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中华口腔医学研究杂志(电子版) ›› 2015, Vol. 09 ›› Issue (06) : 478 -483. doi: 10.3877/cma.j.issn.1674-1366.2015.06.008

所属专题： 文献；

临床研究

冠周局部注射地塞米松预防下颌第三磨牙拔除术后并发症
胡飚1, 周媛2, 刘兴光3, 陶谦3,†()   
  1. 1. 510220　广州市海珠区口腔医院综合科
    2. 510000　广州市第八人民医院口腔科
    3. 510055　广州，中山大学光华口腔医学院·附属口腔医院，广东省口腔医学重点实验室
  • 收稿日期:2015-06-12 出版日期:2015-12-01
  • 通信作者: 陶谦

Effect of pericoronal local injection of dexamethasone to prevent postoperative complication in the third molar impaction surgery

Biao Hu1, Yuan Zhou2, Xingguang Liu3, Qian Tao3,†()   

  1. 1. Department of General, Stomatological Hospital of Haizhu District, Guangzhou 510220, China
    2. Department of Stomatology, the Eighth People′s Hospital, Guangzhou 510000, China
    3. Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2015-06-12 Published:2015-12-01
  • Corresponding author: Qian Tao
  • About author:
    Corresponding author: Tao Qian, Email: , Tel: 020-83846030
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引用本文：

胡飚, 周媛, 刘兴光, 陶谦. 冠周局部注射地塞米松预防下颌第三磨牙拔除术后并发症[J]. 中华口腔医学研究杂志(电子版), 2015, 09(06): 478-483.

Biao Hu, Yuan Zhou, Xingguang Liu, Qian Tao. Effect of pericoronal local injection of dexamethasone to prevent postoperative complication in the third molar impaction surgery[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2015, 09(06): 478-483.

目的

评价拔牙术前或术后行地塞米松冠周局部注射（下颌第三磨牙颊侧组织，磨牙后三角区以及咀嚼肌区）在下颌第三磨牙拔除术后肿胀，疼痛及张口受限的预防效果。

方法

对240例患者的下颌第三磨牙依照阻生类型进行三种方法拔除，对三组牙拔除方式的患者分别列为实验组（拔牙术前冠周局部注射地塞米松组和拔牙术后注射地塞米松组）和对照组（拔牙术前术后均未注射地塞米松），对患者术后第1、3、7天进行随访分析，对患者肿胀指数，疼痛程度和张口受限程度进行统计，并作统计学分析。实验组之间，以及实验组与对照组之间的比较采用卡方检验，以P<0.05为差异有统计学意义。

结果

在拔牙术后第1天和第7天，术前或术后冠周局部注射地塞米松组与未注射地塞米松组在肿胀指数，疼痛程度和张口受限程度差异无统计学意义（P>0.05）；术后第3天，术前或术后冠周局部注射地塞米松组较对照组在肿胀反应中具有更好的疗效（P<0.05），在疼痛和张口受限程度中具有一定的预防、治疗效果（P>0.05）。术前或术后冠周局部注射地塞米松对拔牙后肿痛反应及张口受限程度差异无统计学意义。

结论

拔牙术前或术后冠周局部注射地塞米松可有效的预防下颌第三磨牙拔除术后肿胀、疼痛反应以及张口受限的发生。

关键词: 磨牙，第三，下颌, 地塞米松, 冠周局部注射, 拔牙, 手术后并发症
Objective

To assess the efficacy of dexamethasone (DM) pericoronal injection preoperative or postoperative for the control of swelling, pain and trismus caused by impacted mandibular third molars extraction.

Methods

Totally 240 consecutive patients requiring surgical removal of mandibular third molar were divided into three groups according to extraction of the impacted molars. Each of the three groups was split into experimental group (Dexamethasone pericoronal injection preoperative and postoperative) and control group (Non-pericoronal injection of Dexamethasone) , respectively. Swelling, pain and trismus were assessed by following-up evaluation at 1st, 3rd and 7th postoperative days.

