显微镜辅助下牙周翻瓣术治疗中重度牙周炎的近期疗效观察

Short-term Efficacy of Microscope Assisted Periodontal Flap Surgery in the Treatment of Moderate to Severe eeriodontitis

【目的】探讨显微镜辅助下牙周翻瓣术治疗中重度牙周炎患者的短期疗效。【方法】回顾性分析2013年7月至2014年12月在本院行显微镜下牙周翻瓣术的50例中重度牙周炎患者（观察组）和同期行普通视野下牙周翻瓣术的46例中重度牙周炎患者（对照组）临床资料。比较两组入组时（T0）、手后1个月（T1）、术后3个月（T2）、术后6个月（T3）时口腔卫生状态[简化口腔卫生指数（OHI—S），包括简化软垢指数（DI-S）和简化牙石指数（CI—S）]、牙周指标[探诊深度（PD）、临床附着水平（CAL）、龈沟出血指数（SBI）]，记录其术前、术后24h及术后72h时疼痛评分[数字分级法（NRS）]、炎性因子[血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和C反应蛋白（CRP）]等指标的差异。【结果】T1～T3时，两组患者DI-S、CI-S指数均较T0时明显降低（P均〈0．05），但同时间点组间比较差异无统计学意义（P〉0．05）；两组患者PD、CAL、SBI均较T0时明显降低，且同时间点观察组显著低于对照组，其差异有统计学意义（P〈0．05）。术后24h时，两组患者NRS评分结果均较术前明显升高，但观察组评分低于对照组，其差异有统计学意义（P〈0．05）；术后72h时，两组患者NRS评分结果均较术前及术后24h时明显降低，且观察组评分低于对照组（P〈0.05）。术后24h、72h时，两组患者TNF-α、IL-6、CRP水平均较术前明显降低，且观察组低于对照组，其差异有统计学意义（P〈0．05）。【结论】显微镜下辅助牙周翻瓣术可有效减轻中重度牙周炎患者术后疼痛程度，改善牙周袋深度，降低临床附着丧失，缓解龈沟出血情况，值得临床推广应用。

[Objective]To investigate the short-term efficacy of microscope assisted periodontal flap surgery in the treatment of moderate to severe periodontitis. [Methods]From July 2013 to December 2014, the clinical data of 50 cases with moderate to severe pe- riodontitis treated by microscope assisted periodontal flap surgery （study group） and 46 cases treated by periodontal flap surgery under common view （control group） were retrospectively analyzed. The oral health status [oral health index-simplified （OHI-S）]..Di-s and Ci-s, periodontal indexes probing depth [（PD）, clinical attachment level （CAL）, sulcus bleeding index （SBI）] were compared when patients were enrolled in the study （T0）, 1 month （T1）, 3 months （T2） and 6 months （T3） after surgery. The differences in pain scores [numerical rating scale （NRS）] and inflammatory factors [serum tumor necrosis factor α （TNF-α）, interleukin -6 （IL-6）, C-re- active protein （CRP） before surgery, 24h and 72h after surgery were recorded. [Results]At T1 to T3, the DI-S and CI-S indexes of the two groups were significantly lower than those of To （ P〈0.05）, but there was no significant difference between the groups at the same time point （ P 〈0.05） PD, CAL and SBI with the two groups of patients were significantly lower than those of To, and at the same time point, the observation group was significantly lower than the control group, the difference was statistically significant （ P〈0.05）.At 24 h after operation, the scores of NRS in two groups were significantly higher than those before operation, but the score of observation group was lower than that of control group, the difference was statistically significant （ P 〈0.05） At 72 h after opera- tion, the scores of NRS in two groups were lower than those before operation and at 24 h after operation, and the score of observation group was lower than that of control group （ P〈05） ; At 24 h and 72 h after operation, the levels of TNF-α IL-6 and CRP in the two groups were significantly lower than those before the operation, and the observation group was lower than that of the control group, the difference was statistically significant （ P %0.05）. [Conclusion]Assisted periodontal flap surgery under microscope can ef- fectively reduce the degree of pain in patients with moderate and severe periodontitis, improve the depth of periodontal pocket, reduce the loss of clinical attachment and relieve the bleeding of gingival sulcus, and is worthy of clinical application.