to the alveolar crest level was 13.0 卤4.7 mm (minimum 3 mm, maximum 28 mm), and the average distance to the maxillary sinus floor was 9.3 卤4.8 mm.According to the operative records, 4 sides of intramural vessels were dissected during fenestration of maxillary sinus, and there was no vase-related record in 73 sides of 73 sides which had deliberately avoided 3 sides of the vessels and 1 side of them were interrupted because of bleeding.Conclusion: the detection rate of CBCT in the vascular orifice of anterolateral bone wall of maxillary sinus is high, and the preoperative CBCT examination is reliable, which is helpful to improve the surgical design and reduce the risk of injury of intramural vessels in the anterolateral bone wall of maxillary sinus during operation.
【作者单位】：北京大学口腔医学院·口腔医院第一门诊部口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室;首都医科大学全科医学与继续教育学院全科医学系;
【分类号】：R783

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