这项研究的目的是比较各种方法用于上颌窦前壁的骨重建在鼻窦提升手术中;此外,我们旨在研究上颌窦膜穿孔对愈合过程的影响。
使用北高加索绵羊进行实验。在全身麻醉下对动物进行上颌窦提升手术。将皮肤和肌肉筋膜逐层解剖,为骨骼准备提供最佳条件;然后,在头部的每一侧制作了三个骨窗。用球形车锯了两个窗户,第三个窗口-有一个空心的bur和前壁的一部分被取出。在一边,上颌窦的粘膜被拉动并穿孔;在另一侧,在无膜穿孔的情况下进行了鼻窦提升。在每一边,一扇窗户被揭开,第二个用胶原蛋白膜封闭,第三个用骨头盖封闭。30天和60天后,将绵羊分为三组,从实验中取出;从手术区域收集样品,并使用计算机显微断层扫描和组织学检查。
根据组织学研究,骨修复过程正常发展,无论手术技术。该过程始于肉芽组织和结缔组织索的出现;在最后阶段,细胞分化,明显的成骨细胞活动,并且看到了波束间的形成。在用胶原膜封闭骨缺损的区域观察到最活跃的再生,尤其是在没有上颌窦膜穿孔的窗口中。显微层析成像和组织学测试证明,在鼻窦提升手术中粘膜穿孔会损害骨组织的再生。
获得的结果表明,闭合上颌窦前壁骨缺损的最有希望的方法是使用胶原蛋白膜;因此,我们建议选择这种方法进行鼻窦提升手术。
The aim of the
study was to compare various methods used for the bone reconstruction in the anterior wall of the maxillary sinus during sinus lift surgery; in addition, we aimed to
study the effect of maxillary sinus membrane perforation on the healing process.
The experiments were carried out using the North Caucasian sheep. Maxillary sinus lift surgery was performed on the animals under general anesthesia. The skin and muscle fascia were dissected layer-by-layer providing the optimal conditions for bone preparation; then, three bone windows were made on each side of the head. Two windows were sawn out with a spherical bur, the third window - with a hollow bur and part of the anterior wall was taken out. On one side, the mucous membrane of the maxillary sinus was pulled and perforated; on the other side, the sinus lift was performed with no membrane perforation. On each side, one window was left uncovered, the second was closed with a collagen membrane, and the third was closed with a bone cover. After 30 and 60 days, the sheep were taken out of the experiment in groups of three; samples were collected from the operated areas and examined using computed microtomography and histology.
According to the histological
study, the bone repair process developed normally regardless of the surgery technique. The process started with the appearance of granulation tissue and connective tissue cords; in the final stages, cellular differentiation, pronounced osteoblastic activity, and inter-beam formation were seen.The most active regeneration was observed in the areas where the bone defects were closed with a collagen membrane, and especially in the windows made with no perforation of the maxillary sinus membrane. The microtomographic and histological tests proved that perforation of the mucous membrane during the sinus lift operation impaired bone tissue regeneration.
The obtained results suggest that the most promising way to close a bone defect in the anterior wall of the maxillary sinus is the use of a collagen membrane; therefore, we recommend choosing this approach for sinus lift surgery.