下颌第三磨牙拔除术后下牙槽神经损伤的功能检测及预后分析

doi:10.3969/j.issn.1674-8115.2022.06.004

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (6): 717-722.doi: 10.3969/j.issn.1674-8115.2022.06.004

• 口腔外科专题 • 上一篇

下颌第三磨牙拔除术后下牙槽神经损伤的功能检测及预后分析

董亚兵(), 郝昀博, 张文豪, 王轶雯, 陈敏洁()

上海交通大学医学院附属第九人民医院口腔外科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011

收稿日期:2022-03-16 接受日期:2022-06-23 出版日期:2022-06-28 发布日期:2022-08-19
通讯作者: 陈敏洁 E-mail:dzdybb@163.com;chenmj_sub@163.com
作者简介:董亚兵（1989—），男，住院医师，博士；电子信箱：dzdybb@163.com。
基金资助:
上海市科学技术委员会医学创新研究专项(21Y11903500);上海交通大学医学院附属第九人民医院临床研究助推计划（临+计划）(JYLJ201903);上海交通大学医工（理）交叉基金(YG2022QN050);上海交通大学口腔医学院口腔颌面外科学系研究助力基金(系2021-04)

Functional detection and prognostic analysis of inferior alveolar nerve injury after mandibular third molar extraction

DONG Yabing(), HAO Yunbo, ZHANG Wenhao, WANG Yiwen, CHEN Minjie()

Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China

Received:2022-03-16 Accepted:2022-06-23 Online:2022-06-28 Published:2022-08-19
Contact: CHEN Minjie E-mail:dzdybb@163.com;chenmj_sub@163.com
Supported by:
Special Research on Medical Innovation of Shanghai Municipal Commission of Science and Technology(21Y11903500);Clinical Research Booster Program of Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(JYLJ201903);Interdisciplinary Program of Shanghai Jiao Tong University(YG2022QN050);Research Assistance Fund of Department of Oral and Maxillofacial Surgery, College of Stomatology, Shanghai Jiao Tong University(2021-04)

摘要/Abstract

摘要：

目的·应用电流感觉阈值检测（current perception threshold，CPT）、牙髓电活力测试（electrical pulp test，EPT）以及两点测试（two-point discrimination，2PD）对下牙槽神经损伤致下唇麻木患者的下牙槽神经损伤程度以及预后进行量化评价，建立下牙槽神经损伤诊断检测方案，并为预后评估提供参考。方法·纳入2018年7月—2021年1月在上海交通大学医学院附属第九人民医院口腔外科门诊就诊因拔除下颌第三磨牙导致的单侧下牙槽神经损伤1个月以上的患者。对所有患者定期进行随访，利用视觉模拟评分法（visual analogue scale，VAS）来判定患者感觉恢复程度。随访过程中，若患者VAS<3分，则判定患者感觉恢复，将其纳入恢复组，并且随访结束。若随访时间超过1年，且患者VAS≥3分，则判定患者感觉未恢复，将其纳入未恢复组。对不同组别的患者分别进行CPT、EPT和2PD测试，对3种测试健侧与患侧数值进行比较和对其与预后相关性进行分析。结果·共纳入60例患者，其中男性14例、女性46例。随访过程中有44例患者出现VAS<3，设为恢复组，平均恢复时间为（4.1±1.4）个月。其余16例患者设为未恢复组。所有患者健侧与患侧的CPT、EPT、2PD对比，差异均具有统计学意义（均P<0.05）。下唇感觉恢复组与未恢复组患者患侧的数据，仅在CPT为5 Hz时以及EPT时的差异具有统计学意义（均P=0.000）。CPT为5 Hz时，对患者预后的评估有着较高的灵敏度（93.8％）和特异度（87.5％）。同样EPT也有着较高的灵敏度（93.8％）以及特异度（93.8％）。患侧CPT（5 Hz）和后牙EPT具有较好的一致性。结论·CPT、EPT、2PD均可以对下牙槽神经损伤与否进行评估。其中CPT 5 Hz时测得的数值以及后牙EPT可以对神经恢复预后进行评估。

关键词: 下牙槽神经损伤, 电流感觉阈值检测, 电活力测试, 两点辨别测试, 预后

Abstract:

Objective·To quantitatively evaluate the injury degree and prognosis of inferior alveolar nerve injury in patients with lower lip numbness caused by inferior alveolar nerve injury by using current perception threshold (CPT), electrical pulp test (EPT) and two-point discrimination (2PD), establish a diagnosis and detection scheme for inferior alveolar nerve injury and provide reference for prognosis evaluation.

