上颌窦动脉解剖结构的锥形术计算机断层扫描分析

doi:10.3969/j.issn.1674-8115.2023.02.009

摘要/Abstract

摘要：

目的·通过锥形术计算机断层扫描（cone-beam CT，CBCT）测量分析上颌窦动脉解剖结构。方法·对1 021例因牙列缺损或缺失至上海交通大学医学院附属瑞金医院行种植手术患者的双侧上颌窦中的上颌窦动脉（maxillary sinus artery，MSA）进行观测。在CBCT骨窗视图，测量第二前磨牙（P2）、第一磨牙（M1）、第二磨牙（M2）牙位中线处MSA骨孔与骨壁间的位置关系，并将其走形类型分为窦内型（位于上颌窦黏膜下方）、骨内型（完全位于上颌窦侧壁内）、表浅型（位于上颌窦外侧壁骨膜下方）3类；测量MSA骨孔直径（diameter of the MSA，DMSA）、MSA骨孔下缘至上颌窦底距离（distance between the lower margin of the vessel and the sinus floor，DVSF）；测量M1牙位中线处上颌窦底上方5 mm处的上颌窦侧壁厚度及上颌窦宽度；测量上颌窦底上方10 mm处上颌窦内外侧壁与上颌窦底最低点形成的角度，即上颌窦角度。对不同性别、不同年龄患者的MSA走形位置变异、走形类型、DMSA和DVSF的差异进行统计分析。同时分别对MSA的DMSA及DVSF与上颌窦侧壁厚度、上颌窦宽度、上颌窦角度之间的相关性进行统计分析。结果·① MSA走形位置变异：在1 021例患者中，共42例（4.1%）患者的MSA走形于上颌窦侧壁、紧贴上颌窦底部，其中14例（33.3%）为双侧MSA，28例（66.7%）为单侧MSA；7例（0.7%）患者的MSA走形于上颌窦底根方牙槽骨内，其中1例（14.3%）为双侧MSA，6例（85.7%）为单侧MSA。② MSA走形类型：窦内型占36.5%，骨内型占60.4%，表浅型占3.1%。中年患者中骨内型检出率（63.0%）高于青年和老年患者（P=0.005）。③ DMSA：M1牙位的DMSA最大，为（1.42±0.44）mm。男性在P2、M1、M2牙位的DMSA均大于女性。在P2、M1牙位均发现上颌窦侧壁厚度与DMSA呈弱正相关（r=0.2，r=0.2）。在M1牙位发现上颌窦宽度、上颌窦角度均与DMSA呈弱负相关（r=-0.1，r=-0.2）。④ DVSF：自M2至P2方向，DVSF逐渐降低。男性在P2、M2牙位的DVSF均大于女性。在M1牙位发现上颌窦侧壁厚度、上颌窦宽度均与DVSF呈弱负相关（r=-0.3，r=-0.1）。结论·MSA走形位置变异可发生于上颌窦底及上颌窦底根方的牙槽骨中。随着患者年龄增大，MSA走形类型由窦内型向骨内型转变。男性患者的DMSA较女性更大，动脉出血风险更大；在较厚的上颌窦侧壁中能观测到较大的DMSA，而当上颌窦宽度和角度越大时，DMSA越小。男性患者的DVSF较女性更大，当上颌窦侧壁越厚或当上颌窦宽度越大时，DVSF越小。

关键词: 上颌窦动脉, 锥形术计算机断层扫描, 上颌窦底提升术, 解剖变异

Abstract:

Objective ·To analyze the anatomical structural characteristics of maxillary sinus artery (MSA) by cone-beam CT (CBCT) measurement. Methods ·The MSAs in the bilateral maxillary sinuses were observed in 1 021 patients who went to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, for implant surgery due to dentition defect or loss. In the CBCT bone window view, the position between the MSA foramen and the bone wall at the midline of the second premolar (P2), the first molar (M1), and the second molar (M2) was measured, and the intrasinus (the artery was located below the mucosa of maxillary sinus), intraosseous (the artery was completely located in the lateral wall of maxillary sinus), and superficial (the artery was located below the periost of the lateral wall of maxillary sinus) types of their location were classified. The distance between the upper and lower edges of the MSA foramen was measured as the diameter of the artery (DMSA). The distance between the lower margin of the vessel and the sinus floor (DVSF) was measured. The lateral wall thickness of maxillary sinus and the width of maxillary sinus at 5 mm above the maxillary sinus floor at the middle line of the M1 tooth position were measured, and the angle formed by the internal and external side walls of maxillary sinus at 10 mm above the lowest point of maxillary sinus floor was measured. The differences of variability of MSA position, MSA shape type, DMSA and DVSF in patients of different genders and ages were statistically analyzed. At the same time, the correlation between DMSA and DVSF of MSA and the lateral wall thickness, width and angle of maxillary sinus were statistically analyzed. Results ·① Variability of MSA position: In the 1 021 patients, 42 patients (4.1%) had MSA located at the lateral wall of the maxillary sinus and close to the maxillary sinus floor, of which 14 patients (33.3%) had bilateral MSA, and 28 patients (66.7%) had unilateral MSA. Seven patients (0.7%) had MSA located in the alveolar bone below the maxillary sinus floor, of which 1 case (14.3%) had MSA located in the alveolar bone bilaterally, and 6 cases (85.7%) had MSA located in the alveolar bone unilaterally. ② MSA shape type: The intrasinus type accounted for 36.5%, the intraosseous type accounted for 60.4%, and the superficial type accounted for 3.1%. The proportion of intraosseous type in middle-aged patients (63.0%) was higher than that in young and elderly patients (P=0.005). ③ DMSA: DMSA was the largest in M1 tooth position, which was (1.42±0.44) mm. The DMSAs of males in P2, M1 and M2 tooth position were bigger than those of females. There was a weak positive correlation between the lateral wall thickness of maxillary sinus and DMSA in P2 and M1 tooth position (r =0.2, r =0.2). In M1 tooth position, the width and angle of maxillary sinus were weakly negatively correlated with DMSA (r =-0.1, r =-0.2). ④DVSF: DVSF decreased gradually from M2 to P2. The DVSFs of males in P2 and M2 tooth position were larger than those of females. There was a weak negative correlation between the lateral wall thickness of maxillary sinus and DVSF in M1 tooth position (r =-0.3). There was a weak negative correlation between the width of maxillary sinus and DVSF in M1 position (r =-0.1). Conclusion ·The position of MSA may vary in the alveolar bone at the maxillary sinus floor and at the alveolar bone. With the increasing of age, the shape type of MSA changes from intrasinus type to intraosseous type.Male patients have greater DMSA and greater risk of arterial bleeding than women. The larger DMSA can be observed in the thicker lateral wall of maxillary sinus, while the DMSA is smaller when the width and angle of maxillary sinus is larger. The DVSF in men is larger than that in women, and the DVSF is smaller in the thicker lateral wall of maxillary sinus or when the width of maxillary sinus is larger.

