李浩萍　孟媛

[摘要] 目的 探讨口腔显微镜对于减少老年根管治疗期间磨牙根管遗漏的临床意义。 方法 选取解放军第451医院2011年4月～2014年7月收治的接受根管治疗的老年患者184例，将其随机分为常规组和显微根管治疗组（DOM组），分别进行常规根管治疗和DOM根管治疗，对两组老年患者根管遗漏情况进行统计分析。对所有患者进行1年随访，观察老年患者的磨牙治疗及根管遗漏情况。 结果 常规组检出4根根管为14例（15.22%），与DOM组28例（30.43%）相比，差异有统计学意义（P < 0.05）；常规组检出5根根管0例（0.00%），与DOM组4例（4.35%）比较，差异有统计学意义（P < 0.05）。常规组治疗失败6例（6.52%），DOM组治疗失败2例（2.17%），两组比较，差异有统计学意义（P < 0.05）。 结论 应用DOM对老年磨牙患者进行根管治疗可有效减少磨牙根管遗漏率，值得临床推广使用。

[关键词] 口腔显微镜；老年磨牙；根管治疗；根管遗漏

[中图分类号] R781.3 [文献标识码] A [文章编号] 1673-7210（2015）05（c）-0113-04

[Abstract] Objective To discuss the clinical effect of dental operating microscope for reducing the omission of molars root canal in elderly patients during the treatment of root canal. Methods 184 cases of elderly patients who had received molars root canal treatment in the 451st Hospital of People's Liberation Army from April 2011 to July 2014 were selected. All the patients were divided into conventional group and DOM group， the conventional group was treated with normal root canal therapy and the DOM group was treated with DOM root canal therapy. The incidence of root canal omission was analyzed. Then all the patients were followed up for 1 year， treatment of root canal and the incidence of root canal omission were observed. Results 14 cases of patients （15.22%） of the conventional group and 28 cases （30.43%） of the DOM group were detected with 4 root canals， which showed a statistically significant difference （P < 0.05）. None of the patients （0.00%） of conventional group and 4 cases （4.35%） of the DOM group were detected with 5 root canals， which showed a statistically significant difference （P < 0.05）. 6 cases （6.52%） of conventional group failed in the root canal treatment， while 2 cases （2.17%） of DOM group failed in the root canal treatment， which showed a statistically significant difference between the two groups （P < 0.05）. Conclusion Apply DOM in the treatment of root canal can help lessen omission of molars root canal in elderly patients， and it is worthy of clinical application.

[Key words] Oral operating microscope； Elderly molars； Root canal therapy； Omissions of root canal

随着社会老龄化的加剧，老年人健康问题是亟待关注的社会问题。老年人磨牙牙髓坏死和根尖周病是常见的口腔问题，首选治疗方法为根管治疗[1]。但是由于老年人年龄增大引起根管细小、闭锁，磨牙根管系统形态复杂，且大多数伴有钙化或弯曲，治疗过程中常常会出现根管遗漏[2]。口腔手术显微镜（dental operating microscope，DOM），也称根管显微镜，引入我国已有20年，由于具有更好的放大和照明作用，可以直接观察根管的细微结构，减少治疗中的不确定性，从而减少根管遗漏的发生率，在牙髓治疗，特别是根管治疗中发挥着越来越重要的作用[3]。本研究通过对184例老年磨牙病变患者进行常规根管治疗和口腔显微镜根管治疗的比较，评价口腔显微镜减少老年磨牙根管遗漏的临床效果，现报道如下：

1 资料与方法

1.1 一般资料

随机选取解放军第451医院（以下简称“我院”）2011年4月～2014年7月收治的接受根管治疗的老年患者184例，平均年龄为（65.6±16.8）岁，其中男86例，女98例。……