發(fā)布時(shí)間：2018-03-13 20:36

  本文選題：側(cè)壁開窗　切入點(diǎn)：上頜竇底提升　出處：《浙江大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過(guò)收集106位患者病史資料、治療相關(guān)詳細(xì)資料及影像學(xué)資料,研究側(cè)壁開窗式上頜竇底提升術(shù)對(duì)垂直骨量、竇底黏膜厚度的影響,研究并討論相關(guān)并發(fā)癥以及建議的治療方法,為臨床治療提供一定的參考。 材料方法：以2012年1月9日至2013年12月31日來(lái)浙江大學(xué)醫(yī)學(xué)院附屬口腔醫(yī)院種植科就診的106位上頜后牙缺失患者為研究對(duì)象。根據(jù)口腔檢查、全景片以及CBCT片進(jìn)行術(shù)前評(píng)估,制定合理的種植手術(shù)方案,通過(guò)測(cè)量術(shù)前術(shù)后38例114份同期種植的全景片及22例66份同期種植的CBCT片,統(tǒng)計(jì)出垂直骨量、黏膜厚度的改變情況。記錄所有術(shù)中和術(shù)后的并發(fā)癥,比如過(guò)量出血、上頜竇底黏膜穿孔、感染、創(chuàng)口裂開、急性上頜竇炎、移植骨吸收。統(tǒng)計(jì)出種植體存留率。 結(jié)果：(1)術(shù)前原始骨高度為4.89±2.30mm,術(shù)后即刻骨高度為13.29±2.32mm,相比術(shù)前增加了8.38±3.00mm,術(shù)后3-6個(gè)月骨高度為12.94±2.211mm。術(shù)前與術(shù)后即刻骨高度有顯著性差異,P=0.0000.05。術(shù)前與術(shù)后3-6個(gè)月骨高度有顯著性差異,P=0.0000.05。術(shù)后即刻與術(shù)后3-6個(gè)月骨高度無(wú)顯著性差異,P=0.5320.05。(2)術(shù)前黏膜厚度為2.38±2.99mm,術(shù)后即刻黏膜厚度為2.42±3.15mm,術(shù)后3-6個(gè)月黏膜厚度為2.91±4.06mm。三個(gè)時(shí)間點(diǎn)的黏膜厚度無(wú)顯著性差異,P=0.7820.05。 (3)術(shù)中8例發(fā)生竇底黏膜穿孔,術(shù)后3例當(dāng)晚少量鼻出血,術(shù)后1-2周3例傷口裂開,術(shù)后2周1例急性上頜竇炎伴化膿性感染；術(shù)后6個(gè)月內(nèi),有6例患者的移植骨出現(xiàn)部分吸收,6顆種植體發(fā)生松動(dòng)或自行脫落。平均隨訪時(shí)間為16個(gè)月,種植體存留率為96.6%。 結(jié)論：(1)側(cè)壁開窗式上領(lǐng)竇底提升術(shù)并同期種植,術(shù)后即刻顯示骨高度顯著增加,并能在術(shù)后3-6個(gè)月保持該骨高度,不發(fā)生骨吸收。 (2)側(cè)壁開窗式上頜竇底提升術(shù)并同期種植,術(shù)后即刻及術(shù)后3-6個(gè)月內(nèi)都不會(huì)引起竇底黏膜厚度的增加。 (3)并發(fā)癥有黏膜穿孔、感染、創(chuàng)口裂開、移植骨吸收以及種植體松動(dòng)、脫落,可通過(guò)術(shù)前周密檢查、術(shù)中控制手術(shù)操作、修補(bǔ)穿孔黏膜、術(shù)后適當(dāng)加大抗生素劑量、縫合裂開創(chuàng)口并配合使用漱口水及系統(tǒng)性抗生素治療等方法預(yù)防及治療相關(guān)并發(fā)癥。
[Abstract]:Objective: to study the effects of lateral wall fenestration on the vertical bone mass and the thickness of sinus floor mucosa in 106 patients. To study and discuss the related complications and suggested treatment methods, to provide some reference for clinical treatment. Materials: from January 9th 2012 to December 31st 2013, 106 patients with maxillary posterior tooth loss were selected from the Department of Implant, affiliated Stomatology Hospital of Zhejiang University Medical College as subjects. Preoperative evaluation was performed according to oral examination, panoramic film and CBCT film. To make a reasonable implant operation plan, the changes of vertical bone mass and mucosal thickness were measured in 38 cases (114 cases) and 66 cases (66 cases) of CBCT before and after implantation. All the complications during and after operation were recorded. For example, excessive bleeding, perforation of the maxillary sinus floor, infection, laceration of the wound, acute maxillary sinusitis, bone resorption. Results the original bone height was 4.89 鹵2.30mm before operation and 13.29 鹵2.32mm immediately after operation, which was 8.38 鹵3.00mm higher than that before operation, and 12.94 鹵2.211mm. there was significant difference between preoperative bone height and immediate bone height. There was significant difference between preoperative and postoperative bone height of 3-6 months. There was no significant difference in bone height between 3 and 6 months after operation. The mucosal thickness was 2.38 鹵2.99mm before operation, 2.42 鹵3.15mm immediately after operation and 2.91 鹵4.06mmm. there was no significant difference in mucosal thickness between 3 and 6 months after operation. There were 8 cases of sinus mucosal perforation during operation, 3 cases of epistaxis that night, 3 cases of wound rupture at 1-2 weeks after operation, 1 case of acute maxillary sinusitis with suppurative infection 2 weeks after operation, 6 months after operation, 1 case of acute maxillary sinusitis with suppurative infection. There were 6 patients with partial resorption and 6 implants loosened or self-abscission. The average follow-up time was 16 months and the implant retention rate was 96.6B. Conclusion 1) the lateral wall fenestration of the upper collar sinus floor was implanted simultaneously, and the bone height was significantly increased immediately after operation, and the bone height could be maintained 3 to 6 months after operation without bone resorption. 2) the lateral wall fenestration of maxillary sinus floor lifting and implantation at the same time did not increase the thickness of sinus floor mucosa immediately after operation and 3 to 6 months after operation. Complications include mucosal perforation, infection, wound rupture, graft resorption, loosening and shedding of implants. To prevent and treat related complications by suturing the dehiscence and using gargle and systemic antibiotics.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R783.6

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本文編號(hào)：1608084