下颌近中阻生第三磨牙拔除方法与神经损伤危险因素分析

目的: 调查分析下颌近中阻生第三磨牙拔除术后牙槽骨缺损及下牙槽神经（inferior alveolar nerve,IAN）损伤发生的影响因素,为今后制定更具针对性的预防措施提供参考。方法: 回顾性调查分析500例口腔门诊顺利完成下颌近中阻生第三磨牙拔除术患者的临床资料、影像学资料、随访资料等,对比分析发生与未发生牙槽骨缺损及神经损伤患者的资料,明确危险因素。采用SPSS18.0软件包进行Logistic回归分析,研究发生牙槽骨缺损及神经损伤的独立危险因素。结果: 500例患者中,52例 (10.40%)发生IAN损伤。经单因素分析和Logistic回归分析发现,患者年龄、手术切口、拔牙器械、拔牙术方案、术后其他并发症（血肿、感染、干槽症）均为下颌近中阻生第三磨牙拔除术后牙槽骨缺损及神经损伤的危险因素（P<0.05）。结论: 术前充分考虑患者年龄、下颌阻生第三磨牙的阻生形态、解剖结构、牙根和下颌管位置关系,进而评估拔除风险、个性化拟定手术方案并选择最佳的手术器械,可预防术后并发症的发生。

Analysis of risk factors of alveolar bone defect and inferior alveolar nerve injury after extraction of impacted mandibular third molar

PURPOSE: To investigate the influencing factors of alveolar bone defect and inferior alveolar nerve (IAN) injury after mandibular mesially impacted third molar extraction, and to provide reference for future development of more targeted preventive measures. METHODS: The clinical data, imaging data and follow-up data of 500 cases of mandibular impacted third molar extraction were retrospectively analyzed, and the data of the patients with no alveolar bone defect and IAN injury were compared and analyzed. The independent risk factors of alveolar bone defect and IAN injury were analyzed by logistic regression analysis with SPSS 18.0 software package. RESULTS: In 500 patients, 52 (10.40%) had IAN damage. Single factor analysis and Logistic regression analysis showed that the age of patients, surgical incision, dental instruments, dental surgery, postoperative complications (hematoma, infection, dry socket) were factors of alveolar bone defect and IAN injury (P<0.05). CONCLUSIONS: The age of patients, anatomical structure of the impacted third molar, the relationship between the anatomical structure, the position of the root and the mandibular canal should be fully investigated before operation, in order to prevent and minimize postoperative complications.