超声骨刀在下颌复杂阻生智齿拔除中的应用及对疼痛介质水平的影响

Application of ultrasonic bone knife in the extraction of complex impacted wisdom teeth of mandible and its effects on the levels of pain mediums

目的:探究啄木鸟超声骨刀在下颌复杂阻生智齿拔除中的应用及对疼痛介质水平的影响。方法:选择在医院就诊的586例下颌复杂阻生智齿患者,根据随机数表法将其分为观察组和对照组,每组293例。对照组利用传统的凿骨劈冠法拔除阻生智齿,观察组使用啄木鸟超声骨刀进行拔除。比较两组手术情况、术中畏惧心理、术后并发症和血清疼痛介质和炎性细胞因子水平。结果:观察组术中平均出血量、手术时间显著低于对照组,差异有统计学意义(t=13.554,t=25.541;P<0.05)。观察组的根折率、牙窝损伤率、相邻磨牙松动的比例及中度与重度畏惧心理比例分别为3.07%、11.60%、2.39%和19.11%显著低于对照组的23%、29.01%、6.14%和62.12%,差异有统计学意义(χ^(2)=6.479,χ^(2)=27.427,χ^(2)=5.056,χ^(2)=112.327;P<0.05)。术后第3 d两组疼痛介质和炎性细胞因子水平均显著升高,观察组5-羟色胺(5-TH)、P物质(SP)、炎性细胞因子血清五聚素3(PTX3)、细胞间粘附因子1(ICAM1)、前列腺素E2(PGE2)和过氧化物酶(MPO)炎性因子水平均显著低于对照组,差异有统计学意义(t=6.125,t=7.025,t=7.614,t=7.110,t=6.952,t=7.861;P<0.05)。结论:应用超声骨刀拔除下颌复杂阻生智齿可加快手术过程,减少患者的畏惧心理、术中断根、牙窝受损以及术后并发症,可有效抑制血清疼痛介质和炎性因子的水平。

Objective:To explore the application of woodpecker ultrasonic bone knife in the extraction of complex impacted wisdom teeth of mandible and its effect on the level of pain medium.Methods:586 patients with complex impacted wisdom teeth of mandible were selected and were divided into observation group and control group according to the random number table method,with 293 cases in each group.The control group adopted traditionally chiseling bone and splitting crown to extract wisdom teeth,and the observation group adopted woodpecker ultrasonic bone knife to extract them.The surgical conditions,intraoperative fear mentality,postoperative complications,serum pain mediums and inflammatory cytokine levels between the two groups were compared.Results:The average intraoperative blood loss volume[(4.58±1.03)mL]and operation time[(18.24±5.78)min]of observation group were significantly lower than those of control group[(10.53±2.50)mL and(42.31±8.69)min](t=13.554,t=25.541,P<0.05),respectively.The root fracture rate(3.07%),damage rate of the dental socket(11.60%),ratio of the gomphiasis of adjacent molars(2.39%)and the ratio of moderate to severe fear mentality(19.11%)of observation group were significantly lower than those(23%,29.01%,6.14%and 62.12%)of control group(χ^(2)=6.479,χ^(2)=27.427,χ^(2)=5.056,χ^(2)=112.327,P<0.05),respectively.After the 3ird day post operation,both pain mediums and inflammatory cytokine of two groups increased.And the levels of series of inflammatory factors included 5-hydroxytryptamine(5-TH),substance P(SP),pentraxin 3(PTX3),intercellular adhesion molecule 1(ICAM1),prostaglandin E2(PGE2)and myeloperoxidase(MPO)of observation group were significantly lower than those of control group(t=6.125,t=7.025,t=7.614,t=7.110,t=6.952,t=7.861,P<0.05),respectively.Conclusion:The application of woodpecker ultrasonic bone knife in extraction of complex impacted wisdom teeth of mandible can speed up the surgical process,and reduce the fear mentality of patients,and reduce the intraoperative interrupted roots,the damage of dental sockets and postoperative complications,and can effectively inhibit the levels of serum pain medium and inflammatory factors.