本文選題：阻生牙 + 微創(chuàng)��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:隨著多種拔牙新技術(shù)、尤其是外科專用手機(jī)的廣泛應(yīng)用,減少了拔牙手術(shù)創(chuàng)傷,但是仍存在切口大,去骨多等缺點(diǎn),不符合微創(chuàng)外科的原則。本臨床研究觀察了舌向分牙技術(shù)拔除下頜阻生第三磨牙在手術(shù)時間、創(chuàng)傷大小、術(shù)后反應(yīng)以及其他并發(fā)癥上的優(yōu)劣,為臨床操作進(jìn)一步減少創(chuàng)傷進(jìn)行了探索。方法:1臨床資料選取2015年12月—2016年8月在白求恩國際和平醫(yī)院口腔科門診就診,術(shù)前檢查為下頜近中及水平位阻生第三磨牙的患者作為研究對象,隨機(jī)分為兩組。共計(jì)120例患者,男41例,女79例。累計(jì)拔除120顆患牙,其中近中位82顆,水平位38顆。使用阻生下頜第三磨牙拔除難度評分系統(tǒng)對患牙拔除難度進(jìn)行評分。2拔除方法2.1實(shí)驗(yàn)組舌向分牙技術(shù)拔除下頜阻生第三磨牙:翻瓣、去骨,暴露患牙合面?,舌向分牙,先去除舌側(cè)牙塊,減少去骨尤其是頰側(cè)去骨,創(chuàng)口一般不縫合。2.2對照組口腔外科門診手術(shù)操作規(guī)范法拔除下頜阻生第三磨牙:翻瓣、去骨,暴露患牙最大周徑,近遠(yuǎn)中分牙,先去除近中側(cè)牙塊,患牙拔除后開放式縫合。3術(shù)后處理和記錄拔牙術(shù)后常規(guī)處理。觀察并記錄患者術(shù)后12h疼痛程度、術(shù)后3d、7d腫脹、術(shù)后3d、7d開口受限程度以及出血、干槽癥等其它術(shù)中術(shù)后并發(fā)癥。4統(tǒng)計(jì)方法:用SPSS21.0進(jìn)行分析。對于正態(tài)分布數(shù)據(jù)患牙難度評估值、疼痛程度采用倆樣本t檢驗(yàn)。對于非正態(tài)分布數(shù)據(jù)手術(shù)時間、術(shù)后腫脹程度采用Wilcoxon秩和檢驗(yàn)。等級資料去骨量和張口受限程度采用Wilcoxon秩和檢驗(yàn)。計(jì)數(shù)資料術(shù)后出血、干槽癥、下唇麻木、氣腫以及術(shù)中并發(fā)癥采用四格表X~2檢驗(yàn)。結(jié)果:1患牙難度評估實(shí)驗(yàn)組患牙難度為10.77±1.94,對照組10.97±1.88。兩組在拔除患牙拔除難度上無統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。2去骨量實(shí)驗(yàn)組平均秩次為42.05,秩次之和為2523;對照組平均秩次為78.95,秩次之和為4737,實(shí)驗(yàn)組去骨量明顯少于對照組(P0.05)。3手術(shù)時間實(shí)驗(yàn)組拔除時間其中位數(shù)為11.5 min,四分位間距為11min;對照組拔除時間其中位數(shù)為10min,四分位間距為8min。兩組在拔牙手術(shù)時間上無統(tǒng)計(jì)學(xué)差異(P0.05)。4疼痛術(shù)后12小時疼痛程度3.87±0.81,對照組6.91±1.21。實(shí)驗(yàn)組疼痛程度小于對照組(P0.05)。5張口受限程度術(shù)后第三天實(shí)驗(yàn)組對患者張口度影響較對照組小(P0.05)。術(shù)后第七天兩組張口度程度無統(tǒng)計(jì)學(xué)差異(P0.05)。6腫脹術(shù)后第三天腫脹程度:兩組無統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后第七天腫脹程度無統(tǒng)計(jì)學(xué)差異(P0.05)。7其它術(shù)后出血、干槽癥、氣腫、下唇麻木以及術(shù)中并發(fā)癥均無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1舌向分牙技術(shù)拔除下頜阻生第三磨牙不需要暴露患牙最大徑,翻瓣范圍小,去骨少2通過舌側(cè)分牙,去除舌側(cè)和近中阻力,改善視野,為小切口、小術(shù)野拔牙創(chuàng)造了條件。頰側(cè)牙挺用力,牙根不但可以近中合向移動,而且可以近中舌側(cè)合向三個方向運(yùn)動,減少了脫位的阻力、去骨量和切磨時間。3術(shù)后反應(yīng)小:舌向分牙拔除下頜第三磨牙的方法無需特殊儀器設(shè)備要求,但能有效減輕術(shù)后反應(yīng),提高患者生活質(zhì)量,值得推廣。
[Abstract]:Objective: with the extensive application of a variety of new tooth extraction technology, especially the special surgical mobile phone, it reduces the trauma of tooth extraction operation, but there are still many defects such as large incision and more bone removal, which do not conform to the principle of minimally invasive surgery. This clinical study observed the operation time, trauma size and postoperative reaction of mandibular impacted third molar extraction by tongue splitting technique. And other complications, in order to further reduce the trauma in clinical operation. Methods: 1 clinical data were selected from December 2015 to August 2016 in the Department of Stomatology, Department of Stomatology, Heping Hospital, Bethune international. The preoperative examination was used as the research object in the proximal and horizontal third molar of the lower jaw and the horizontal position, which were randomly divided into two groups. A total of 12 patients were randomly divided into two groups. 