Stacchi Claudio, Andolsek Francesca, Berton Federico, Perinetti Giuseppe, Navarra Chiara Ottavia, Di Lenarda Roberto
Int J Oral Maxillofac Implants. 2017 May/Jun;32(3):e107-e118. doi: 10.11607/jomi.4884.
To analyze the occurrence of intraoperative complications during sinus floor elevation with a lateral approach and their correlations with the technique adopted by surgeons.
Electronic and manual searches resulted in 4,417 records on sinus floor elevation. Twenty-one randomized clinical trials (RCTs) and 11 prospective controlled clinical trials (CCTs) reporting occurrence of intraoperative complications were included. Risk of bias was assessed according to the Cochrane tool and a modified Downs and Black quality analysis for RCTs and CCTs, respectively.
Sinus membrane perforation and hemorrhagic events following vascular lesions were the only intraoperative complications reported by the selected studies with overall occurrences of 15.7% and 0.4%, respectively. Three different surgical devices (rotary instruments, piezoelectric osteotomes, and manual bone scrapers) were used to perform the lateral antrostomy. Ultrasonic devices and bone scrapers showed a lower incidence (10.9% and 6.0%, respectively) of membrane perforation compared with that of rotary instruments (20.1%). Among the different ultrasonic procedures, erosion of the lateral antral wall showed the lowest membrane perforations (4.7% incidence). Hemorrhagic complications seemed to be extremely infrequent with any surgical technique.
Sinus membrane perforation was the most frequently described intraoperative complication during sinus floor elevation with a lateral approach. Thinning the lateral wall of the sinus before performing the antrostomy (either with ultrasonic devices or manual bone scrapers) seemed to be an important factor in preventing membrane perforation during sinus surgery. Further high-quality RCTs specifically investigating intraoperative complication occurrence are needed.
分析外侧入路上颌窦底提升术中术中并发症的发生情况及其与外科医生所采用技术的相关性。
通过电子检索和手工检索共获得4417篇关于上颌窦底提升的记录。纳入了21项随机临床试验（RCT）和11项前瞻性对照临床试验（CCT），这些试验报告了术中并发症的发生情况。分别根据Cochrane工具以及针对RCT和CCT的改良唐斯和布莱克质量分析方法评估偏倚风险。
所选研究报告的仅有的术中并发症为窦膜穿孔和血管损伤后的出血事件，总体发生率分别为15.7%和0.4%。使用了三种不同的手术器械（旋转器械、压电骨凿和手动骨刮匙）进行外侧窦口切开术。与旋转器械（20.1%）相比，超声器械和骨刮匙的膜穿孔发生率较低（分别为10.9%和6.0%）。在不同的超声操作中，外侧窦壁侵蚀的膜穿孔发生率最低（4.7%）。出血并发症在任何手术技术中似乎都极为罕见。
外侧入路上颌窦底提升术中，窦膜穿孔是最常描述的术中并发症。在进行窦口切开术前（使用超声器械或手动骨刮匙）使窦外侧壁变薄似乎是预防鼻窦手术中膜穿孔的一个重要因素。需要进一步开展专门研究术中并发症发生情况的高质量RCT。
