微创侧壁开窗与传统侧壁开窗上颌窦底提升术临床效果评价

Clinical Effect Evaluation of Minimally Invasive Lateral Window and Traditional Lateral Window Technique Maxillary Sinus Floor Lifting

摘要: 目的：探讨微创侧壁开窗上颌窦底提升术与传统侧壁开窗上颌窦底提升术的临床应用效果。方法：选取2023年4月至2024年7月于我院就诊的26例上颌后牙区剩余骨量严重不足的患者作为研究对象。将纳入的病例随机分为两组，试验组行微创侧壁开窗上颌窦底提升术，对照组则行传统侧壁开窗上颌窦底提升术。分别记录两种术式的具体操作时长及上颌窦黏膜穿孔情况，并通过视觉模拟量表和测量面部表面距离来评估患者术后疼痛和肿胀程度。于术后即刻以及术后6月拍摄CBCT，通过三维重建技术对上颌窦内新增骨高度和骨移植材料体积进行测量。结果：试验组术中翻瓣和骨窗预备的用时均少于对照组，而试验组在剥离上颌窦底黏膜及填充骨粉时所耗时间长于对照组，差异均具有统计学意义(P < 0.05)，但两组患者的手术总用时无明显差异(P > 0.05)；术中两组患者均未出现上颌窦黏膜穿孔；在术后前3天的随访中，试验组患者的肿胀程度均显著轻于对照组，差异均具有统计学意义(P < 0.05)；在术后1至7天的随访中，试验组患者的疼痛评分均显著低于对照组，差异均具有统计学意义(P < 0.05)；在术后即刻和术后6月时，两组患者的上颌窦内新增骨高度及骨移植材料体积均无显著差异(P > 0.05)。结论：相较于传统侧壁开窗术式，微创开窗术式并未增加上颌窦膜穿孔的风险，缩短了术中翻瓣及骨窗预备的用时，改善术后反应，且能实现不错的骨增量效果。在本研究的局限性内，可认为微创开窗术式是一种有效且创伤较小的骨增量方法。

Abstract: Objective: To investigate the clinical effects of minimally invasive lateral fenestration maxillary sinus floor lifting and traditional lateral fenestration maxillary sinus floor lifting. Methods: A total of 26 patients with severe bone deficiency in the maxillary posterior dental region who were treated in our hospital from April 2023 to July 2024 were selected as the study objects. The patients were randomly divided into two groups: the experimental group received minimally invasive lateral fenestration and the control group received traditional lateral fenestration. The length of operation and the perforation of maxillary sinus mucosa were recorded respectively, and the degree of postoperative pain and swelling was evaluated by visual analog scale and facial surface distance measurement. CBCT was taken immediately after surgery and 6 months after surgery, and the height of new bone and the volume of bone graft material in maxillary sinus were measured by three dimensional reconstruction technique. Results: The experimental group exhibited shorter durations for flap dissection and bone window preparation compared to the control group. However, the experimental group required more time for maxillary sinus mucosa dissection and bone graft material placement, with statistically significant differences observed between the groups (P < 0.05). Notably, no significant difference was found in the overall surgical duration between the two groups (P > 0.05). No maxillary sinus mucosa perforation occurred in both groups during operation. In the first 3 days of postoperative follow-up, the swelling degree of experimental group was significantly less than that of control group, with statistical significance (P < 0.05). In the follow-up from 1 to 7 days after surgery, the pain scores of experimental groups were significantly lower than those of control group, with statistical significance (P < 0.05). There were no significant differences in the height of new bone and the volume of bone graft material in maxillary sinus between the two groups immediately after surgery and 6 months after surgery (P > 0.05). Conclusion: Compared with the traditional lateral window technique, the minimally invasive lateral window technique does not increase the risk of maxillary sinus membrane perforation, shortens the time for flap dissection and bone window preparation during the operation, improves postoperative reactions, and achieves a good bone augmentation effect. Within the limitations of this study, it can be considered that the minimally invasive lateral window technique is an effective and less-invasive method for bone augmentation.