高寒地区264例上颌窦解剖结构与病变的CBCT影像学分析

doi:10.12439/kqhm.1005-4979.2025.04.008

摘要/Abstract

摘要：

目的：分析影响高寒地区患者上颌窦底提升术的影像学因素：上颌窦间隔、牙槽上颌窦动脉（alveolar antral artery，AAA）、囊肿及囊肿样病变等，为上颌窦底提升方案的选择提供参考依据。方法：选择2023年5月—2024年3月于我科就诊并拍摄锥形束CT（cone beam CT，CBCT）的患者132例，共纳入264侧上颌窦影像学资料。收集患者性别、上颌后牙区牙齿状态、上颌窦内黏骨膜状态、AAA、窦内间隔等信息，运用χ ²检验和logistic回归模型分析导致上颌窦内异常状态的风险因素。结果：132例患者的264侧上颌窦影像资料中，上颌后牙区牙齿状态未见异常影像者（如牙缺失、种植义齿、埋伏牙及根尖周病变等）140侧（53.0%）。264侧上颌窦中，未见异常影像学表现的为131侧（49.6%），存在异常影像或病变的为133侧（50.4%），其中上颌窦黏液潴留囊肿（mucous retention cyst, MRC）占比最大，为26.5%（70侧）；上颌后牙区检出上颌窦间隔87侧（33.0%）；影像中可显示出的牙槽上颌窦动脉为215侧（81.4%）。χ ²检验和logistic回归模型分析显示，性别和上颌后牙区牙齿状态对窦内黏骨膜状态有影响（P<0.05），上颌后牙区牙缺失、根尖周疾病及混合因素可以增加窦内黏骨膜患病风险（P<0.05）；而上颌后牙区的种植义齿与埋伏牙不会增加这种风险。结论：建议临床上行上颌窦底提升术前重点评估男性、缺牙及根尖周病变患者的上颌窦黏骨膜状态。

Abstract:

Objective: To analyze the radiological factors influencing maxillary sinus floor elevation in patients from alpine region, including maxillary sinus septa, alveolar antral artery (AAA), cysts, and cyst-like lesions, and to provide a reference for surgical planning. Methods: A total of 132 patients who underwent cone beam CT (CBCT) in our department from May 2023 to March 2024 were included, with 264 maxillary sinuses evaluated. Data on gender, posterior maxillary tooth status, maxillary sinus mucoperiosteal condition, AAA, and sinus septa were collected. Chi-square tests and logistic regression were used to identify risk factors of pathological sinus conditions. Results: Among the 264 maxillary sinuses imaging data sets from 132 patients, 140 (53.0%) showed no abnormalities in the maxillary posterior teeth region (e.g., missing teeth, dental implants, impacted teeth, or periapical lesions). A total of 131 sinuses (49.6%) exhibited normal imaging findings, while 133 (50.4%) showed abnormalities, with mucous retention cyst (MRC) being the most common (26.5%, 70 sinuses). Maxillary sinus septa were detected in 87 sinuses (33.0%), and AAA was visible in 215 (81.4%). Chi-square and logistic regression analyses revealed that gender and posterior maxillary tooth status significantly influenced mucoperiosteal pathology (P<0.05). Missing teeth, periapical diseases, and mixed factors increased the risk of sinus pathology (P<0.05), whereas dental implants and impacted teeth did not. Conclusion: Clinically, it is recommended that, the maxillary sinus mucoperiosteal condition should be prioritized for evaluation in male patients with missing teeth and periapical lesions before sinus floor elevation.

中图分类号:

王屹博, 徐冉, 栗景坤, 刘玉林. 高寒地区264例上颌窦解剖结构与病变的CBCT影像学分析[J]. 《口腔颌面外科杂志》, 2025, 35(4): 299-307.

WANG Yibo, XU Ran, LI Jingkun, LIU Yulin. A CBCT imaging analysis of maxillary sinus anatomical structure and lesions in 264 cases from alpine region[J]. 《Journal of Oral and Maxillofacial Surgery》, 2025, 35(4): 299-307.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2025/V35/I4/299

图/表 11

图1 上颌窦骨间隔分型（十字交叉线中心为兴趣点标记处） A.颊舌向走行间隔(Ⅰ型）；B.近远中走行间隔(Ⅱ型）；C.水平走向间隔(Ⅲ型）。

Figure 1 Classification of bone septal of maxillary sinus（the center of the cross hair lines is the marker of the region of interest）

图2 骨内型AAA（十字交叉线中心为兴趣点标记处） A.水平截面：可见上颌窦外侧壁内外两侧骨板，中间所夹骨管内走行即为AAA；B.血管处平行于骨壁截面，骨管清晰可见；C.垂直骨壁截面，可见点状骨管截面。

Figure 2 Intraosseous AAA（the center of the cross-hair lines is the marker of the region of interest）

图3 切迹型AAA（十字交叉线中心为兴趣点标记处） A.水平截面：仅见正常骨壁；B.血管处平行于骨壁截面，管状骨沟清晰可见；C.垂直骨壁截面，可见朝向窦腔内的切迹状骨沟截面。

