横行分冠法和斜行分冠法拔除下颌阻生第三磨牙联合术后冠周局部注射地塞米松的临床效果

Clinical effect of transverse crown separation method and oblique crown separation method on extraction of impacted mandibular third molar combined with postoperation pericoronal local injection of dexamethasone

目的观察高速涡轮钻横行分冠法和斜行分冠法联合术后冠周局部注射地塞米松拔除下颌阻生第三磨牙的临床效果，探讨斜形分冠法在下颌第三磨牙拔出中的临床价值。方法选取2015年1月～2016年12月于伊犁州奎屯医院就诊的阻生下颌第三磨牙患者468例进行研究，随机数字法将患者分为研究组和对照组，各234例。研究组采用斜形分冠法拔出下颌阻生第三磨牙，对照组采用横形分冠法拔除下颌阻生第三磨牙，2组术后均给予地塞米松冠周局部注射。观察2组的拔牙时间、术后疼痛评分、肿胀程度、张口受限程度、术中并发症和干槽症发生情况。结果对照组和研究组拔牙时间分别为（26.14±12.36）min和（17.31±8.25）min（P＜0.05）。术后3d研究组和对照组VAS评分分别为（3.69±1.23）分和（11.34±2.14）分（P＜0.05），术后第7天2组的疼痛评分分别为（0.59±0.28）分和（0.64±0.25）分，差异无统计学意义。术后3d研究组肿胀程度低于对照组（P＜0.05），术后第7天2组肿胀程度差异无统计学意义。术后3d，研究组张口受限程度显著低于对照组（P＜0.05）。研究组干槽症及术中并发症发生率均低于对照组（P＜0.05）。结论斜形分冠法拔除下颌阻生第三磨牙联合术后冠周局部注射堵塞米松具有手术时间短、术中和术后并发症少等优点。

Objective To observe the clinical effect of transverse crown separation method and oblique crown separation method on extraction of impacted mandibular third molar combined with postoperation pericoronal local injection of dexamethasone,and to study the clinical value of oblique crown separation method on extraction of impacted mandibular third molar.Methods468patients with impacted mandibular third molar in our hospital from January2014to December2015were selected to study.468patients were randomly divided into the study group and control group with234patients each group.The impacted mandibular third molar of patients in the control group were extracted with oblique crown separation method,while the impacted mandibular third molar of patients in the study group were extracted with transverse crown separation method,two groups were treated with postoperation pericoronal local injection of dexamethasone.The teeth extraction time,postoperative pain score,degree of swelling,limitation of mouth opening,incidence of intraoperative complications and dry socket of two groups were observed.Results The teeth extraction time of the control group and study group were(26.14±12.36)min and(17.31±8.25)min(P<0.05),respectively.At3d after operation,the VAS scores of the study group and control group were(3.69±1.23)scores and(11.34±2.14)scores(P<0.05),respectively.At7d after operation,the VAS scores of the study group and control group were(0.59±0.28)scores and(0.64±0.25)scores(P<0.05),respectively.At3d after operation,the swelling degree of the study group were lower than that of control group(P<0.05).There was no significant difference in the degree of swelling in the two groups at7d after operation.At3d after operation,the degree of restriction of mouth opening in the study group was significantly lower than that in the control group(P<0.05).The incidence of intraoperative complications and dry socket of study group were lower than those of control group.Conclusion The oblique crown separation method on extraction of impacted mandibular third molar combined with postoperation pericoronal local injection of dexamethasone has the advantages of shorter operation time,less postoperative complications.