侧壁开窗上颌窦底提升术中黏骨膜状态的光纤内镜观察  

Evaluation of Schneiderian membrane state using fiber optic endoscope during maxillary sinus floor elevation with lateral window

作　　者：皮雪敏 潘红 张彩月 陈德平 刘倩 王璐 苑秋华 陶丹 宿玉成 Pi Xuemin;Pan Hong;Zhang Caiyue;Chen Deping;Liu Qian;Wang Lu;Yuan Qiuhua;Tao Dan;Su Yucheng(Department of Oral Implantology,Beijing Ruicheng Stomatology Hospital,Beijing Ruicheng Implant Technology College,Beijing 100032,China;Dental Implant Center,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100033,China)

机构地区：[1]北京瑞城口腔医院种植外科·种植医学研究院,100032 [2]中国医学科学院,北京协和医学院,北京协和医院口腔种植中心,100033

出　　处：《中华口腔医学杂志》2020年第11期897-901,共5页Chinese Journal of Stomatology

摘　　要：目的利用光纤内镜观察侧壁开窗上颌窦底提升术中黏骨膜的状态,为临床医师对于上颌窦黏骨膜的处理提供参考。方法选取2016年9月至2019年12月就诊于北京瑞城口腔医院种植外科行侧壁开窗上颌窦底提升术的66例患者(72侧上颌窦),其中男性40例,女性26例,年龄(56.2±11.5)岁(26~80岁)。术中使用光纤内镜对上颌窦黏骨膜的状态进行观察并分类。结果本组72侧上颌窦术中黏骨膜状态可分为以下4类,①Ⅰ类,占25%(18/72),骨膜完整,黏骨膜无损伤;②Ⅱ类,占39%(28/72),骨膜损伤,固有层未暴露;③Ⅲ类,占6%(4/72),骨膜破裂,固有层和上皮层暴露;④Ⅳ类,占31%(22/72),黏骨膜穿孔,骨膜层、固有层和上皮层均破裂。结论侧壁开窗上颌窦底提升术中上颌窦黏骨膜的状态可分为4类,对Ⅱ类及Ⅲ类黏骨膜状态应加以保护,避免发展为黏骨膜穿孔而产生术中或术后并发症;光纤内镜作为临床辅助检查手段,可提高术者对上颌窦底黏骨膜状态的把控,辅助黏骨膜剥离。Objective To observe the status of the sinus membrane using fiber optic endoscope during the lateral window approach sinus floor elevation to provide a reference for clinicians when evelvating the sinus mucoperiosteum.Methods Sixty-six patients(72 sides)who underwent maxillary sinus floor elevation in Beijing Ruicheng Stomatology Hospital from September 2016 to December 2019 were selected,including 40 males and 26 females,aged 26-80 years old[(56.2±11.5)years].And fiber optic endoscopy was used to observe the maxillary mucoperiosteum during the operation.Results The status of maxillary sinus mucoperiosteal during lateral window approach sinus floor elevation can be divided into four categories:①ClassⅠ,complete periosteal,no damage to mucoperiosteum;②ClassⅡ,periosteal injury,unexposed laminae propria;③ClassⅢ,periosteal Rupture,exposed lamina propria;④ClassⅣ,mucoperiosteum perforation,rupture of periosteum,lamina propria and epithelial layer.A total of 72 operations were performed,including 18 cases of class I,28 cases of classⅡ,4 cases of classⅢ,and 22 cases of classⅣ.Conclusions The status of maxillary sinus mucoperiosteal during lateral window approach sinus floor elevation can be divided into four categories.Fiberoptic endoscopy as a clinical auxiliary examination method can improve the operator′s control of the status of the maxillary sinus membrane and assist the peeling of the mucosa.

关 键 词：上颌窦 上颌窦底提升 侧壁开窗 骨膜 黏骨膜 光纤内镜 

分 类 号：R783.6[医药卫生—口腔医学]