水平内褥式缝合在组织增量术中的实践要点  

Key points to execute internal horizontal mattress suture in tissue augmentation

作　　者：屈依丽[1,2,3] 满毅 QU Yili;MAN Yi(State Key Laboratory of Oral Diseases,Chengdu 610041,China;National Clinical Research Center for Oral Dis-eases,Chengdu 610041,China;Department of Prosthodontics,West China Hospital of Stomatology,Sichuan Univer-sity,Chengdu 610041,China;Department of Oral Implantology,West China Hospital of Stomatology,Sichuan Uni-versity,Chengdu 610041,China)

机构地区：[1]口腔疾病研究国家重点实验室,四川成都610041 [2]国家口腔疾病临床医学研究中心,四川成都610041 [3]四川大学华西口腔医院修复科,四川成都610041 [4]四川大学华西口腔医院种植科,四川成都610041

出　　处：《口腔疾病防治》2023年第3期153-161,共9页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(81970965);四川省重点研发项目(2022YFS0041)。

摘　　要：良好的缝合能够起到固定、关闭创口的作用,是保证创口良好愈合的基本条件。牙缺失种植位点的软硬组织再生术,无张力的对位缝合对于组织的再生十分重要。水平内褥式缝合与常规水平褥式缝合类似,通过两针进针、两针出针形成一个能被切口平分的矩形,水平内褥式缝合在矩形的基础上,强调经过切口的缝线需位于切口下方,因此创缘的外翻为该术式亮点。水平内褥式缝合通过缝合和打结可以紧密贴合受区组织与移植物,实现胶原膜、根向复位瓣、软组织移植替代物的固定,关闭创口还能进一步释放创缘张力。在满足固定、关闭创口的基本需求之外,水平内褥式缝合还能起到应力中断作用,降低周围肌肉牵拉对术区的干扰,搭配常规间断缝合能更精细调节创口张力,因此在种植相关再生性手术中应用潜力大。笔者基于临床经验和文献,阐述水平内褥式缝合在组织增量术区应用的优势,尝试明确进出针位点及缝线与组织和切口的空间关系,提出命名根据,有利于同行交流与实践。Ideal sutures can provide great fixation,wound closure and a stable environment for healing of the surgical site.Tension-free apposition sutures are important for tissue regeneration and could tackle insufficient amounts of soft and hard tissue,especially in missing tooth sites that require implantation.The internal horizontal mattress suture,similar to the conventional horizontal mattress suture,forms a rectangle that can be bisected by the incision with both intrusion and extrusion of the needle on each side.On the basis of the rectangle,the internal horizontal mattress suture emphasizes that the suture should be located below the incision,so the eversion of the wound margin is the highlight of this procedure.The internal horizontal mattress suture could stabilize the graft on the targeting tissue,realize the fixation of the collagen membrane,apically repositioned flap and soft tissue graft,reduce the tension on the incision,and further release the tension of the incision margin.Beyond the primary need for fixation and wound closure,internal horizontal mattress sutures can also achieve stress interruption that reduces the interference of the surrounding muscle and can better master wound tension with the assistance of interrupted sutures.Given the above advantages,horizontal internal mattress sutures have great potential in the application of implant-related regenerative surgery.In this review,according to our experience in clinical practice and the literature,we summarize the advantages of internal horizontal mattress sutures in tissue augmentation.In addition,the sites and sequence to insert the needle and the spatial relationship between the suture and incision are clarified with the rationale of the naming pattern,which is conducive to experience exchange and clinical practice.

关 键 词：水平褥式缝合 水平内褥式缝合 组织再生 牙槽骨增量 骨再生 牙种植 口腔黏膜 腭侧半厚瓣唇侧卷入技术 应力中断 

分 类 号：R78[医药卫生—口腔医学]