开窗减压术治疗下颌骨牙源性囊肿的临床和影像学研究

摘要

Objective:To explore the differences between decompression and curettage on the treatment of mandibular odontogenic cyst. Methods:A total of 28 patients with mandibular odontogenic cyst over 3 teeth involvement in diameter (D≥6 cm) were selected and divided into the decompression group and the curettage group. The operation time and postoperative recovery were compared between the two groups. The preoperative and postoperative cone-beam CT (CBCT) data after 3, 6, 9 and 12 months were collected and reconstructed in three-dimension. The changes of bone volume fraction of the lesion and the newly regenerated bone were measured, while the relative position between cyst and the neural tube was also observed. Results:Mean operation time of the decompression group was significantly shorter than that of the curettage group (P＜ 0. 05). The class-A healing rate of the decompression group was significantly higher than that of the curettage group (P＜ 0. 05). The average cyst volume decreased more in the decompression group than in the curettage group in 3, 6, 9 and 12 months after the operation (P＜ 0. 05). The bone volume fraction of newly regenerated bone was significantly higher in the curettage group than the decompression group after 3 and 6 months (P＜ 0. 05). However, there was no significant difference after 9 months (P＞ 0. 05). It was significantly lower in the curettage group after 12 months (P＜ 0. 05). Ten cases with neurothlipsis preoperatively all had a recovery of neural tube in CT images after the decompression. Conclusion:Decompression can be a better choice for the treatment of mandibular odontogenic cyst.%目的:探讨开窗减压术与刮治术对下颌骨囊性病变治疗进程和疗效的影响.方法:选择直径超过3个牙位(D≥6 cm)的下颌骨牙源性囊肿患者28例,分为开窗减压组(16例)和刮治组(12例).比较两组手术时间和术后恢复情况,收集两组患者术前和术后3、6、9和12个月的锥形束CT(CBCT)数据,进行三维重建,测量病变体积比和新生骨体积分数的变化,并观察囊肿与神经管相对位置关系的变化.结果:开窗组的平均手术时间明显短于刮治组(P＜0.05).开窗组术创甲级愈合情况明显优于刮治组(P＜0.05).术后3、6、9和12个月时开窗组平均囊肿体积减少程度高于刮治组(P＜0.05).术后3、6个月时,刮治组的新生骨体积分数明显高于开窗组(P＜0.05);术后9个月时,两组没有明显差别(P＞0.05);术后12个月时,开窗组的新生骨体积分数明显高于刮治组(P＜0.05).10例术前CT显示囊肿压迫神经管的患者在开窗术后均观察到神经管结构恢复的影像.结论:开窗减压较刮治术治疗大型颌骨囊性病变更加值得选择.