Methods·We selected patients with unilateral inferior alveolar nerve (IAN) injury for more than one month caused by mandibular third molar extraction who went to the outpatient department of oral surgery of the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from July 2018 to January 2021. All patients were followed up regularly, and the visual analog scale (VAS) was used to determine the degree of numbness recovery. During the follow-up, if the patient's VAS<3, it was determined that the patients recovered from numbness and were included in the recovery group. The follow-up ended. If the follow-up time was more than 1 year, and the patients' VAS≥3, it was judged that the patients' numbness didn't recover and they were included in the unrecovered group. We performed current perception threshold (CPT), electrical pulp test (EPT) and two-point discrimination (2PD) on patients of different groups, and compared the values of the three tests on the healthy side and the correlation with prognosis.

Results·A total of 60 patients were included in this study, including 14 males and 46 females. At the end of follow-up, 44 patients had VAS<3, and were setted as recovery group. The average recovery time was (4.1±1.4) months. The remaining 16 patients did not have VAS<3, and were setted as the non-recovery group. The differences of two sides of all patients' CPT, EPT and 2PD were statistically significant (all P<0.05). For the data of affected side of patients with and without lower lip sensation recovery, only CPT 5 Hz and EPT were significantly different (both P=0.000). CPT (5 Hz) had high sensitivity (93.8%) and specificity (87.5%) in the evaluation of prognosis. Similarly, EPT also had high sensitivity (93.8%) and specificity (93.8%). The CPT (5 Hz) of the affected side was consistent with the value of EPT of the posterior teeth.

Conclusion·CPT, EPT and 2PD can evaluate the injury of inferior alveolar nerve. The value measured at CPT 5 Hz and posterior tooth EPT can evaluate the prognosis of nerve recovery.

Key words: inferior alveolar nerve injury, current sensory threshold test (CPT), electrical pulp test, two-point discrimination test (2PD)

中图分类号:

R782.4

董亚兵, 郝昀博, 张文豪, 王轶雯, 陈敏洁. 下颌第三磨牙拔除术后下牙槽神经损伤的功能检测及预后分析[J]. 上海交通大学学报（医学版）, 2022, 42(6): 717-722.

DONG Yabing, HAO Yunbo, ZHANG Wenhao, WANG Yiwen, CHEN Minjie. Functional detection and prognostic analysis of inferior alveolar nerve injury after mandibular third molar extraction[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(6): 717-722.

图/表 4

参考文献 8

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Item	Recovery group （n=44）	Non-recovery group （n=16）	t value	P value
Age	28.4±6.0	29.6±6.1	0.655	0.865
Gender			1.167	0.451
Male	8	6
Female	36	10
Injury site			4.968	0.127
Left	21	6
Right	23	10

Item	Recovery group （n=44）	Non-recovery group （n=16）	t value	P value
Age	28.4±6.0	29.6±6.1	0.655	0.865
Gender			1.167	0.451
Male	8	6
Female	36	10
Injury site			4.968	0.127
Left	21	6
Right	23	10

Item	Recovery group （n=44）	Non-recovery group （n=16）	U value	P value
Uninjured side	12.0±2.2	12.4±2.2	0.402	0.688
Injured side	15.9±3.1	26.7±3.9	5.677	0.000

Item	Recovery group （n=44）	Non-recovery group （n=16）	U value	P value
Uninjured side	12.0±2.2	12.4±2.2	0.402	0.688
Injured side	15.9±3.1	26.7±3.9	5.677	0.000

Item	Recovery group （n=44）	Non-recovery group （n=16）	U value	P value
Uninjured side/mm	10.0±1.4	9.7±0.85	-0.568	0.570
Injured side/mm	10.6±1.8	11.2±1.5	1.438	0.151

下颌第三磨牙拔除术后下牙槽神经损伤的功能检测及预后分析

Functional detection and prognostic analysis of inferior alveolar nerve injury after mandibular third molar extraction

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