Figure 3 Notch type AAA（the center of the cross-hair lines is the marker of the region of interest）

图4 上颌后牙区牙齿异常状态（十字交叉线中心为兴趣点标记处） A.根尖囊肿，相关位置同时可见黏骨膜增厚；B.窦内埋伏牙，相关位置同时可见假性囊肿。

Figure 4 Abnormal dental conditions in posterior maxilla region（the center of the cross-hair lines is the marker of the region of interest）

图5 上颌窦内黏骨膜异常影像（十字交叉线中心为兴趣点标记处） A. MRC：箭头所指的“空泡”样影像为MRC所特有的；B.假性囊肿；C.上颌窦黏骨膜轻度增厚（均匀）；D.上颌窦黏骨膜中度增厚；E.上颌窦黏骨膜重度增厚；F.上颌窦内充满中等密度影像。

Figure 5 Abnormal images of maxillary sinus mucoperiosteum（the center of the cross-hair lines is the marker of the region of interest）

表1 窦内黏骨膜状态相关资料[n(%)]

Table 1 Relevant data on the status of maxillary sinus mucoperiosteum [n(%)]

变量	窦内黏骨膜状态无异常	窦内黏骨膜状态异常	总计	χ²值	P值
牙齿状态				13.366	0.014
健康牙	82(62.6)	58(43.6)	140(53.0)
牙缺失	32(24.4)	42(31.6)	74(28.0)
根尖周病变	9(6.9)	20(15.0)	29(11.0)
种植义齿	4(3.1)	3(2.3)	7(2.7)
窦内埋伏牙	2(1.5)	2(1.5)	4(1.5)
混合因素	2(1.5)	8(6.0)	10(3.8)
性别				3.277	0.070
女	81(61.8)	67(50.4)	148(56.1)
男	50(38.2)	66(49.6)	116(43.9)
间隔				2.330	0.126
无	82(62.6)	95(71.4)	177(67.0)
有	49(37.4)	38(28.6)	87(33.0)

表2 对各项统计指标的单因素logistic回归分析

Table 2 The statistical indicators of single factor logistic regression analysis

变量	β值	SE值	Wald值	P值	比值比（95%置信区间）
牙缺失vs健康牙	0.618	0.291	4.523	0.033	1.856(1.050~3.280)
根尖周病变vs健康牙	1.145	0.437	6.878	0.009	3.142(1.335~7.392)
种植义齿vs健康牙	0.059	0.783	0.006	0.940	1.060(0.229~4.918)
窦内埋伏牙vs健康牙	0.346	1.015	0.117	0.733	1.414(0.194~10.328)
混合因素vs健康牙	1.733	0.809	4.587	0.032	5.655(1.158~27.608)
男vs女	0.467	0.250	3.500	0.061	1.596(0.978~2.604)
有间隔vs无间隔	-0.401	0.264	2.320	0.128	0.669(0.399~1.122)

表3 对有意义变量的逐步多因素logistic分析

Table 3 Stepwise multi-factor logistic regression analysis of meaningful variables

变量	β值	SE值	Wald值	P值	比值比（95%置信区间）
牙缺失vs健康牙	0.681	0.296	5.309	0.021	1.976(1.107~3.526)
根尖周病变vs健康牙	1.177	0.441	7.120	0.008	3.244(1.367~7.701)
种植义齿vs健康牙	-0.085	0.792	0.012	0.914	0.918(0.195~4.335)
窦内埋伏牙vs健康牙	0.333	1.025	0.105	0.746	1.395(0.187~10.401)
混合因素vs健康牙	1.855	0.816	5.171	0.023	6.393(1.292~31.631)
男vs女	0.578	0.261	4.908	0.027	1.782(1.069~2.971)

图6 根尖周炎的患牙拔除6个月后，原上颌窦内中度增厚的黏骨膜恢复正常（十字交叉线中心为兴趣点标记处） A.拔牙前上颌窦影像；B.拔牙后上颌窦影像。

Figure 6 The moderately thickened mucoperiosteal in the original maxillary sinus returned to normal half a year after extraction of the affected tooth with periapical inflammation（the center of the cross-hair lines is the marker of the region of interest）

图7 上颌窦侧壁开窗窦底提升种植体植入术同期摘除上颌窦MRC 术前、术后CBCT 影像（十字交叉线中心为兴趣点标记处） A.术前上颌窦内MRC；B.术后当日囊肿影像明显缩小。

Figure 7 CBCT images before and after the simultaneous removal of maxillary sinus MRC during the lateral wall fenestration of the maxillary sinus and sinus floor elevation implant（the center of the cross-hair lines is the marker of the region of interest）

图8 图7中的患者侧壁开窗窦底提升术中同期摘除MRC 右下小图：完整摘除的MRC标本。

Figure 8 MRC removed simultaneously during the lateral wall fenestration and sinus floor elevation surgery in the patient from figure 7

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