局部麻醉下第三磨牙拔除手术难度与临床及血液参数术后演变的关系
Relationship Between Surgical Difficulty of Third Molar Extraction Under Local Anesthesia and the Postoperative Evolution of Clinical and Blood Parameters.
作者信息
Sainz de Baranda Beatriz, Silvestre Francisco-Javier, Silvestre-Rangil Javier
机构信息
Dental Surgeon, Private Practice, Albacete, Spain.
Professor, Department of Stomatology, University of Valencia, Valencia, Spain.
出版信息
J Oral Maxillofac Surg. 2019 Jul;77(7):1337-1345. doi: 10.1016/j.joms.2019.02.020. Epub 2019 Feb 20.
PURPOSE
To determine whether the Pederson scale is a good predictor of the surgical difficulty of third molar extraction and establish whether such surgical difficulty is directly related to the postoperative course as assessed from clinical (pain, inflammation, and trismus) and blood (C-reactive protein, interleukin-6 [IL-6], and fibrinogen) parameters.
MATERIALS AND METHODS
A prospective observational study was conducted of 2 groups of patients who underwent simple or surgical third molar extraction under local anesthesia. Clinical and blood parameters and possible complications were recorded for 1 week after extraction.
RESULTS
A total of 118 patients were studied. Surgical difficulty as predicted by the Pederson scale showed significant differences (P < .001) for osteotomy, sectioning of the crown, root sectioning, duration of intervention, type of closure, and number of sutures. Under conditions of equal surgical difficulty, the evolution of the groups was similar for pain and inflammation, although trismus was greater for patients subjected to surgical extraction. After the operation, marked increments were recorded in serum C-reactive protein, IL-6, and fibrinogen, although without differences among different levels of surgical difficulty. The probability of complications was similar in the routine and surgical extraction groups. The appearance of complications was the principal cause of alterations in clinical and blood parameters.
CONCLUSIONS
The Pederson scale is a good predictor of the surgical difficulty of third molar removal as assessed from different clinical and blood parameters. C-reactive protein, IL-6, and fibrinogen concentrations varied considerably after the operation but were not influenced by the degree of surgical difficulty. The presence of postoperative complications was associated with a poorer evolution of clinical and blood parameters.
目的
确定佩德森量表是否能很好地预测第三磨牙拔除术的手术难度，并确定这种手术难度是否与从临床（疼痛、炎症和牙关紧闭）和血液（C反应蛋白、白细胞介素-6 [IL-6]和纤维蛋白原）参数评估的术后病程直接相关。
材料与方法
对两组在局部麻醉下接受简单或外科第三磨牙拔除术的患者进行了一项前瞻性观察研究。记录拔牙后1周的临床和血液参数以及可能出现的并发症。
结果
共研究了118例患者。佩德森量表预测的手术难度在截骨、牙冠切割、牙根切割、干预持续时间、缝合类型和缝合数量方面显示出显著差异（P <.001）。在手术难度相同的情况下，两组在疼痛和炎症方面的进展相似，尽管接受外科拔牙的患者牙关紧闭情况更严重。术后，血清C反应蛋白、IL-6和纤维蛋白原显著升高，尽管不同手术难度水平之间没有差异。常规拔牙组和外科拔牙组并发症的发生率相似。并发症的出现是临床和血液参数改变的主要原因。
结论
从不同的临床和血液参数评估，佩德森量表是第三磨牙拔除术手术难度的良好预测指标。术后C反应蛋白、IL-6和纤维蛋白原浓度变化很大，但不受手术难度程度的影响。术后并发症的出现与临床和血液参数的较差进展相关。
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