数字化聚醚醚酮囊肿塞在开窗减压术中的应用研究

doi:10.12439/kqhm.1005-4979.2024.03.003

摘要/Abstract

摘要：

目的: 评价数字化聚醚醚酮囊肿塞在颌骨囊肿开窗减压术中的治疗效果及其优缺点。方法: 选取2021—2022年于同济大学附属口腔医院收治的颌骨囊肿患者13例，均采用开窗减压术配合术后使用数字化聚醚醚酮囊肿塞治疗，通过临床检查及影像学资料，评估佩戴数字化聚醚醚酮囊肿塞对开窗减压术治疗颌骨囊肿的疗效。术后定期随访，观察囊腔缩小、新骨形成、并发症发生情况及囊肿塞佩戴满意度等。结果: 开窗手术同期拔除囊腔内埋伏牙者存在轻度张口受限、颊部肿胀等情况。问卷调查显示，除1例患者对囊肿塞外观不满意，其余各项指标均达到可接受或满意。术后3、6、9、12个月测得的新骨沉积率分别为71.03% (59.37%，82.84%)、82.75% (77.25%，88.66%)、89.93% (86.41%，95.08%)和94.21% (90.21%，95.09%)；术后3、6、9、12个月测得的囊腔缩小率分别为96.91% (92.47%，98.65%)、100% (98.36%，100%)、100% (99.79%，100%)和100% (100%，100%)。结论: 数字化聚醚醚酮囊肿塞凭借其独特的材料优势和设计优势，在开窗减压术的应用中取得了良好的治疗效果，患者佩戴满意度高，值得进一步推广。

关键词: 颌骨囊肿, 开窗减压术, 聚醚醚酮, 囊肿塞, 数字化技术

Abstract:

Objective: To evaluate the therapeutic effect, advantages, and disadvantages of digital polyetheretherketone cyst plug in fenestration decompression of jaw cyst. Methods: A total of thirteen patients with jaw cyst who underwent surgery in Tongji University Stomatological Hospital from 2021 to 2022 were treated with fenestration decompression and digital polyetheretherketone cyst plug after operation. Through clinical examination and imaging data, the effect of digital polyetheretherketone cyst plug was evaluated. Postoperative follow-up was conducted regularly to observe the shrinkage of cyst cavity, the formation of new bone, the occurrence of complications and the wearing satisfaction of cyst plug. Results: In some cases, mild mouth opening restriction and cheek swelling appeared in those who pulled out the impacted teeth in the capsule cavity at the same time of fenestration. Questionnaire survey showed that all indexes were acceptable or satisfactory except one patient who was dissatisfied with the appearance of cyst plug. The new bone deposition rates measured in 3, 6, 9, 12 months after operation were 71.03% (59.37%, 82.84%), 82.75% (77.25%, 88.66%), 89.93% (86.41%, 95.08%), and 94.21% (90.21%, 95.09%) respectively. The reduction rates of cysts measured in 3, 6, 9, 12 months after operation were 96.91% (92.47%, 98.65%), 100% (98.36%, 100%), 100% (99.79%, 100%), and 100% (100%, 100%) respectively. Conclusion: Digital polyetheretherketone cyst plug, with its unique material advantages and design advantages, has achieved good therapeutic effect in the application of fenestration decompression, and patients' wearing satisfaction is high, which is worthy of further promotion.

Key words: jaw cyst, fenestration decompression, polyetheretherketone, cyst plug, digital technology

中图分类号:

R782

杨丽, 李功臣, 康非吾, 张雪明. 数字化聚醚醚酮囊肿塞在开窗减压术中的应用研究[J]. 《口腔颌面外科杂志》, 2024, 34(3): 180-186.

YANG Li, LI Gongchen, KANG Feiwu, ZHANG Xueming. Digital polyetheretherketone cyst plug in fenestration decompression: An applied research[J]. 《Journal of Oral and Maxillofacial Surgery》, 2024, 34(3): 180-186.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2024/V34/I3/180

图/表 9

图1 囊肿塞设计图片 A.囊肿塞正面观；B.囊肿塞面观；C.上下牙列咬合，检查有无咬合干扰；D.拟合下牙列与下颌骨，检查囊肿塞与囊腔有无干扰；E.聚醚醚酮材料（PEEK本色圆盘）；F.数控铣削机整体切削PEEK本色圆盘；G.数字化聚醚醚酮囊肿塞。

Figure 1 Design pictures of cyst plug

图2 手术过程 A.术前口内照片；B.暴露囊肿周围骨壁；C.超声骨刀去骨，暴露囊壁；D.切取囊壁组织送冷冻病理检查；E.暴露埋伏牙；F.拔除埋伏牙；G.暴露囊腔；H.戴入数字化聚醚醚酮囊肿塞。

Figure 2 Surgical procedures

图3 利用mimics 21.0软件计算囊腔体积 A.手动描记冠状面每层切片中的囊腔；B.手动描记水平面每层切片中的囊腔；C.手动描记矢状面每层切片中的囊腔。

Figure 3 Volume of capsule cavity calculation with mimics 21.0 software

图4 新骨沉积率与囊腔缩小率的测算 A.绿圈内包含新生纤维结缔组织及囊腔；B.红圈内为实际囊腔。

Figure 4 Calculation of new bone deposition rate and capsule cavity reduction rate

表1 患者对囊肿塞的满意度

Table 1 Satisfaction degree of patients with the cyst plug

指标	满意	可接受	不满意	满意率/%
饮食	8	5	0	61.54
语言	12	1	0	92.31
外观	7	5	1	53.85
恶心度	13	0	0	100
固位力	8	5	0	61.54
舒适度	9	4	0	69.23
清洁度	8	5	0	61.54
抗折性	13	0	0	100
摘戴	7	6	0	53.85

图5 开窗减压术后囊腔缩小率和新骨沉积率的折线图示

Figure 5 The broken line diagram of capsule cavity reduction rate and new bone deposition rate after fenestration decompression

表2 开窗减压术后囊腔缩小率及新骨沉积率

Table 2 Capsule cavity reduction rate and new bone deposition rate after fenestration decompression

项目	术后3个月(n=8)	术后6个月(n=13)	术后9个月(n=6)	术后12个月(n=5)
新骨沉积率/%	71.03(59.37,82.84)	82.75(77.25,88.66)	89.93(86.41,95.08)	94.21(90.21,95.09)
囊腔缩小率/%	96.91(92.47,98.65)	100(98.36,100)	100(99.79,100)	100(100,100)

图6 开窗减压术及囊肿塞戴入过程 A.术前口内照片；B.超声骨刀去骨，拔除埋伏牙；C.戴入数字化聚醚醚酮囊肿塞；D数字化聚醚醚酮囊肿塞；E.数字化聚醚醚酮囊肿塞在模型上试戴。

Figure 6 Fenestration decompression and insertion of cyst plug

图7 开窗减压术后的影像学变化 A.术前CBCT；B.术后3个月CBCT；C.术后6个月CBCT。

Figure 7 Imaging changes after fenestration decompression

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