0 cases, 41 men and 79 women, 120 teeth were removed, of which 82 were proximal and 38. The difficulty scoring system of impacted mandible third molar extraction was used to remove the difficulty of tooth extraction by.2 extraction method 2.1. First remove the tongue and side teeth, reduce the bone, especially the buccal side of the bone, the wound usually does not suture the.2.2 control group dental surgery outpatient operation standard method to remove the mandibular impacted third molar: flap, bone, exposure to the maximum circumferential diameter of the teeth, near the distal middle teeth, first removal of the proximal part of the teeth, after the extraction of open type.3 after extraction of tooth extraction and extraction of tooth extraction after extraction and extraction of teeth after extraction and extraction of teeth after extraction. Postoperative routine treatment. Observe and record the degree of postoperative 12h pain, postoperative 3D, 7d swelling, postoperative 3D, 7d opening limitation, and other postoperative complications such as hemorrhage, and dry grooves, and other postoperative complications.4 statistical methods: SPSS21.0 analysis. The degree of difficulty assessment for normal distribution data, the degree of pain using the two samples t test. For non normal fractions. Wilcoxon rank sum test was used for the operation time of the data and the degree of postoperative swelling was measured by the rank sum test. Wilcoxon rank and test were used for the bone mass and the degree of opening restriction. Four lattice X~2 tests were used for the postoperative bleeding, dry grooves, lower lip numbness, emphysema and intraoperative complications. Results: the difficulty of the 1 tooth difficulty assessment was 10.77 + 1.94, There was no statistical difference between the 10.97 + 1.88. two groups in the control group (P0.05). The average rank of the experimental group was 42.05, the rank sum was 2523, the average rank of the control group was 78.95, and the rank sum was 4737. The bone mass of the experimental group was significantly less than that of the control group (P0.05) in the.3 operation time group. The number was 11.5 min, the interval of four division was 11min, the number of the extraction time in the control group was 10min, the four division interval was 8min. two, there was no statistical difference in the time of extraction operation (P0.05).4 pain 12 hours pain 3.87 + 0.81, and the pain range of the control group 6.91 + 1.21. group was less than that of the control group (P0.05).5 opening restriction third. The mouth degree of the experimental group was smaller than that of the control group (P0.05). There was no statistical difference between the two groups at seventh days after operation (P0.05) the swelling degree at third days after the operation of.6 swelling: there was no statistical difference between the two groups (P0.05). There was no statistical difference in the swelling degree of the seventh days after the operation (P0.05).7 other postoperative bleeding, dry slots, emphysema, lower lip numbness and operation. There was no statistical difference in the complications (P0.05). Conclusion: the extraction of mandibular impacted third molar by 1 lingual teeth technique does not need to expose the maximum diameter of the mandibular impacted molar, the range of the flap is small, the bone removal is small, and the reduction of the bone is 2 through the lingual side of the tooth. The lateral and proximal resistance can be removed and the visual field is improved. It moves in the middle, and can move near the middle tongue to three directions, reducing the resistance of the dislocation, reducing the bone mass and cutting time after.3. The method of removing the third molar of the mandible is not required by the tongue to remove the mandibular third molars, but it can effectively reduce the postoperative reaction and raise the quality of life of the patients. It is worth popularizing.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782.11

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