远中三角瓣在下颌阻生第三磨牙拔除术中的应用

doi:10.7518/hxkq.2021.05.016

华西口腔医学杂志 ›› 2021, Vol. 39 ›› Issue (5): 598-604.doi: 10.7518/hxkq.2021.05.016

远中三角瓣在下颌阻生第三磨牙拔除术中的应用

刘济远(), 刘畅, 潘剑, 曲涛, 华成舸()

口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院，成都 610041

收稿日期:2020-12-21 修回日期:2021-06-19 出版日期:2021-10-01 发布日期:2021-10-11
通讯作者: 华成舸 E-mail:20532465@qq.com;huacg@163.com
作者简介:刘济远，副主任医师，博士，E-mail：20532465@qq.com
基金资助:
四川省重点研发项目(2018SZ0181)

Distal-triangular flap design for impacted mandibular third molars: a randomized controlled trial

Liu Jiyuan(), Liu Chang, Pan Jian, Qu Tao, Hua Chengge.()

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2020-12-21 Revised:2021-06-19 Online:2021-10-01 Published:2021-10-11
Contact: Hua Chengge. E-mail:20532465@qq.com;huacg@163.com
Supported by:
Key Research and Development Foundation of Sichuan Province(2018SZ0181);Correspondence: Hua Chengge, E-mail: huacg@163.com

摘要/Abstract

摘要： 目的

通过一项前瞻性研究对远中三角瓣在下颌第三磨牙拔除术中的应用效果进行研究。

方法

将60例下颌阻生第三磨牙患者随机分为远中三角瓣、近中三角瓣及封套瓣3组，分别采用相应的翻瓣方式拔除阻生第三磨牙。拔牙后随访观察3个月，记录患者术后疼痛、肿胀、张口度及邻牙牙周状况等指标，采用重复测量方差分析及卡方检验对结果进行分析。

结果

60例患者均顺利完成拔牙及3个月的随访观察，无1例出现术后感染或下唇、舌、颊黏膜感觉障碍。3组患者的术后疼痛、肿胀、张口度及邻牙牙周状况等差异均无统计学意义（P>0.05）。

结论

远中三角瓣与近中三角瓣、封套瓣一样安全可靠，但其具有方便术野暴露，对患者张口度要求不高等优势，是阻生下颌第三磨牙拔除术中可供选择的翻瓣方案之一。

关键词: 下颌第三磨牙拔除术, 远中三角瓣, 近中三角瓣, 封套瓣, 术后反应

Abstract: Objective

This prospective study was performed to evaluate whether the distal-triangular flap was a practical alternative surgical approach for extracting mandibular third molars.

Methods

Sixty participants with impacted mandibular third molars were randomly divided into three groups: group A, distal-triangular flap; group B, Szmyd flap; and group C, envelope flap. The impacted third molars were extracted by the corresponding flapping method. During a three-month follow-up observation after the extraction, the postoperative pain, swelling, mouth opening, and periodontal status were recorded and analyzed by ANOVA and chi-square tests.

Results

The 60 participants had successful extraction and 3-month follow-up observation. No participant suffered from postoperative infections, lower lip disorder, or tongue sensory disorders. No statistical differences were found in the postoperative symptoms and signs of the three flap designs, such as postoperative pain, swelling, mouth opening, and periodontal status (P>0.05).

Conclusion

The distal-triangular flap was as safe and reliable as the Szmyd and envelope flaps but more advantageous because of its convenient operative field exposure and low requirement for the patient's mouth opening. Thus, the distal-triangular flap is one of the alternative flap options for extracting impacted mandibular third molars.

Key words: mandibular third molar extraction, distal-triangular flap, Szymd flap, envelope flap, postoperative complication

中图分类号:

R 782.11

刘济远, 刘畅, 潘剑, 曲涛, 华成舸. 远中三角瓣在下颌阻生第三磨牙拔除术中的应用[J]. 华西口腔医学杂志, 2021, 39(5): 598-604.

Liu Jiyuan, Liu Chang, Pan Jian, Qu Tao, Hua Chengge.. Distal-triangular flap design for impacted mandibular third molars: a randomized controlled trial[J]. West China Journal of Stomatology, 2021, 39(5): 598-604.

