改良信封皮瓣和三角形皮瓣用于下颌阻生第3磨牙拔除术的效果对比

Comparison of the effects of modified envelope flap and triangular flap in mandibular impacted third molar extraction surgery

目的 比较改良的信封皮瓣和传统的三角形皮瓣用于下颌阻生第3磨牙拔除手术的效果。方法 前瞻性选取2023年12月至2024年2月在首都医科大学附属北京天坛医院口腔科进行牙槽外科手术拔除的100例下颌近中向阻生第3磨牙患者作为研究对象。按照随机数字表法将患者分为三角形皮瓣组和改良信封皮瓣组,每组各50例。记录和比较两组的手术时间、术后疼痛持续时间、术后止痛药服用数量、术后面部肿胀程度变化、第2磨牙牙周探诊深度变化和术后疼痛程度评分的情况。结果 改良信封皮瓣组的手术时间、术后疼痛持续时间分别为(14.56±2.47) min、(2.48±0.65) d,均明显短于三角形皮瓣组[(25.76±5.82) min、(3.48±0.68) d],术后止痛药服用数量为(1.22±0.82)片,明显少于三角形皮瓣组[(2.72±0.93)片],差异均有统计学意义(P<0.05)。术后第3天和术后第5天,改良信封皮瓣组面部肿胀程度分别为(12.24±4.06)、(4.98±4.03) mm,均低于三角形皮瓣组[(35.64±9.97)、(16.06±8.09) mm],差异均有统计学意义(P<0.05)。术后24、48和72 h,改良信封皮瓣组视觉模拟评分法(VAS)评分分别为(4.20±0.93)、(2.20±2.00)、(0.72±0.71)分,均低于三角形皮瓣组[(7.22±2.08)、(5.98±3.79)、(2.64±1.41)分],差异均有统计学意义(P<0.05)。术后7 d,改良信封皮瓣组患者第2磨牙颊面远中部探诊深度为(1.37±0.74) mm,明显大于三角形皮瓣组[(0.39±0.59) mm],差异有统计学意义(P<0.05)。结论 与三角形皮瓣比较,改良信封皮瓣对第2磨牙牙周组织的损伤较重,但可以有效缩短手术时间,减轻患者术后疼痛和肿胀程度,在临床工作中值得推荐。

Objective To compare the effects of modified envelope flap and triangular flap for extraction of impacted mandibular third molars.Methods A total of 100 patients with mandibular mesial impacted third molars who underwent alveolar surgery in the Department of Stomatology,Beijing Tiantan Hospital,Capital Medical University from December 2023 to February 2024 were prospectively selected as subjects.According to the random number table method,patients were divided into the triangular flap group and the modified envelope flap group,with 50 cases in each group.The operative time and the postoperative pain,the amount of postoperative painkillers taken,the degree of postoperative facial swelling,the depth of the second molar periodontal examination and the postoperative pain score were recorded and compared between the two groups.Results The operative time and postoperative pain duration of the modified envelope flap group were(14.56±2.47)minutes and(2.48±0.65)days,respectively,which were significantly shorter than those of the triangular flap group[(25.76±5.82)minutes and(3.48±0.68)days],the number of postoperative painkillers taken was(1.22±0.82)tablets,which was significantly less than that of the triangular flap group[(2.72±0.93)tablets],and the differences were statistically significant(P<0.05).At 3 days after surgery and 5 days after surgery,the degree of facial swelling in the modified envelope flap group was(12.24±4.06)and(4.98±4.03)mm,respectively,which were lower than those in the triangular flap group(35.64±9.97)and(16.06±8.09)mm,and the differences were statistically significant(P<0.05).At 24,48,and 72 hours postoperatively,the analogue scale(VAS)scores of the modified envelope flap group were(4.20±0.93),(2.20±2.00),and(0.72±0.71)points,respectively,which was lower than those of the triangular flap group[(7.22±2.08),(5.98±3.79),and(2.64±1.41)points],and the differences were statistically significant(P<0.05).At 7 days after surgery,the exploration depth of the second molar buccal surface in the modified envelope flap group was(1.37±0.74)mm,which was significantly greater than that in the triangular flap group[(0.39±0.59)mm],and the difference was statistically significant(P<0.05).Conclusion Compared with the triangular flap,the modified envelope flap has more serious damage to the periodontal tissue of the second molar,but it can effectively shorten the operation time and reduce the postoperative pain and swelling of the patients.It is worth recommending in clinical work.