下颌第三磨牙不同拔除方式与颞下颌关节紊乱病的相关性

Study of Correlation between Different Extraction Methods of Mandibular Third Molars and Temporomandibular Joint Disorders

目的分析下颌第三磨牙拔除后患者颞下颌关节紊乱病(TMD)的相关指数,以探讨2种拔牙术式与TMD的相关性。方法选择18~25岁首次拔除下颌第三磨牙的患者100例,随机分2组,分别采用微创法或传统法拔除不颌第三磨牙,一次只拔除一侧。分别于拔牙前及拔牙后1、4、12周评估关节症状,颞下颌关节功能评价指标包括关节杂音指数、关节压诊指数、咀嚼肌压痛指数及下颌动值等。采用SPSS 22.0软件对数据进行统计学分析。结果术后1及4周,2组患者的关节杂音指数差别具有统计学意义;术后12周,2组患者的关节压诊指数差别具有统计学意义;术后1周,2组患者的下颌运动指数差别具有统计学意义,而2组的咀嚼肌压痛指数差别则均无统计学意义。2组患者在术后1及4周评估的TMD指数均显著高于术前(P<0.05),但术后12周与术前的差别则无统计学意义(P>0.05);术后各阶段的TMD指数2组间差别均具有统计学意义(P<0.05)。结论下颌第三磨牙不同拔除方式与TMD存在一定相关性,微创法拔牙对颞颌关节的影响显著低于传统法。

Objective To investigate the correlation between the two extraction methods and joint disorder by analyzing temporomandibular joint index in patients who undergo extraction of mandibular third molar.Methods A total of 100 patients aged 18-25 years old who had their mandibular wisdom teeth extracted for the first time were selected.Only one side of the mandibular wisdom teeth was removed each time.Minimally invasive and conventional extraction were performed randomly.The joint symptoms were evaluated before tooth extraction,1 week,4 weeks,and 12 weeks after operation.SPSS 22.0 was used for statistical analysis.Results During the follow-up visits,The joint noise index of patients between the different extraction methods was significantly different at 1 and 4 weeks after surgery,but the joint pressure index was significantly different only at 12 week after surgery.There was no statistically significant difference in mastication muscle palpation index at any period.The mandibular movement index was significantly different only after 1 week.The TMD index of the two groups of patients evaluated at 1 and 4 weeks after surgery was significantly higher than that before surgery(P<0.05),but there was no significant difference between TMD index at 12 week after tooth extraction(P>0.05).The TMD index between the traditional group and the minimally invasive group was statistically significant at each stage after surgery(P<0.05).Conclusion There are certain correlations between different extraction methods of jaw wisdom teeth and temporomandibular joint disorders.The effect of minimally invasive extraction on the temporomandibular joint is significantly lower than that of traditional extraction.