锥形束计算机断层扫描评估上颌后牙区施耐德膜增厚与根尖周病变的相关性分析

doi:10.7518/hxkq.2024.2024164

摘要/Abstract

摘要：

目的评估患者上颌窦内衬黏膜上皮，即施耐德膜（SM）增厚的情况及其与上颌后牙区根尖周病变（PAL）的关系，以期为牙源性上颌窦炎的预防和治疗提供参考。方法回顾性分析符合纳入标准的301例患者554个上颌窦的锥形束计算机断层扫描（CBCT）影像学资料，以确定上颌后牙PAL与SM增厚的相关性。记录病理性黏膜增厚的病例数，并根据SM增厚的程度与类型进行分类。评估SM增厚与PAL的直径，PAL上缘与上颌窦底的波及关系及有PAL的患牙是否进行根管治疗之间的相关性。结果在上颌后牙区，当患者出现PAL时，SM增厚的检出率高于无PAL，并且PAL与SM增厚之间具有相关性。PAL各项检测指标与SM增厚程度相关性分析结果显示，CBCT根尖周指数（CBCT-PAI）PAL直径与SM增厚程度呈现正相关性，而PAL上缘与上颌窦底的3种不同波及关系、有PAL的患牙是否进行根管治疗与SM增厚程度不具有相关性。PAL各项检测指标与SM增厚类型相关性分析结果显示，有PAL的患牙是否进行根管治疗与SM增厚类型之间具有相关性，而PAL直径和PAL上缘与上颌窦底的3种不同波及关系与SM增厚类型不具有相关性。结论上颌后牙PAL与SM增厚密切相关，PAL直径与SM增厚程度呈正相关；有PAL且进行过根管治疗的患牙常见出现SM息肉型增厚，PAL上缘与上颌窦底的波及关系不影响SM的发展。

关键词: 施耐德膜增厚, 根尖周病变, 锥形束计算机断层扫描

Abstract:

Objective This study aimed to evaluate the thickening of sinus membrane, which is also named Schneiderian membrane (SM), in patients and its relationship with periapical lesions (PAL) in the posterior maxillary region to provide reference for the prevention and treatment of odontogenic maxillary sinusitis. Methods A retrospective analysis was conducted on 554 cone beam computed tomography (CBCT) imaging data of maxillary sinuses from 301 patients who met the inclusion criteria to determine the correlation between PAL and SM thickening in the posterior maxillary region. Cases of pathological SM were recorded and classified on the basis of the degree and type of SM thickening. The correlation between SM thickening and the diameter of PAL, the relationship between the upper edge of PAL and the maxillary sinus floor, and its relationship with whether affected teeth with PAL undergo root canal treatment were evaluated. Results The detection rate of SM thickening in patients with PAL was significantly higher than in those without PAL, so PAL was correlated with SM thickening. Analysis on the correlation between PAL detection indicators and SM thickening degree showed that SM thickening degree was positively correlated with PAL diameter (cone beam computed tomography-periapical index) and not correlated with the three spread effects between the upper edge of PAL and the maxillary sinus floor, as well as whether the teeth with PAL undergo root canal treatment. The correlation analysis between PAL detection indicators and SM thickening types showed that whether the teeth with PAL undergo root canal treatment was not correlated with SM thickening types, and the diameter of PAL, the three spread effects between the upper edge of PAL, and the maxillary sinus floor were not correlated with SM thickening types. Conclusion The PAL of posterior maxillary teeth is closely related to SM thickening, and the diameter of PAL is positively correlated with the degree of SM thickening. Patients with PAL who have undergone root canal treatment often exhibit SM polyp thickening. In addition, the relationship between the upper edge of PAL and the maxillary sinus floor does not affect the possibility of SM development.

Key words: Schneiderian membrane thickening, periapical lesions, cone beam computed tomography

中图分类号:

R781.34

冯博, 李凤翔, 杜启涛. 锥形束计算机断层扫描评估上颌后牙区施耐德膜增厚与根尖周病变的相关性分析[J]. 华西口腔医学杂志, 2024, 42(5): 644-651.

Feng Bo, Li Fengxiang, Du Qitao. Analysis on the relationship between Schneiderian membrane thickening in the posterior maxillary region and periapical lesions by cone beam computed tomography[J]. West China Journal of Stomatology, 2024, 42(5): 644-651.

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有无PAL	有无SM增厚/n（%）		合计	χ²值	P值
有无PAL	无增厚	有增厚	合计	χ²值	P值
无PAL	237（70.5）	99（29.5）	336	7.606	0.000
有PAL	86（39.4）	132（60.6）	218	7.606	0.000
合计	323	231	554

各项检测指标		SM增厚程度/n				卡方检验/Fisher 确切概率法		Spearman 相关分析
各项检测指标		轻度	中度	重度	合计	χ²值	P值	r值	P值
CBCT-PAI分级	1	5	0	2	7	/	0.000	0.470	0.000
	2	22	1	1	24
	3	38	14	5	57
	4	9	25	10	44
PAL上缘与上颌窦底之间的波及关系	OS型	18	5	0	23	/	0.110	/	/
	CO型	39	24	12	75
	IS型	17	11	6	34
有PAL的患牙是否进行根管治疗	未经根管治疗的PAL	43	14	10	67	5.739	0.057	/	/
有PAL的患牙是否进行根管治疗	根管治疗后的PAL	31	26	8	65	5.739	0.057	/	/