上牙槽后动脉与上颌窦底、牙槽嵴位置关系的解剖学研究

目的 探讨上牙槽后动脉(PSAA)与上颌窦底、牙槽嵴顶的位置关系,为上颌窦底提升术等临床口腔外科相关手术提供解剖学依据。方法 2015年6—12月,对10%甲醛溶液固定的10侧成人头颅湿标本的PSAA进行解剖,观察PSAA的走行特点。分别以上颌窦底、牙槽嵴顶为参照面分为上颌窦底组、牙槽嵴顶组,以上颌第二、第一磨牙和上颌第二、第一前磨牙为标志点,分别测量PSAA与上颌窦底、牙槽嵴顶的距离。结果 PSAA由上颌动脉进入翼腭窝前发出,沿上颌骨体颞下面下行,发出分支与上牙槽后神经伴行进入牙槽孔;继而在上颌体内或上颌窦黏膜外经过上颌第二磨牙、上颌第一磨牙、上颌第二前磨牙、上颌第一前磨牙的根尖上方呈弓形向前上内走行,并发出分支止于上颌磨牙及前磨牙牙槽突颊侧牙根和黏膜。PSAA在上颌第二磨牙、上颌第一磨牙、上颌第二前磨牙、上颌第一前磨牙处与牙槽嵴顶的平均距离逐渐加大,分别为(15.57±0.53) mm、(16.07±0.30) mm、(18.96±0.43) mm、(21.27±0.61) mm,与上颌窦底的平均距离逐渐加大,分别为(6.68±0.26)mm、(7.26±0.34) mm、(8.54±0.45) mm、(9.81±0.43) mm,差异均有统计学意义(P值均＜0.05)。结论 PSAA在由上颌第二磨牙向上颌第一前磨牙的走行过程中,与上颌窦底和牙槽嵴顶的距离均在上颌第二磨牙处最短,与上颌第一磨牙、上颌第二前磨牙、上颌第一前磨牙的距离逐渐加大,准确测量PSAA在不同标志点与上颌窦底、牙槽嵴顶间的距离,为临床口腔外科相关手术提供可靠的解剖学依据,有助于减少术中PSAA的损伤。

Study on the relationships between the posterior superior alveolar artery and maxillary sinus floor,alveolar ridge by exquisitely dissection

Objective To provide anatomical basis for maxillary sinus floor elevation and other clinical oral surgery by discussing the anatomical relationships between the posterior superior alveolar artery(PSAA) and maxillary sinus floor, and the relationships between the PSAA and alveolar ridge.Methods Ten sides of wet skull specimens fixed by 10% formaldehyde were exquisitely dissected from June 2015 to December 2015.The locations and anatomical relationships of the PSAA and maxillary sinus, alveolar ridge were studied respectively. The group of alveolar ridge and the group of maxillary sinus floor were set up. The maxillary second molar area, maxillary first molar area, maxillary second premolar area and maxillary first premolar area were selected as the positions of measurement in every group. The measured data were statistically processed with SPSS19.0 statistic software.Results PSAA arised from maxillary artery in the pterygopalatine fossa. It ran down the temporal side of maxilla body before entering the alveolar foramen with posterior superior alveolar nerve. Then in maxilla body or the wall of maxillary sinus, it passed through maxillary second molar, maxillary first molars, maxillary second premolars and maxillary first premolar root above like a converse arch and branched into in the buccal root and mucosa of the maxillary molars and premolars. In the group of alveolar ridge, in maxillary second molar area, maxillary first molar area, maxillary second premolar area and maxillary first premolar area, the mean distances from the PSAA to the alveolar ridge were(15.57±0.53) mm, (16.07±0.30) mm, (18.96±0.43) mm, (21.27±0.61) mm, respectively. In the group of maxillary sinus floor, in maxillary second molar area,maxillary first molar area,maxillary second premolar area and maxillary first premolar area, the mean distances from the PSAA to the maxillary sinus floor were(6.68±0.26)mm, (7.26±0.34) mm, (8.54±0.45) mm, (9.81±0.43) mm, respectively. The distance was gradually increasing. The differences were statistically significant(all P values<0.05).Conclusions In the process of the maxillary second molar to the maxillary first premolar, the PSAA has the shortest distance from maxillary sinus floor and alveolar crest, and increases the distance between maxillary second molar, maxillary first molar, maxillary second premolar and maxillary first premolar. The mean distances of PSAA to the maxillary sinus and alveolar crest in different landmarks are accurately measured, respectively. The data provide reliable anatomical basis for clinical operation and will be helpful to decrease the injury of PSAA in clinical oral surgery.