阻生下颌第三磨牙拔除术后干槽症的循证预防  

Evidence-based Prevention for Dry Socket Following an Impacted Mandibular Third Molar Extraction

作　　者：曾宪涛[1,2] 陈启林[1,2] 倪小兵[1,2] 菅玥[1,3] 王竹[1,3] 黄伟[1,2] 

机构地区：[1]湖北医药学院附属太和医院口腔科,湖北十堰442000 [2]湖北医药学院口腔颌面外科研究室,湖北十堰442000 [3]湖北医药学院口腔医学院,湖北十堰442000

出　　处：《湖北医药学院学报》2013年第2期125-128,共4页Journal of Hubei University of Medicine

基　　金：湖北省教育科学"十二五"规划2012年度重点课题(2012A050);湖北医药学院2011年度优秀中青年科技创新团队项目(2011CZX01);湖北医药学院2010年度教学研究项目(2010017)

摘　　要：目的:运用循证医学理念,为1例行阻生下颌第三磨牙拔除术的患者提供术后干槽症预防的依据。方法:在充分评估患者病情的基础上,根据"PICO"原则提出临床问题,检索Cochrane Library、Clinical Evidence、PubMed、CNKI和万方数据库,检索时间为2012年12月24日,查找干槽症预防的证据,并结合医师的经验及患者的意愿,为患者选择最佳的方案。结果:最终纳入8篇系统评价/Meta分析和3篇随机对照试验。证据表明:当前预防干槽症的最佳证据有冠切术、中药、氯己定、术前和术后使用抗生素、脱细胞真皮基质或者颊部带蒂皮瓣转移覆盖。综合文献信息及医师的建议,患者选择了术前及术后使用抗生素的方法。术后随访9天,患者拔牙创愈合良好,未发生干槽症及其他感染性并发症。结论:对阻生下颌第三磨牙拔除术的患者,术前及术后联合使用抗生素能够有效预防干槽症的发生。Objective To provide the evidence for preventing dry socket following an impacted mandibular third molar extraction based on the principle of evidence-based medicine.Methods Based on fully assessing the conditions of patients,the clinical problems were raised according to 'PICO' principle.The Cochrane Library,Clinical Evidence,PubMed,CNKI and Wanfang databases were searched up to December 24,2012 for the high quality clinical evidence relevant to prevent dry socket,and then choose the best therapeutic schedule combined with experiences of doctor and willing of patients.Results Finally 8 systematic reviews/meta-analyses and 3 randomized controlled trials were enrolled.The evidences indicated that coronectomy,Chinese medicine,chlorhexidine,pre-and post-operative antibiotics,acellular dermal matrix,and buccal envelope or pedicle flap are the best approaches currently.Based on literature evidence and the suggestion of doctor,the patient chose the pre-and post-operative antibiotics treatment.After nine days of follow-up,the tooth wound healed in good condition and the dry socket or other infections has not occurred.Conclusion The using of pre-and post-operative antibiotics could prevent patients who need to remove mandibular third impact molars from dry socket effectively.

关 键 词：阻生牙 第三磨牙 智齿 拔牙术 干槽症 循证决策 

分 类 号：R782.1[医药卫生—口腔医学]