Results

The statistics analysis showed similar result in the severity of swelling, pain and trismus at the experimental group and control group on 1st and 7th postoperative day. It was noticed that the experimental group promoted a better prognosis of swelling, pain and trismus. There was no difference between the groups of DM pericoronal injection preoperative and DM pericoronal injection postoperative on these parameters.

Conclusion

It appeared that DM pericoronal injection preoperative or postoperative would control swelling, pain and trismus following impacted mandibular third molar extraction.

Key words: Molar, third, mandibular, Dexamethasone, Pericoronal local injection, Tooth extraction, Postoperative complication
图1 下颌第三磨牙拔除术后颌面部肿胀评估定点及连线示意图
表1 240例下颌第三磨牙拔除术患者性别、年龄分布及拔牙时间
组别 例数 年龄（岁， ± s） 性别（例） 拔牙时间（min， ± s）
男 女
Aa组 30 26.77 ± 6.78 16 14 12.67 ± 4.50
Ab组 30 27.23 ± 5.48 17 13 12.13 ± 4.43
Ac组 30 25.73 ± 4.70 17 13 12.63 ± 3.86
Ba组 30 26.97 ± 4.84 16 14 19.80 ± 4.60
Bb组 30 25.87 ± 5.50 16 14 20.20 ± 4.69
Bc组 30 27.63 ± 5.42 18 12 19.77 ± 4.52
Ca组 20 26.45 ± 3.82 10 10 22.05 ± 4.56
Cb组 20 27.05 ± 5.10 11 9 21.30 ± 4.35
Cc组 20 28.10 ± 5.21 10 10 22.55 ± 5.02
表2 240例下颌第三磨牙拔除术后患者颌面部肿胀指数统计（cm， ± s）
组别 例数 术后第1天 术后第3天 术后第7天
Aa组 30 1.58 ± 0.59 2.50 ± 1.22 0.75 ± 0.81
Ab组 30 1.64 ± 0.60 2.38 ± 1.07 0.78 ± 0.70
Ac组 30 1.92 ± 0.77 2.99 ± 0.96 0.97 ± 0.85
Ba组 30 1.92 ± 0.59 2.62 ± 0.63 0.87 ± 0.69
Bb组 30 2.02 ± 0.59 2.67 ± 0.78 0.86 ± 0.69
Bc组 30 2.19 ± 0.45 3.08 ± 0.63 0.90 ± 0.78
Ca组 20 1.94 ± 0.49 2.74 ± 0.78 0.79 ± 0.58
Cb组 20 1.96 ± 0.51 2.67 ± 0.77 0.70 ± 0.50
Cc组 20 2.09 ± 0.46 3.22 ± 0.64 0.71 ± 0.41
表3 240例下颌第三磨牙拔除术后患者疼痛程度比较（%）
组别 例数 术后第1天 术后第3天 术后第7天
Aa组 30 63.3 86.7 90.0
Ab组 30 60.0 86.7 90.0
Ac组 30 50.0 80.0 93.3
Ba组 30 43.3 66.7 90.0
Bb组 30 46.7 63.3 83.3
Bc组 30 36.7 60.0 83.3
Ca组 20 75.0 70.0 90.0
Cb组 20 40.0 55.0 75.0
Cc组 20 70.0 40.0 70.0
表4 240例下颌第三磨牙拔除术后患者张口受限程度比较（%）
组别 例数 术后第1天 术后第3天 术后第7天
Aa组 30 76.6 80.0 96.7
Ab组 30 70.0 73.3 90.0
Ac组 30 56.7 66.7 83.3
Ba组 30 76.7 80.0 96.7
Bb组 30 76.7 73.3 93.3
Bc组 30 73.3 66.7 90.0
Ca组 20 65.0 65.0 80.0
Cb组 20 60.0 60.0 75.0
Cc组 20 50.0 45.0 55.0
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