两种缝合方式对下颌低位阻生智齿拔除术后并发症的影响

摘要/Abstract

摘要： 目的〓观察两种不同的缝合方式对下颌低位阻生智齿拔除术后并发症的影响。方法选择100例需翻瓣去骨拔除的下颌低位阻生智齿，随机分为观察组和对照组各50例。术中均采用传统角形切口（近中颊侧切口+远中切口），对照组拔牙术后切口采取完全缝合（远中切口缝合+颊侧切口缝合），观察组拔牙术后切口采取部分缝合（远中切口缝合+龈瓣转折处缝合，颊侧切口不缝合），两组术后均常规预防性抗感染治疗。比较两组术后48 h及7 d拔牙后出血、面颊部肿胀、疼痛及张口受限情况，并作统计学分析。结果两组术后在48 h及7 d拔牙后出血、疼痛、张口受限及面部肿胀程度均无显著性差异（P＞0.05）。结论两种缝合方式对于下颌低位阻生智齿拔除术后出血、疼痛、张口受限及局部肿胀程度等并发症并无明显差异，但部分缝合术可以减少手术操作时间，简化手术过程，减少患者的创伤。

关键词: 智齿, 拔牙术, 缝合术, 并发症

Abstract: Objective To evaluate the effects of two different suture techniques of the triangular flap on the postoperative complications after the removal of impacted lower third molar. Method A prospective, randomized clinical trial was conducted among 100 patients who underwent surgical extraction of impacted lower third molar at the Department of Oral Surgery in Stomatological Hospital of Jiangsu Province. Patients were randomly divided into 2 groups (each group of 50 people). Two different techniques (complete closure and partial closure of the wound) were performed respectively with conventional antiinfection therapy postoperatively. The control group adopted the complete closure while the observation group the partial closure after operation. Postoperative complications were evaluated prior to the surgical procedure and also at 48 hours and 7 days postoperatively. Result No statistically significant differences were observed for bleeding(P＞0.05), swelling(P＞0.05)，pain (P＞0.05) and trismus(P＞0.05) between the observation group and the control group. Conclusion Partial closure of the flap without suturing the relieving incision after surgical extraction of lower third molar reduces operating time and it does not increase the postoperative complications compared with complete closure of the wound.

Key words: wisdom tooth, extraction of tooth, suture techniques, complication

中图分类号:

R782.11

惠镠玲李冰张栋华丁思阳陈宁. 两种缝合方式对下颌低位阻生智齿拔除术后并发症的影响[J]. , 2016, 36(11): 1006-1010.

