上颌窦的CT三维重建及其临床意义

目的 为上颌牙种植术等临床口腔外科提供解剖学基础。方法 选取全牙志愿者20名,在螺旋CT机以眦耳线（CML）为基线连续扫描,采用ADW 4.2重建软件的曲面重组技术（CPR）重建上颌窦,观察上颌窦的位置、形态和测量上颌窦下壁至上颌后牙牙根的距离。在Amira 3D重建软件下重建上颌骨及上颌窦的可视化模型,观察半透明上颌骨内上颌窦的位置及其与上颌牙根的关系。结果 上颌窦系一呈三边形或四边形的锥形腔隙,其下壁常有凸起的骨隔。半透明上颌骨可视化模型内的上颌窦可清晰显示其位置、形态及其与上颌牙根的关系。上颌窦下壁至上颌后牙牙根的距离以第一磨牙最近,由近及远依次为第一磨牙、第二磨牙、第三磨牙、第二前磨牙和第一前磨牙。上颌窦下壁至左右侧第一前磨牙、第二前磨牙、第一磨牙、第二磨牙、第三磨牙牙根尖的最短距离分别为（9.58±1.13） mm和（9.64±1.15） mm、（4.54±0.92） mm和（4.60±0.90） mm、（2.13±0.50） mm和（2.21±0.53） mm、（2.19±0.65） mm和（2.27±0.65） mm、（3.94±1.14） mm。结论 上颌窦的3D重建,对指导临床选择适宜长度的牙种植体、避免牙种植体误入上颌窦等并发症具有重要的临床意义。

Three-dimensional reconstruction of the maxillary sinus and its clinical significance

Objective To provide anatomical basis for the maxillary dental implant operation of the clinical oral surgery. Methods Twenty volunteers with teeth were selected and scanned in series by spiral CT from the canthomeatal line（CML）, the maxillary sinus was reconstructed by the curve-planar reconstruction（CPR） under the ADW 4.2 reconstruction software. The position and shape of maxillary sinus were observed, and the distance from the inferior wall of maxillary sinus to the dental root of maxillary posterior teeth was measured. The visual model of maxilla and maxillary sinus were reconstructed by the Amira 3D reconstruction software, the position of maxillary sinus in the semi-diaphanous maxilla and the relationship of the dental root of maxillary teeth with it were observed. Results It showed triangular or quadrilateral cone-shaped space of the maxillary sinus, the processes of bony septum were often appeared on the inferior wall of maxillary sinus. The visual model of maxillary sinus in the semi-diaphanous maxilla could clearly display its position, shape and the relationship of the dental root of maxillary teeth with it. The distance from the inferior wall of maxillary sinus to the dental root of first molar was nearer than the others, it was the first molar, second molar, third molar, second premolar and first premolar from near and far. The nearest distance from the inferior wall of maxillary sinus to the dental root of first premolar, second premolar, first molar, second molar, third molar were （9.58±1.13） mm（left） and （9.64±1.15） mm（right）, （4.54±0.92） mm（left） and （4.60±0.90） mm（right）, （2.13±0.50） mm（left） and （2.21±0.53） mm（right）, （2.19±0.65） mm（left） and （2.27±0.65） mm（right）, （3.94±1.14） mm respectively. Conclusions It has an important clinical significance for choosing appropriate length of dental implantation and avoiding dental implantation to pierce into the maxillary sinus of the three-dimensional reconstruction of maxillary sinus.