图/表 5

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表 1

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表 3

参考文献 19

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项目	远中三角瓣组	近中三角瓣组	封套瓣组	P值
性别				0.817
女	12	11	10
男	8	9	10
年龄/岁	22.75±2.05	21.65±1.57	22.10±1.83	0.169
阻生位置				0.766
左侧	11	9	11
右侧	9	11	9
Pell & Gregory分类				0.583
Ⅰ类	5	8	6
Ⅱ类	15	12	14

项目	远中三角瓣组	近中三角瓣组	封套瓣组	P值
手术时间/min	8.40±5.91	8.95±4.11	7.95±5.04	0.823
术后疼痛/mm				时间P=0.000，时间×组间P=0.592，组间P=0.587
术后1 d	27.65±16.63	28.15±21.62	30.40±19.12
术后2 d	23.50±18.00	30.80±20.71	25.45±19.48
术后3 d	18.80±15.93	24.35±18.35	21.55±17.14
术后7 d	2.90±4.61	7.50±10.57	4.95±6.60
术后肿胀/mm				时间P=0.000，时间×组间P=0.473，组间P=0.787
术后1 d	3.8±7.0	3.5±4.4	5.1±6.2
术后2 d	6.3±7.2	4.1±3.8	5.0±9.0
术后3 d	3.7±5.4	2.7±2.8	2.5±5.5
术后7 d	0.7±3.3	0.3±4.1	0.9±3.8
张口度/mm				时间P=0.000，时间×组间P=0.367，组间P=0.661
术前	49.65±6.47	51.35±7.49	48.25±7.24
术后1 d	43.95±10.49	46.10±12.81	44.65±5.80
术后2 d	44.30±10.90	46.65±11.94	45.35±5.84
术后3 d	46.25±9.36	47.70±11.30	47.20±6.11
术后7 d	49.55±6.93	49.80±9.28	48.40±6.58
术后1月	51.50±5.03	52.25±7.00	49.60±5.99
术后2月	52.25±4.84	52.50±7.54	49.10±5.78
术后3月	52.45±4.72	52.40±7.88	49.80±6.07

项目	远中三角瓣组	近中三角瓣组	封套瓣组	P值
第二磨牙PPD/mm
近颊				时间P=0.955，时间×组间P=0.904，组间P=0.995
术前	2.33±0.47	2.23±0.57	2.20±0.70
术后1月	2.28±0.68	2.25±0.41	2.30±0.64
术后2月	2.20±0.50	2.28±0.57	2.25±0.51
术后3月	2.25±0.53	2.25±0.50	2.25±0.62
颊侧中点				时间P=0.200，时间×组间P=0.313，组间P=0.310
术前	1.98±0.55	2.03±0.53	1.93±0.49
术后1月	2.03±0.53	2.08±0.37	1.85±0.61
术后2月	2.15±0.33	2.13±0.46	1.93±0.49
术后3月	2.28±0.44	2.00±0.43	2.00±0.56
远颊				时间P=0.000，时间×组间P=0.113，组间P=0.215
术前	3.03±0.99	3.50±1.54	4.23±2.28
术后1月	2.45±0.67	3.03±1.29	2.98±1.36
术后2月	2.38±0.65	2.63±1.02	2.43±0.54
术后3月	2.38±0.48	2.25±1.00	2.25±0.44
近舌				时间P=0.033，时间×组间P=0.448，组间P=0.798
术前	2.30±0.50	2.35±0.83	2.15±0.86
术后1月	2.60±0.58	2.48±0.55	2.68±0.49
术后2月	2.53±0.55	2.38±0.48	2.50±0.36
术后3月	2.50±0.79	2.38±0.58	2.55±0.39
舌侧中点				时间P=0.101，时间×组间P=0.062，组间P=0.168
术前	2.00±0.46	1.88±0.58	2.18±0.57
术后1月	2.30±0.55	1.93±0.49	1.90±0.42
术后2月	2.30±0.47	2.13±0.43	2.05±0.43
术后3月	2.20±0.57	2.03±0.44	2.35±0.49
远舌				时间P=0.000，时间×组间P=0.723，组间P=0.759
术前	2.83±1.17	2.78±1.56	2.85±1.13
术后1月	2.20±0.55	2.05±0.54	2.08±0.67
术后2月	2.33±0.67	2.10±0.75	2.13±0.32
术后3月	2.25±0.62	2.10±0.80	2.38±0.43
第二磨牙远中裂隙/n				P=0.918 P=0.490 P=0.362
术后1月	14	15	15
术后2月	5	5	8
术后3月	0	1	0

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远中三角瓣在下颌阻生第三磨牙拔除术中的应用

Distal-triangular flap design for impacted mandibular third molars: a randomized controlled trial

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