下颌第三磨牙拔除术手术难度与术后疼痛张口受限相关性研究.docVIP

下颌第三磨牙拔除术的手术难度与术后疼痛、张口受限的相关性研究 　　【摘要】 目的：研究拔除下颌第三磨牙的手术难度与术后疼痛、张口受限的关系。方法：选取需要拔除下颌第三磨牙的患者244例，按照手术难度，将手术方式分为4级：Ⅰ级，直接牙钳、牙挺拔除；Ⅱ级，切割牙冠后挺松拔除；Ⅲ级，需翻瓣、去骨、切割牙冠后拔除；Ⅳ级，需要翻瓣、去骨、切割冠、分根等复杂操作。记录手术时间，采用视觉模拟评分法（VAS）记录术后6 d每天的疼痛程度及最大开口度（MID）。结果：拔牙后0～6 d，Ⅲ级、Ⅳ级手术患者每天的疼痛VAS值均高于Ⅰ级手术，差异有统计学意义（P0.05）；拔牙后0～5 d，Ⅱ级手术患者每天的VAS值高于Ⅰ级手术，差异有统计学意义（P0.05）；术后6 d，Ⅰ级手术患者的MID最大，与术前比较变化不大，但与其他组比较差异有统计学意义（P0.05）；Ⅱ、Ⅲ、Ⅳ级手术患者的MID术后3 d显著下降；Ⅰ级手术患者术后24 h内需要服用止痛药的例数低于Ⅱ、Ⅲ、Ⅳ级。结论：下颌第三磨牙拔除术，手术越困难复杂，拔牙时间越长，术后的疼痛及张口受限越严重。 　　【关键词】 阻生牙； 拔除术； 疼痛； 张口受限 　　【Abstract】 Objective： To investigate the influence of surgical difficulty on postoperative pain and trismus after extraction of mandibular third molars.Method： A prospective study was performed of 244 patients who underwent mandibular third molar extractions. For evaluation of surgical difficulty， a 4-class scale was completed after surgery： I： extraction with forceps and elevator； II： extraction requiring coronal section； III： extraction requiring flap operation， osteotomy and coronal section； IV： complex extraction （root section）. the operation time was record， postoperative 6 d， the level of pain was record every day by the method of visual analogue scale （VAS）， and the MID was record too.Result： Mean pain evaluation was significantly higher in difficulty class Ⅲ and IV than in difficulty class I on days 0 to 6 inclusive （P0.05）， and significantly higher in class II than class I on days 0 to5 inclusive（P0.05）. MID on day 0 to 6 in the class I was the biggest， there was no significantly difference compared with preoperative， but the differences were significantly compared with other classes （P0.05）. MID of class II， III， IV were significantly decreased after 3 days. Patients need a painkiller in classⅠwithin 24 h after surgery were lower than that of classⅡ， Ⅲ， Ⅳ. Conclusion： Mandibular third molar removal surgery， surgery more difficult and complex， tooth， the longer the more serious the postoperative pain and limited mouth opening. 　　【Key words】 Impacted tooth； Ex