CAJ | 학술논문

背景：如何避免闭合式上颌窦提升种植治疗中医源性上颌窦黏膜穿孔等并发症成为近年研究的热点。 　　目的：以有限元法比较闭合式上颌窦提升种植治疗中不同上颌窦黏膜厚度对黏膜穿孔的影响。 　　方法：在ANSYS有限元分析软件的SHELL63单元中分别建立0.3，0.5，0.8 mm厚度上颌窦黏膜与4.2 mm直径种植体的有限元模型，模拟闭合式上颌窦提升手术抬高黏膜，根据大变形非线性理论计算3种厚度上颌窦黏膜中心Von Mises最大应力值，并进行统计学分析。 　　结果与结论：通过对3种厚度上颌窦黏膜提升1-5 mm的形变与应力分析，发现上颌窦黏膜高变形区发生在黏膜顶端中心，在黏膜提升1-4 mm时，最大应变值曲线变化温和，在大于4 mm高度后曲线斜率明显增加；在上颌窦黏膜提升5 mm之内，0.3，0.5，0.8 mm 3种厚度黏膜中心最大Von Mises应力值差异无显著性意义(P>0.05)。提示上颌窦黏膜提升高度大于4 mm之后，黏膜弹性拉伸大幅增加，增大了穿孔的概率；对于上颌窦黏膜厚度为0.3-0.8 mm 需要进行闭合式上颌窦提升治疗的患者，其所面对的黏膜穿孔风险是无差别的；而上颌窦黏膜厚度小于0.3 mm的患者，要更加慎重地选择上颌窦提升方案以防止黏膜穿孔的发生。
배경：여하피면폐합식상합두제승충식치료중의원성상합두점막천공등병발증성위근년연구적열점。 　　목적：이유한원법비교폐합식상합두제승충식치료중불동상합두점막후도대점막천공적영향。 　　방법：재ANSYS유한원분석연건적SHELL63단원중분별건립0.3，0.5，0.8 mm후도상합두점막여4.2 mm직경충식체적유한원모형，모의폐합식상합두제승수술태고점막，근거대변형비선성이론계산3충후도상합두점막중심Von Mises최대응력치，병진행통계학분석。 　　결과여결론：통과대3충후도상합두점막제승1-5 mm적형변여응력분석，발현상합두점막고변형구발생재점막정단중심，재점막제승1-4 mm시，최대응변치곡선변화온화，재대우4 mm고도후곡선사솔명현증가；재상합두점막제승5 mm지내，0.3，0.5，0.8 mm 3충후도점막중심최대Von Mises응력치차이무현저성의의(P>0.05)。제시상합두점막제승고도대우4 mm지후，점막탄성랍신대폭증가，증대료천공적개솔；대우상합두점막후도위0.3-0.8 mm 수요진행폐합식상합두제승치료적환자，기소면대적점막천공풍험시무차별적；이상합두점막후도소우0.3 mm적환자，요경가신중지선택상합두제승방안이방지점막천공적발생。
BACKGROUND:How to avoid iatrogenic maxil ary sinus mucosal perforation after closed maxil ary sinus augmentation. OBJECTIVE:To compare the influence of maxil ary sinus mucosa at different thicknesses on the mucosal perforation in closed maxil ary sinus augmentation operation by using finite element analysis. METHODS:Three finite element models of maxil ary sinus mucosa at different thicknesses of 0.3 mm, 0.5 mm, 0.8 mm respectively and implant with 4.2 mm diameter were established in the SHELL63 units. ANSYS finite element analysis software was used to evaluate maxil ary sinus mucosal deformation by the simulated closed maxil ary sinus augmentation surgery. Differences of Von Mises maximum stress values of mucosa surface were calculated according to the non-linear large-deformation theory. RESULTS AND CONCLUSION:When maxil ary sinus mucosa height was increased from 1 mm to 5 mm, the large deformation was observed in the center of mucosa center. The maximum stress curve slope was shifted mild between 1-4 mm deformation, while shifted abruptly after 4 mm. There was no difference in the value of Von Mises maximum stress values between three maxil ary sinus mucosa at 0.3 mm, 0.5 mm, 0.8 mm thickness, when the lift height was increased from 1 mm to 5 mm (P>0.05). Maxil ary sinus mucosa are faced with a higher risk of mucosal perforation and elastic elongation when maxil ary sinus height is increased more than 4 mm. Maxil ary sinus mucosa at 0.3-0.8 mm thickness are faced the similar risk of mucosal perforation in closed maxil ary sinus augmentation operation within 5 mm. While more considerations should be paid on patients with less than 0.3 mm maxil ary sinus mucosa thickness.