采用超声骨刀在局部麻醉下行外科辅助上颌骨快速扩弓术的临床应用  

Piezosurgery for surgically assisted rapid maxillary expansion under local anesthesia

作　　者：刁晓洁 李彪[2,3] 孙昊[2,3] 柳稚旭[2,3] 王旭东[2,3] 

机构地区：[1]新疆维吾尔自治区中医医院口腔科,乌鲁木齐830000 [2]上海交通大学医学院附属第九人民医院口腔颅颌面科 [3]上海市口腔医学重点实验室,上海200011

出　　处：《华西口腔医学杂志》2014年第4期350-354,共5页West China Journal of Stomatology

基　　金：国家自然科学基金资助项目(81271122);上海市自然科学基金资助项目(10ZR1418000)

摘　　要：目的探讨采用超声骨刀在局部麻醉下进行外科辅助上颌骨快速扩弓(SARME)手术的可行性。方法选择14例上颌骨横向发育不足的患者(其中男性6例,女性8例)为研究对象,在局部麻醉下用超声骨刀行SARME手术,手术方式采用腭中缝截骨术+侧方骨皮质切开术+双侧翼颌连接截骨术。采用问卷调查方式调查患者的术中感受。结果所有患者的SARME手术均在门诊手术室采用局部麻醉完成,患者均耐受并配合手术。超声骨刀损伤小,可以精确截骨,术后反应小。问卷调查结果显示,术中没有或者仅感觉到轻度震动感的有8例(占57.14%);术中没有或仅感觉到轻度疼痛和牙齿酸痛的有12例(占85.71%);对超声骨刀的声音无畏惧感或仅有轻度畏惧感的有11例(占78.57%)。患者术前和术后6个月牙弓宽度的测量值显示手术扩弓的效果非常明显。结论利用超声骨刀在局部麻醉下行SARME手术是可行的,但需要更多病例的实践和更长时间的随访。Objective This study evaluates piezosurgery for surgically assisted rapid maxillary expansion （SARME） under local anesthesia. Methods SARME was performed on adults with maxillary transverse deficiency under local anesthesia with a piezosurgical device. Fourteen patients （six males and eight females） underwent lateral maxillary osteotomies, midpalatal osteotomies, and bilateral pterygomaxillary disjunction. The feelings of patients during the operation were determined through questionnaires. Results All patients underwent SARME in the out-patient operating room. The surgical procedures were completed under local anesthesia. All patients exhibited satisfactory tolerance. Ultrasonic bone-cutting surgery was recently introduced as a feasible alternative to the conventional tools of cranio-maxillofacial surgery for its technical characteristics of precision and safety. The device used was unique in that cutting action occurred when the tool was employed on mineralized tissues, but stoped on soft tissues. The results of the questionnaires showed that eight （57.14%） patients felt a mild sensation of ultrasonic vibration, tweleve （85.71%） felt mild tolerable pain and tooth soreness during surgery, and eleven （78.57%） felt little fear and hardly heard the ultrasonic sound. Preoperative and postoperative six months later measurements showed an evident effect of expansion. Conclusion Piezosurgery enabled patients to undergo all the steps of SARME under local anesthesia, but more cases and longer follow-up are needed to verify the results.

关 键 词：外科辅助上颌骨快速扩弓 超声骨刀 局部浸润麻醉 

分 类 号：R782.2[医药卫生—口腔医学]