参考文献

[1]Yuasa H,Sugiura M.Clinical postoperative findings after removal of impacted mandibular third molars: Prediction of postoperative facial swelling and pain based on preoperative variables[J].Br J Oral Maxillofac Surg,2004,42(3):209-214
[2]白晓峰.阻生齿拔除术及拔牙术后并发症[J].中国实用口腔科杂志,2010,3(3):26-28
[3]Dolanmaz D,Esen A,Isik K,et al.Effect of 2 flap designson postoperative pain and swelling after impacted third molar surgery[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2013,116(4):e244-e246
[4]Hashemi HM,Beshkar M,Aghajani R,et al.The effect of sutureless wound closure on postoperative pain and swelling after impacted mandibular third molar surgery[J].Br J Oral Maxillofac Surg,2012,50(3):256-258
[5]Waite PD,Cherala S,et al.Surgical outcomes for suture-less surgery in 366 impacted third molar patients[J].J Oral Maxillofac Surg,2006,64(4):669-673
[6]Bello SA,Olaitan AA,LadeindeAL,et al.A randomized comparison ofthe effect of partial and total wound closure techniques on postoperative morbidity after mandibular third molar surgery[J].J Oral Maxillofac Surg,2011,69(6):24-30
[7]Danda AK,Krishna Tatiparthi M,Narayanan V,et al.Influence of primary and secondary closure of surgical wound after impacted mandibular third molar removal on postoperative pain and swellingA comparative and split mouth study[J]..J Oral Maxillofac Surg,2010,68(2):309-312
[8]Hashemi HM,Beshkar M,Aghajani R,et al.The effect of sutureless wound closure on postoperative pain and swelling after impacted mandibular third molar surgery[J].Br J Oral MaxillofacSurg,2012,50(3):256-258
[9]Baqain ZH,Al-Shafii A,Hamdan AA,et al.Flap design and mandibular third molar surgery: A split mouth randomized clinical study[J].Int J Oral MaxillofacSurg,2012,41(8):1020-1024
[10]Sandhu A,Sandhu S,Kaur T,et al.Comparison of two different flap designs in the surgical removal of bilateral impacted mandibular third molars[J].Int J Oral MaxillofacSurg,2010,39(11):1091-1096
[11]周宏志,胡开进,秦瑞峰,等.下颌阻生第三磨牙拔除难度预判[J].口腔医学研究,2009,6(25):327-329
[12]Cosme Gay-Escoda,Gómez-Santos L,Sánchez-Torres A,et al.Effect of the suture technique on postoperative pain,swelling and trismusafter removal of lower third molars: A randomized clinical trial[J].Med Oral Patol Oral Cir Bucal,2015,3(20):e372-e377
[13]张震康.口腔颌面外科学[M].北京:北京大学出版社，2007：11
[14]Singh G,Gaur A,Mishra M,et al.Comparative evaluation of primary and secondary closure after surgical removal of impacted mandibular third molar[J][J].J Oral MaxillofacSurg Med Pathol,2014,26(2):133-137
[15]Maria A,Malik M,Virang P,et al.Comparison of primary and secondary closure of the surgical wound after removal of impacted mandibular third molars[J].MaxillofacOral Surg,2012,11(3):276-283
[16]H Shigeishi，K Ohta，M Takechi,et al.Risk factors for postoperative complications following oral surgery[J].J Appl Oral Sci,2015,4 (23):419-423
[17]Lee CT,Zhang S,Leung YY,et al.Patients' satisfaction and prevalence of complications on surgical extraction of third molar[J].Patient Prefer Adherence,2015,9:257-263
[18]王静娟，吴迪，丁宇翔，等.拔牙并发症原因及防治(4)：全身性因素导致的拔牙术后出血[J].中国实用口腔科杂志,2014,(12):705-707
[19]童爱国，闰平.188例拔牙术后出血的临床分析[J].内蒙古中医药,2011,30(6):373-374
[20]刘景文，黄雅南，范勇斌，等.老年心血管病患者拔牙术后出血46例临床分析[J].海南医学,2009,20(12):131-132
[21]Yang Linchun,Chu Jianqiang.Discussion of the mandibular impacted wisdom tooth root pruning treatment[J].China Modern Medicine,2011,33(6):176-177
[22]Bened IS,WenzelA,PetersenJK,et al.Mandibular third moles removal: Risk indicators for extended operation time,postoperative pain,and complications[J].Oral SurgOral Med Oral Pathol Oral Radiol Endod,2004,97(4):438-446
[23]WENG Suqing,ZHANG Hezhi.Prevention of dry sockets after extraction of impacted mandibular third molar by using para-aminomethylbenzoic gelatin sponge [J] West China J Stomatol,1996,14(3):241
[24]Troullos ES,Hargreaves KM,Hutler DP,et al.Comparison of nosteroidal anti-inflammatory Drugs,ibuprofen and flurbiprofen,with methylprednisolone and placebo for acute pain,swelling,and Trismus[J].J Oral Maxillofac Surg,1990,48(9):945-952
[25]Koyuncu B,Zeytinoglu M,Tetik A,et al.Effect of tube drainage compared with conventional suturing on postoperative discomfort after extraction of impacted mandibular third molars[J].Br J Oral Maxillofac Surg,2015,53(1):63-67
[26]陈芳，邵江红.高速涡轮手机在下颌低位水平阻生智齿拔除术中的临床观察[J].山西医药杂志,2015,44(7):810-812
[27]许国雄，陈建灵，王晓山,等.下颌第三阻生牙拔除术并发症回顾性分析[J].临床医学工程,2012,19(6):915-916
[28]Osunde OD,Saheeb BD,Adebola RA,et al.Comparative study of effect of single and multiple suture techniques on inflammatory complications after third molar surgery[J].J Oral MaxillofacSurg,2011,69(69):971-976
[29]Osunde OD,Adebola RA,Saheeb BD,et al.A comparative study ofthe effect of suture-less and multiple suture techniques on inflammatory complications following third molar surgery[J].Int J Oral Maxillofac Surg,2012,41(10):1275-1279
[30]Carrasco-Labra A,Brignardello-Petersen R,Yanine N,et al.Secondary versus primary closure techniques for the prevention of postoperative complications following removal of impacted mandibular third molars: A systematic review and meta analysis of randomized controlled trials[J].J Oral Maxillofac Surg,2012,70(8):e441-e457