Key words: maxillary sinus artery (MSA), cone-beam CT (CBCT), maxillary sinus floor elevation, anatomic variation

中图分类号:

R782.1

吴炯睿, 高益鸣. 上颌窦动脉解剖结构的锥形术计算机断层扫描分析[J]. 上海交通大学学报（医学版）, 2023, 43(2): 201-207.

WU Jiongrui, GAO Yiming. Cone-beam CT analysis of anatomical structure of maxillary sinus arteries[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(2): 201-207.

图/表 8

图1 MSA走形类型Note：A. Intrasinus type. B. Intraosseous type. C. Superficial type.

Fig 1 Shape type of MSA

图2 M1牙位上颌窦角度测量方法Note： Point A—The bottom of maxillary sinus in M1 tooth position; Point B—The intersection point of the parallel line and the medial wall of maxillary sinus; Point C—The intersection point of the parallel line and the lateral wall of maxillary sinus.

Fig 2 Measurement method of maxillary sinus angle in M1 tooth position

图3 MSA走形位置变异Note：A.The MSA was located at the bottom of maxillary sinus. B. The MSA was located in the root apical of molars. C. The MSA was located in the alveolar bone 4.14 mm from maxillary sinus floor.

Fig 3 Variability of the MSA position

表1 不同性别及不同年龄段MSA走形类型［n（%）］

Tab 1 Types of MSA in different genders and different age groups ［n（%）］

Item	Gender				Age
Item	Male (n=544)	Female (n=580)	χ²value	P value	Youthful (n=379)	Middle-aged (n=387)	Aged (n=358)	χ²value	P value
Intrasinus type	198 (36.4)	212 (36.6)	0.003	0.957	138 (36.4)	129 (33.3)	143 (39.9)	1.388	0.500
Intraosseous type	324 (60.0)	355 (61.2)	0.319	0.572	232 (61.2)	244 (63.0)	203 (56.7)	10.471	0.005
Superficial type	22 (4.0)	13 (2.2)	3.024	0.082	9 (2.4)	14 (3.6)	12 (3.4)	1.461	0.482

表2 不同性别及年龄段在不同牙位的上颌窦DMSA （mm）

Tab 2 DMSA in different gender and age groups in different tooth positions （mm）

Tooth position	Gender				Age
Tooth position	Male	Female	t value	P value	Youthful	Middle-aged	Aged	F value	P value
P2 (n=489)	1.40±0.45	1.09±0.30	8.429	0.000	1.22±0.40	1.28±0.46	1.29±0.40	1.077	0.311
M1 (n=479)	1.52±0.45	1.25±0.37	6.997	0.010	1.29±0.39	1.44±0.40	1.51±0.49	1.142	0.163
M2 (n=963)	1.37±0.44	1.15±0.33	8.703	0.000	1.19±0.32	1.28±0.45	1.33±0.42	0.964	0.612

表3 上颌窦DMSA>2 mm及≤1 mm者在不同牙位的分布情况［n（%）］

Tab 3 Distribution of maxillary sinus with DMSA>2 mm and ≤1 mm in different tooth positions ［n（%）］

Item

(n=489)

(n=479)

(n=963)

χ²

value

表4 不同性别及年龄患者在不同牙位的DVSF （mm）

Tab 4 DVSF in different gender and age groups in different tooth positions （mm）

Tooth position	Gender				Age
Tooth position	Male	Female	t value	P value	Youthful	Middle-aged	Aged	F value	P value
P2 (n=489)	5.82±4.12	5.30±3.51	1.515	0.024	5.97±4.00	5.71±3.94	5.15±3.67	1.077	0.311
M1 (n=479)	7.15±3.85	6.54±3.40	1.765	0.059	6.96±3.77	7.15±3.49	6.62±3.82	1.036	0.420
M2 (n=963)	9.01±3.84	7.79±3.54	5.085	0.017	8.49±3.89	8.67±3.61	8.08±3.74	0.972	0.619

表5 不同牙位LWT与上颌窦DMSA及DVSF相关性

Tab 5 Correlation between LWT in different tooth positions and maxillary sinus DMSA and DVSF

Tooth position	DMSA		DVSF
Tooth position	r	P value	r	P value
P2	0.2	0.000	-0.1	0.057
M1	0.2	0.000	-0.3	0.000
M2	0.0	0.095	-0.1	0.066

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