牙种植术后三叉神经创伤性神经病理性疼痛的诊断与防治

doi:10.7518/gjkq.2023104

摘要/Abstract

摘要：

如今种植牙已成为修复缺失牙的首选治疗方案。随着种植牙数量的爆发式增长，相关手术并发症的发生率随之增加。其中，种植手术导致的三叉神经创伤性神经病理性疼痛（PTNP）是口腔颌面部神经损伤后的严重并发症，日益成为种植修复临床不能忽视的问题。目前，PTNP的病理机制尚未完全明确、临床治疗对策尚无统一认识。本文对种植术后PTNP的病因、发生机制、临床诊断以及治疗、预防的研究进展作一系统综述，为口腔临床医生针对PTNP的临床诊疗策略提供参考依据。

关键词: 牙种植, 三叉神经, 神经损伤, 三叉神经创伤性神经病理性疼痛

Abstract:

Dental implants are preferred in the restoration of missing teeth. With the explosive growth in the number of dental implants, the incidence of surgical complications has increased. Post-traumatic trigeminal neuropathic pain (PTNP) caused by implant surgery is a serious complication in the oral and maxillofacial regions and cannot be ignored in the application of implant prosthesis. The pathological mechanism of PTNP remains unclear, and no unified standard for clinical treatment is available. This article is a systematic review on the etiology, pathogenesis, clinical diagnosis, treatment, and prevention of PTNP, providing a reference for clinical management strategies for PTNP.

Key words: dental implant, trigeminal nerve, nerve injury, post-traumatic trigeminal neuropathic pain

中图分类号:

R 783.4

廖洪林,方仲瀚,张艳艳,刘飞,沈颉飞. 牙种植术后三叉神经创伤性神经病理性疼痛的诊断与防治[J]. 国际口腔医学杂志, 2023, 50(6): 729-738.

Liao Honglin,Fang Zhonghan,Zhang Yanyan,Liu Fei,Shen Jiefei.. Diagnosis and treatment of post-traumatic trigeminal neuropathic pain after dental implantation[J]. Int J Stomatol, 2023, 50(6): 729-738.

图/表 1

表 1

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Sunderland	Seddon	病因	组织学改变	损伤表现	恢复潜力
第1类	神经机能麻痹	神经压迫、水肿、血肿、热损伤、轻微拉伸	神经束内水肿、传导阻滞	神经炎、感觉异常	一般1~7 d可完全恢复
第1类	神经机能麻痹	神经压迫、水肿、血肿、热损伤、轻微拉伸	节段性脱髓鞘	神经炎、感觉异常	一般4~8周可完全恢复
第2类	轴索断伤	神经压迫、牵拉、血肿、挤压、水肿、拉伸	轴突撕裂，神经内膜、神经束膜和神经外膜完好	感觉异常、发作性感觉障碍	一般8~16周可完全恢复
第3类		挤压、穿刺、严重血肿、拉伸	神经内膜管切断，可能发生沃尔特变性	感觉异常、感觉迟钝	一般12周内可部分恢复
第4类		完全粉碎、严重拉伸、直接化学创伤、严重热创伤	只有神经外膜完整，整个神经束受损	感觉丧失、感觉迟钝、神经瘤形成	一般无恢复潜力
第5类	神经断伤	神经完全断裂、神经瘤形成	神经连续性丧失	麻醉、顽固性疼痛、神经瘤形成	一般无恢复潜力
			同一神经束内的不同轴突可表现为该列上述任意组织学改变的组合	可表现为该列上述任意损伤表现的组合	恢复潜力不可预测

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