微创远中三角瓣与封套瓣在下颌阻生第三磨牙拔除术中应用效果比较研究

Comparative study on the application effect of minimally invasive distal triangular flap and envelope flap in mandibular impacted third molar extraction

目的比较微创远中三角瓣与封套瓣在下颌阻生第三磨牙拔除术中的应用效果,为微创远中三角瓣的临床应用提供依据。方法选取2020年7月至2021年7月于四川大学华西口腔医院口腔颌面外科门诊就诊的下颌第三磨牙黏膜下阻生患者80例(阻生牙80颗),随机分为2组,每组40例(阻生牙40颗)。对2组患者行下颌阻生第三磨牙拔除术,根据翻瓣方式分别记为封套瓣组和微创远中三角瓣组。比较2组手术时间,术后第1、3、7天疼痛视觉模拟评分法(visual analogue scale,VAS)评分、肿胀和张口受限程度,以及手术并发症发生情况。结果2组手术时间比较,差异无统计学意义(t=0.834,P=0.408)。术后第1天,微创远中三角瓣组VAS评分[(2.37±1.31)分]、面部肿胀程度[(0.92±0.74)%]、张口受限程度[(25.00±15.04)%]均小于封套瓣组[VAS评分:(3.46±1.07)分、面部肿胀程度:(1.98±0.98)%、张口受限程度:(35.83±17.17)%],差异均有统计学意义(t值依次为3.325、4.468、2.444,均P<0.05);术后第3天,微创远中三角瓣组VAS评分[(1.70±1.10)分]、面部肿胀程度[(0.79±0.73)%]均小于封套瓣组[VAS评分:(2.46±1.10)分、面部肿胀程度:(1.64±1.00)%],差异均有统计学意义(t值依次为2.500、3.557,均P<0.05);术后第7天,2组VAS评分、面部肿胀程度、张口受限程度比较,差异均无统计学意义(均P>0.05)。2组在术中及术后7 d均未发生感染或神经损伤等并发症。结论微创远中三角瓣相对于传统封套瓣,术后前3 d患者疼痛和面部肿胀程度更轻微,可作为下颌阻生第三磨牙拔除术的翻瓣方式之一。

Objective To compare the application effects of minimally invasive distal triangular flap and envelope flap in mandibular impacted third molar extraction,so as to provide a basis for the clinical application of minimally invasive distal triangular flap.Methods A total of 80 patients with submucosal impacted mandibular third molar(80 impacted teeth)who were treated in the Department of Oral and Maxillofacial Surgery of West China Hospital of Stomatology,Sichuan University from July 2020 to July 2021 were recruited and randomly divided into 2 groups with 40 cases(40 impacted teeth)in each group.Two groups of patients underwent mandibular impacted third molar extraction,and according to the flap methods,they were recorded as envelope group and minimally invasive distal triangular flap group respectively.The operation time,the visual analogue scale(VAS)score,swelling and mouth opening restriction on the 1st,3rd and 7th postoperative days,and the occurrence of surgical complications were compared between the two groups.Results There was no significant difference in operation time between the two groups(t=0.834,P=0.408).On the first day after surgery,the VAS score[(2.37±1.31)points],facial swelling[(0.92±0.74)%]and mouth opening restriction[(25.00±15.04)%]in the minimally invasive distal triangular flap group were significantly lower than those in the envelope flap group[VAS score:(3.46±1.07)points,facial swelling degree:(1.98±0.98)%,and mouth opening restriction(35.83±17.17)%],and the differences were statistically significant(t values were 3.325,4.468,2.444,all P<0.05).On the third day after surgery,the VAS score[(1.70±1.10)]and facial swelling[(0.79±0.73)%]in the minimally invasive distal triangular flap group were significantly lower than those in the envelope flap group[VAS score:(2.46±1.10)and facial swelling(1.64±1.00)%],and the differences were statistically significant(t values were 2.500 and 3.557,both P<0.05).On the 7th day after surgery,there were no significant differences in VAS score,facial swelling or mouth opening restriction between the two groups(all P>0.05).There were no complications such as infection or nerve injury during the operation and 7 days after surgery in the two groups.Conclusion Compared with the traditional envelope flap,the minimally invasive distal triangular flap causes less pain and facial swelling in patients during the first 3 days after surgery,and can be used as one of the flap design methods for mandibular impacted third molar extraction.