伴上颌窦囊肿或慢性上颌窦炎的上颌窦底外提升术效果评价

目的探讨伴上颌窦囊肿或慢性上颌窦炎的经外侧壁开窗上颌窦底提升术同期牙种植的治疗效果。 方法从2014年3月至2018年3月期间在广州市海珠区口腔医院种植修复科以及口腔外科诊治的行经外侧壁开窗的上颌窦底提升术同期牙种植的患者共53例种植体，根据文献报道的纳入标准，分为三组，可进行上颌窦底提升术的伴上颌窦囊肿者为囊肿组共17例，可进行上颌窦底提升术的伴有慢性上颌窦炎者为炎症组共15例，上颌窦内无明显炎症或囊肿者为正常对照组共21例。术前记录上颌窦黏膜厚度，上颌窦底剩余牙槽骨高度（RBH），术中记录有无上颌窦黏膜撕裂、破裂。术后7 d记录术后并发症情况，定期随访，在修复后12个月记录分析上颌窦内成骨高度（SBG）、种植体尖端成骨高度（ABH）、种植体边缘骨吸收（MBL）、上颌窦囊肿变化或上颌窦黏膜增厚情况。使用SPSS 20.0进行数据统计分析。术后急性感染比较使用卡方检验中Fisher精确检验，三组间的上颌窦黏膜厚度、上颌窦内成骨、边缘骨吸收等指标使用单因素方差分析进行差异比较，术前、术后囊肿直径和上颌窦黏膜厚度对比使用配对t检验。 结果三组病例术中均未出现上颌窦黏膜撕裂。囊肿组2例、炎症组3例、对照组1例出现术后急性上颌窦炎，三组间急性炎症例数差异无统计学意义（χ² = 2.049，P = 0.352）。三组病例均无术后上颌窦积血、积液等情况。修复后12个月，囊肿组SBG为（8.09 ± 1.20）mm，炎症组SBG为（7.17 ± 1.18）mm，对照组SBG为（7.36 ± 1.41）mm，组间比较差异无统计学意义（F = 2.409，P = 0.100）；囊肿组ABH为（1.94 ± 1.34）mm，炎症组ABH为（1.40 ± 1.12）mm，对照组ABH为（2.10 ± 1.30）mm，组间差异无统计学意义（F = 1.382，P = 0.261）；囊肿组MBL为（0.53 ± 0.70）mm，炎症组MBL为（0.47 ± 0.92）mm，对照组MBL为（0.48 ± 0.67）mm，组间差异无统计学意义（F = 0.118，P = 0.889）。囊肿组术后囊肿直径（2.35 ± 3.51）mm]较术前的囊肿直径（8.41 ± 3.04）mm]有所缩小，差异有统计学意义（t = 5.216，P<0.001）。炎症组术后黏膜厚度（6.27 ± 2.15）mm]较术前厚度（5.27 ± 1.58）mm]有所增加，差异有统计学意义（t = -2.562，P = 0.023）。 结论伴上颌窦囊肿或慢性上颌窦炎的经外侧壁开窗的上颌窦底提升术同期牙种植可以取得较好的临床效果。

Treatment effect of the elevation of maxillary sinus floor accompanied with maxillary cyst or chronic maxillary sinusitis

Objective To evaluate the treatment effect of immediate implantation with the elevation of maxillary sinus floor through the lateral wall,accompanied with maxillary cyst or chronic maxillary sinusitis.Methods From March 2014 to March 2018,a total of 53 immediate implantations with the elevation of maxillary sinus floor through the lateral wall were selected from dental implant department and surgery department in stomatology hospital of Haizhu District.According to the inclusion criteria of literature reports,all the cases were divided into three groups,including 17 cases with maxillary cyst,15 cases with chronic maxillary sinusitis and 21 cases without cyst or sinusitis for control.Mucosal thickness and residual bone height of maxillary sinus were recorded preoperatively.Mucosal ruptures of maxillary sinus were recorded during the operation.Postoperative complications were recorded 7 days after the operation.Sinus bone gain(SBG),apical bone height(ABH),marginal bone loss(MBL),cyst change and mucosal thickening were also recorded 12 months after restorations.Statistical data analysis was taken by SPSS 20.0.Acute postoperative infections among the three groups were compared with Fisher exact test.Mucosal thickness of maxillary sinus,sinus bone gain and marginal bone absorption among the three groups were compared with single factor variance analysis.Preoperative and postoperative diameter of the cyst and mucosal thickness of maxillary sinus were compared with paired t test.Results All patients finished treatments without mucosal rupture.Acute inflammations were found,including two cases in the maxillary cyst group,three cases in the chronic maxillary sinusitis group and one case in the control group.No significant difference was found among the three groups for acute inflammations(Fisher exact testχ^2=2.049,P=0.352).Postoperative hematocele and hydrops in sinus was not found in all cases.SBG at 12 months after restoration in the cyst group,the sinusitis group,and the control group was found to be(8.09±1.20),(7.17±1.18)and(7.36±1.41)mm,respectively.There was no significant difference in SBG among the three groups(F=2.409,P=0.100).ABH in the cyst group,the sinusitis group and the control group was(1.94±1.34),(1.40±1.12)and(2.10±1.30)mm,respectively.There was no significant difference in ABH(F=1.382,P=0.261),either.MBL in the cyst group,the sinusitis group and the control group was(0.53±0.70),(0.47±0.92)and(0.48±0.67)mm,respectively.There was no significant difference in bone absorptions(F=0.118,P=0.889).In the cyst group,the mean postoperative diameter of cysts(2.35±3.51)mm was smaller than that of the pre-operative ones(8.41±3.04)mm,which was significantly different(t=5.216,P<0.001).In sinusitis group,the thickness of mucosa(6.27±2.15)mm was increased than that of pre-operation(5.27±1.58)mm,which was of significant difference(t=-2.562,P=0.023).Conclusion It may be feasible to apply immediate implantation with the elevation of maxillary sinus floor through the lateral wall,in case of maxillary cyst or chronic maxillary sinusitis.