CAJ | 학술논문

目的：研究拔除下颌第三磨牙的手术难度与术后疼痛、张口受限的关系。方法：选取需要拔除下颌第三磨牙的患者244例，按照手术难度，将手术方式分为4级：Ⅰ级，直接牙钳、牙挺拔除；Ⅱ级，切割牙冠后挺松拔除；Ⅲ级，需翻瓣、去骨、切割牙冠后拔除；Ⅳ级，需要翻瓣、去骨、切割冠、分根等复杂操作。记录手术时间，采用视觉模拟评分法（VAS）记录术后6 d每天的疼痛程度及最大开口度（MID）。结果：拔牙后0~6 d，Ⅲ级、Ⅳ级手术患者每天的疼痛VAS值均高于Ⅰ级手术，差异有统计学意义（P<0.05）；拔牙后0~5 d，Ⅱ级手术患者每天的VAS值高于Ⅰ级手术，差异有统计学意义（P<0.05）；术后6 d，Ⅰ级手术患者的MID最大，与术前比较变化不大，但与其他组比较差异有统计学意义（P<0.05）；Ⅱ、Ⅲ、Ⅳ级手术患者的MID术后3 d显著下降；Ⅰ级手术患者术后24 h内需要服用止痛药的例数低于Ⅱ、Ⅲ、Ⅳ级。结论：下颌第三磨牙拔除术，手术越困难复杂，拔牙时间越长，术后的疼痛及张口受限越严重。
목적：연구발제하합제삼마아적수술난도여술후동통、장구수한적관계。방법：선취수요발제하합제삼마아적환자244례，안조수술난도，장수술방식분위4급：Ⅰ급，직접아겸、아정발제；Ⅱ급，절할아관후정송발제；Ⅲ급，수번판、거골、절할아관후발제；Ⅳ급，수요번판、거골、절할관、분근등복잡조작。기록수술시간，채용시각모의평분법（VAS）기록술후6 d매천적동통정도급최대개구도（MID）。결과：발아후0~6 d，Ⅲ급、Ⅳ급수술환자매천적동통VAS치균고우Ⅰ급수술，차이유통계학의의（P<0.05）；발아후0~5 d，Ⅱ급수술환자매천적VAS치고우Ⅰ급수술，차이유통계학의의（P<0.05）；술후6 d，Ⅰ급수술환자적MID최대，여술전비교변화불대，단여기타조비교차이유통계학의의（P<0.05）；Ⅱ、Ⅲ、Ⅳ급수술환자적MID술후3 d현저하강；Ⅰ급수술환자술후24 h내수요복용지통약적례수저우Ⅱ、Ⅲ、Ⅳ급。결론：하합제삼마아발제술，수술월곤난복잡，발아시간월장，술후적동통급장구수한월엄중。
Objective:To investigate the influence of surgical difficulty on postoperative pain and trismus after extraction of mandibular third molars.Method:A prospective study was performed of 244 patients who underwent mandibular third molar extractions. For evaluation of surgical difficulty,a 4-class scale was completed after surgery:I:extraction with forceps and elevator;II:extraction requiring coronal section;III:extraction requiring flap operation, osteotomy and coronal section;IV:complex extraction(root section). the operation time was record,postoperative 6 d,the level of pain was record every day by the method of visual analogue scale(VAS),and the MID was record too. Result:Mean pain evaluation was significantly higher in difficulty classⅢand IV than in difficulty class I on days 0 to 6 inclusive(P<0.05),and significantly higher in class II than class I on days 0 to5 inclusive(P<0.05). MID on day 0 to 6 in the class I was the biggest,there was no significantly difference compared with preoperative,but the differences were significantly compared with other classes(P<0.05). MID of class II,III,IV were significantly decreased after 3 days. Patients need a painkiller in classⅠwithin 24 h after surgery were lower than that of classⅡ,Ⅲ,Ⅳ. Conclusion:Mandibular third molar removal surgery,surgery more difficult and complex,tooth,the longer the more serious the postoperative pain and limited mouth opening.