【摘要】：目的:上頜竇穿孔是牙槽外科常見并發(fā)癥,若穿孔不能得到及時(shí)有效治療可導(dǎo)致上頜竇感染。傳統(tǒng)皮瓣轉(zhuǎn)移修復(fù)上頜竇穿孔治療方案易給患者帶來二次創(chuàng)傷。濃縮生長(zhǎng)因子(concentrate growth factor,CGF)富含濃縮纖維蛋白和血小板,在組織缺損修復(fù)和再生中能夠起到促進(jìn)作用。本課題對(duì)濃縮生長(zhǎng)因子與皮瓣轉(zhuǎn)移技術(shù)在修補(bǔ)上頜竇穿孔的病例進(jìn)行回顧性研究,評(píng)價(jià)濃縮生長(zhǎng)因子修復(fù)上頜竇穿孔臨床效果,為上頜竇穿孔修復(fù)提供最優(yōu)臨床治療方案。方法:回顧性分析2006年12月至2016年1月山東省立醫(yī)院口腔頜面外科上頜竇穿孔修復(fù)患者(門診及住院患者),采用CGF進(jìn)行上頜竇穿孔修補(bǔ)的15例患者(CGF組),其中上頜后牙根尖病變致上頜竇底骨質(zhì)缺如5例,拔牙術(shù)后上頜竇穿孔10例;采用皮瓣轉(zhuǎn)移技術(shù)(頰側(cè)黏骨膜瓣滑行術(shù)、腭側(cè)黏骨膜瓣轉(zhuǎn)移術(shù)和頰脂墊移植術(shù)等)進(jìn)行上頜竇穿孔修補(bǔ)術(shù)患者15例作為研究對(duì)照組(皮瓣轉(zhuǎn)移組),其中上頜后牙根尖病變致上頜竇底骨質(zhì)缺如6例,拔牙術(shù)后上頜竇穿孔9例。比較兩組(1)手術(shù)區(qū)域牙齦有無腫脹、感染,牙齦色澤是否正常,檢查有無瘺道形成。(2)數(shù)字化根尖片(或曲面斷層片)檢查牙槽骨愈合情況,拔牙窩洞內(nèi)是否有連續(xù)性陰影。(3)術(shù)后是否適合可摘活動(dòng)義齒、固定橋或種植修復(fù)治療,評(píng)價(jià)修補(bǔ)效果。(4)采用SPSS20.0統(tǒng)計(jì)軟件包對(duì)數(shù)據(jù)進(jìn)行處理,計(jì)數(shù)資料采用X2檢驗(yàn),P值小于0.05為差異有顯著性意義。結(jié)果:本研究中15例CGF組上頜竇穿孔修補(bǔ)術(shù)后隨訪無不適癥狀,未出現(xiàn)感染及瘺道,術(shù)后3個(gè)月牙齦色澤正常,竇底新骨形成,牙槽窩骨愈合,術(shù)區(qū)及上頜竇無不適和炎癥,術(shù)后3-6月無需二次手術(shù)即可行義齒修復(fù)治療。15例皮瓣轉(zhuǎn)移組上頜竇穿孔修補(bǔ)術(shù)后隨訪3例患者術(shù)后出現(xiàn)術(shù)區(qū)腫脹不適,1例出現(xiàn)術(shù)后感染,術(shù)后3個(gè)月15例患者術(shù)區(qū)牙齦色澤正常,竇底新骨形成,牙槽窩骨愈合,無瘺道,術(shù)區(qū)及上頜竇無不適和炎癥,術(shù)后3-6月2例患者需行前庭溝底加深術(shù)方可行義齒修復(fù)治療。CGF組和皮瓣轉(zhuǎn)移組在術(shù)后腫脹、感染、瘺道及術(shù)后二次手術(shù)等方面尚不能認(rèn)為兩組處理有差異(P0.05)。結(jié)論:CGF對(duì)上頜竇穿孔的修補(bǔ)效果同傳統(tǒng)皮瓣轉(zhuǎn)移技術(shù)相比無明顯差異性,術(shù)后均能夠形成正常的軟硬組織,但利用CGF對(duì)上頜竇穿孔進(jìn)行修補(bǔ)可以減少術(shù)后不良反應(yīng),臨床應(yīng)用效果良好,值得臨床應(yīng)用開展。
[Abstract]:Objective: maxillary sinus perforation is a common complication in alveolar surgery. The treatment of maxillary sinus perforation by traditional flap transfer is easy to bring secondary trauma to patients. Concentrated growth factor (concentrate growth factor,CGF) is rich in fibrin and platelets and can promote tissue defect repair and regeneration. In this paper, we retrospectively studied the effects of concentrated growth factor and flap transfer in repairing maxillary sinus perforation, and evaluated the clinical effect of concentrated growth factor in repairing maxillary sinus perforation, which provided the best clinical treatment for maxillary sinus perforation. Methods: from December 2006 to January 2016, 15 patients (CGF group) with maxillofacial sinus perforation repair in Shandong Provincial Hospital were analyzed retrospectively. CGF was used to repair maxillary sinus perforation. Among them, 5 cases suffered from maxillary sinus floor bone deficiency caused by root tip lesion of maxillary posterior teeth, and 10 cases had maxillary sinus perforation after extraction of teeth. Fifteen patients with maxillary sinus perforation were treated with flap transfer (buccal mucoperiosteal flap sliding, palatal mucoperiosteal flap transfer and buccal fat pad transplantation) as the control group (flap transfer group). 6 cases of maxillary sinus floor bone defect caused by maxillary posterior tooth root tip lesion, 9 cases of maxillary sinus perforation after extraction of teeth. The results were as follows: (1) gingival swelling, infection, normal gingival color and fistula formation were compared between the two groups. (2) Digital apical films (or curved tomograms) were used to examine alveolar bone healing. (3) whether it is suitable for removable denture, fixed bridge or implant repair after operation, and evaluate the effect of repair. (4) the data were processed by SPSS20.0 statistical software package. The count data were tested by X _ 2, P < 0.05 was significant difference. Results: in the CGF group, 15 patients with maxillary sinus perforation were followed up with no symptoms, no infection or fistula, normal gingival color, new bone formation in the sinus floor, alveolar fossa bone healing, no discomfort and inflammation in the area of operation and maxillary sinus. In 15 cases of flap transfer group, 3 cases of maxillary sinus perforation and repair of maxillary sinus were followed up with swelling and discomfort of operation area, 1 case with postoperative infection, 3 cases with maxillary sinus perforation repair, 3 cases with maxillary sinus perforation repair and 1 case with postoperative infection. Three months after operation, 15 patients had normal gingival color, new bone formation at the sinus floor, alveolar fossa bone healing, no fistula, no discomfort and inflammation in the operation area and maxillary sinus. From 3 to 6 months after operation, 2 patients needed to perform vestibular furrow deepening to repair the denture. The CGF group and the flap transfer group could not be considered as having any difference in terms of postoperative swelling, infection, fistula and secondary operation (P0.05). Conclusion: the effect of CGF in repairing maxillary sinus perforation is not significantly different from that of traditional flap transfer technique, and normal soft and hard tissue can be formed after operation. However, repairing maxillary sinus perforation with CGF can reduce the adverse reaction after operation. The effect of clinical application is good and worthy of clinical application.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R782

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