改良三点注射麻醉方法在下颌阻生第三磨牙拔除术中的解剖学可行性研究  

Anatomic feasibility evaluation of a modified three site anesthesia injection method for extraction of an impacted mandibular third molar

作　　者：聂小汉 陈栋 吕娇 张雪梅[1] 张啸飞[1] 罗顺云 NIE Xiao-han!;CHEN Dong;LV Jiao;ZHANG Xue-mei;ZHANG Xiao-fei;LUO Shunyun(Department of Stomatology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China;Department of Stomatology,Beijing Chaoyang Maternal and Child Care Hospital,Beijing 100021,China)

机构地区：[1]清华大学附属北京清华长庚医院口腔科,清华大学临床医学院,北京102218 [2]北京市朝阳区妇幼保健医院口腔科,北京100021

出　　处：《临床口腔医学杂志》2022年第1期14-18,共5页Journal of Clinical Stomatology

摘　　要：目的:通过三维测量分析改良三点注射法远中位点进针时针尖止点距下颌孔的距离,从解剖学上证实远中位点注射可有效阻滞麻醉下牙槽神经。方法:选取63名患者进行CBCT扫描,获得DICOM数据,导入到Simplant OMS软件进行三维测量分析。通过计算模拟进针时下颌孔距针尖止点的距离,与麻醉药品有效浸润距离10 mm进行单侧t检验分析,并进行描述性统计分析双侧进针角度。结果:左侧进针深度(20.49±2.20)mm与20 mm无统计学差异(P>0.05);右侧进针深度(21.17±2.75)mm)与20 mm存在统计学差异(P<0.05)。左侧及右侧浸润距离与10 mm采用单侧t检验(μ>10 mm),90%置信区间分别为(4.1061,4.7879)、(4.2169,5.1231),具有统计学差异(P<0.05)。左侧进针角度为(40.60±6.81)°;右侧进针角度为(41.28±4.91)°。结论:解剖学上证实改良三点注射法远中位点注射可以成功阻滞麻醉下牙槽神经,通过三维测量分析数据,可以更好地指导临床注射。Objective:This study is aimed to determine the anatomic feasibility of a modified three site anesthesia injection method for extraction of an impacted mandibular third molar.Methods:Three-dimensional(3D)reconstruction and analysis of the mandibles was performed using cone-beam computed tomography(CBCT)scanning to measure the simulated needle insertion depth,infiltration distance,and other important parameters.These parameters were compared with an actual depth of 20 mm and a theoretic infiltration distance of 10 mm.The main parameters were compared between males and females.Sixty-three CBCT datasets were imported into Simplant OMS software for 3D reconstruction.Results:The left simulated insertion depth did not differ from 20 mm,while right insertion depth was>20 mm(P<0.05).The bilateral infiltration distances were<10 mm(P<0.05)and articaine blocked the inferior alveolar nerve(IAN).The left injection angle was(40.60±6.81)°.The right injection Angle was(41.28±4.91)°.Conclusion:The modified three-distal site anesthesia injection method was shown to block the IAN based on anatomic evidence derived from an analysis of 3D measurements,which will facilitate the administration of clinical anesthesia.

关 键 词：改良三点注射麻醉 下牙槽神经阻滞麻醉 阻生第三磨牙拔除 

分 类 号：R782.05[医药卫生—口腔医学]