CGF在上颌窦穿孔修补术中的应用研究

发布时间：2018-12-31 15:16

【摘要】：目的:上颌窦穿孔是牙槽外科常见并发症,若穿孔不能得到及时有效治疗可导致上颌窦感染。传统皮瓣转移修复上颌窦穿孔治疗方案易给患者带来二次创伤。浓缩生长因子(concentrate growth factor,CGF)富含浓缩纤维蛋白和血小板,在组织缺损修复和再生中能够起到促进作用。本课题对浓缩生长因子与皮瓣转移技术在修补上颌窦穿孔的病例进行回顾性研究,评价浓缩生长因子修复上颌窦穿孔临床效果,为上颌窦穿孔修复提供最优临床治疗方案。方法:回顾性分析2006年12月至2016年1月山东省立医院口腔颌面外科上颌窦穿孔修复患者(门诊及住院患者),采用CGF进行上颌窦穿孔修补的15例患者(CGF组),其中上颌后牙根尖病变致上颌窦底骨质缺如5例,拔牙术后上颌窦穿孔10例;采用皮瓣转移技术(颊侧黏骨膜瓣滑行术、腭侧黏骨膜瓣转移术和颊脂垫移植术等)进行上颌窦穿孔修补术患者15例作为研究对照组(皮瓣转移组),其中上颌后牙根尖病变致上颌窦底骨质缺如6例,拔牙术后上颌窦穿孔9例。比较两组(1)手术区域牙龈有无肿胀、感染,牙龈色泽是否正常,检查有无瘘道形成。(2)数字化根尖片(或曲面断层片)检查牙槽骨愈合情况,拔牙窝洞内是否有连续性阴影。(3)术后是否适合可摘活动义齿、固定桥或种植修复治疗,评价修补效果。(4)采用SPSS20.0统计软件包对数据进行处理,计数资料采用X2检验,P值小于0.05为差异有显著性意义。结果:本研究中15例CGF组上颌窦穿孔修补术后随访无不适症状,未出现感染及瘘道,术后3个月牙龈色泽正常,窦底新骨形成,牙槽窝骨愈合,术区及上颌窦无不适和炎症,术后3-6月无需二次手术即可行义齿修复治疗。15例皮瓣转移组上颌窦穿孔修补术后随访3例患者术后出现术区肿胀不适,1例出现术后感染,术后3个月15例患者术区牙龈色泽正常,窦底新骨形成,牙槽窝骨愈合,无瘘道,术区及上颌窦无不适和炎症,术后3-6月2例患者需行前庭沟底加深术方可行义齿修复治疗。CGF组和皮瓣转移组在术后肿胀、感染、瘘道及术后二次手术等方面尚不能认为两组处理有差异(P0.05)。结论:CGF对上颌窦穿孔的修补效果同传统皮瓣转移技术相比无明显差异性,术后均能够形成正常的软硬组织,但利用CGF对上颌窦穿孔进行修补可以减少术后不良反应,临床应用效果良好,值得临床应用开展。
[Abstract]:Objective: maxillary sinus perforation is a common complication in alveolar surgery. The treatment of maxillary sinus perforation by traditional flap transfer is easy to bring secondary trauma to patients. Concentrated growth factor (concentrate growth factor,CGF) is rich in fibrin and platelets and can promote tissue defect repair and regeneration. In this paper, we retrospectively studied the effects of concentrated growth factor and flap transfer in repairing maxillary sinus perforation, and evaluated the clinical effect of concentrated growth factor in repairing maxillary sinus perforation, which provided the best clinical treatment for maxillary sinus perforation. Methods: from December 2006 to January 2016, 15 patients (CGF group) with maxillofacial sinus perforation repair in Shandong Provincial Hospital were analyzed retrospectively. CGF was used to repair maxillary sinus perforation. Among them, 5 cases suffered from maxillary sinus floor bone deficiency caused by root tip lesion of maxillary posterior teeth, and 10 cases had maxillary sinus perforation after extraction of teeth. Fifteen patients with maxillary sinus perforation were treated with flap transfer (buccal mucoperiosteal flap sliding, palatal mucoperiosteal flap transfer and buccal fat pad transplantation) as the control group (flap transfer group). 6 cases of maxillary sinus floor bone defect caused by maxillary posterior tooth root tip lesion, 9 cases of maxillary sinus perforation after extraction of teeth. The results were as follows: (1) gingival swelling, infection, normal gingival color and fistula formation were compared between the two groups. (2) Digital apical films (or curved tomograms) were used to examine alveolar bone healing. (3) whether it is suitable for removable denture, fixed bridge or implant repair after operation, and evaluate the effect of repair. (4) the data were processed by SPSS20.0 statistical software package. The count data were tested by X _ 2, P < 0.05 was significant difference. Results: in the CGF group, 15 patients with maxillary sinus perforation were followed up with no symptoms, no infection or fistula, normal gingival color, new bone formation in the sinus floor, alveolar fossa bone healing, no discomfort and inflammation in the area of operation and maxillary sinus. In 15 cases of flap transfer group, 3 cases of maxillary sinus perforation and repair of maxillary sinus were followed up with swelling and discomfort of operation area, 1 case with postoperative infection, 3 cases with maxillary sinus perforation repair, 3 cases with maxillary sinus perforation repair and 1 case with postoperative infection. Three months after operation, 15 patients had normal gingival color, new bone formation at the sinus floor, alveolar fossa bone healing, no fistula, no discomfort and inflammation in the operation area and maxillary sinus. From 3 to 6 months after operation, 2 patients needed to perform vestibular furrow deepening to repair the denture. The CGF group and the flap transfer group could not be considered as having any difference in terms of postoperative swelling, infection, fistula and secondary operation (P0.05). Conclusion: the effect of CGF in repairing maxillary sinus perforation is not significantly different from that of traditional flap transfer technique, and normal soft and hard tissue can be formed after operation. However, repairing maxillary sinus perforation with CGF can reduce the adverse reaction after operation. The effect of clinical application is good and worthy of clinical application.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782

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