儿童和青少年牙外伤急诊患者临床分析

doi:10.19723/j.issn.1671-167X.2021.02.025

摘要/Abstract

摘要：

目的: 分析口腔急诊18岁以下牙外伤患者的发病情况和临床特点,指导儿童和青少年的牙外伤防护和治疗。方法: 回顾性分析2016年1月至2018年12月就诊于北京大学口腔医院急诊科有完整电子病历信息的18岁以下儿童和青少年牙外伤患者的临床资料,总结急诊儿童和青少年牙外伤的性别、年龄、时间分布,外伤牙的数目、牙位、牙外伤类型及合并伤等情况。结果: 纳入儿童和青少年牙外伤初诊患者共5 506例,占所有牙外伤患者(10 164例)的54.2%。牙外伤的高峰年龄段为3~4岁和7~9岁,各年龄组男童发病率均高于女童。5—6月份及9—11月份牙外伤的发病率较高,牙外伤患者的日就诊高峰时段为19:00~20:00。受伤牙位左右基本对称,上中切牙最易受累,52.3%的患者累及两颗及两颗以上牙。各类型恒牙外伤中,釉质-牙本质折断最为多见。各类型乳牙外伤中,亚脱位最为多见。19.7%的患者合并较严重的颌面部软硬组织损伤。结论: 儿童和青少年牙外伤具有明显的年龄双峰特点,常累及发育中的乳牙和年轻恒牙,临床诊疗应考虑儿童生长发育特点,同时应加强家庭、学校和幼托机构中针对儿童和青少年牙外伤的宣教,提高防护意识。

关键词: 牙损伤, 急症, 青少年, 儿童

Abstract:

Objective: To analyze the etiological and clinical characteristics of oral emergency patients under 18 years with dental trauma, and to provide guidance on the prevention and treatment in children and adolescents. Methods: A retrospective study on the intact data of the dental trauma patients under 18 years from January 2016 to December 2018 in the Department of Oral Emergency in Peking University School of Stomatology was conducted, and the distribution of the patients’ gender, age and visiting time, as well as the number and position of traumatic teeth, diagnostic classification, and multiple injury with dental trauma were analyzed. Results: During the period, 54.2% of the first visit dental trauma patients (10 164) were children or adolescents (5 506). The two peak ages were 3-4 and 7-9 years. The incidence of the male was higher than the female in every age group (Wilcoxon test, P<0.001). From May to June and September to November, there were more cases of dental trauma. The peak time of daily dental trauma cases was from 19:00 to 20:00 (Jonckheere-Terpstra test, P<0.001). The positions of traumatic teeth in both sides were approximate symmetrical, and maxillary central incisors were the most affected. 52.3% of the patients suffered multiple teeth injuries. Among the permanent teeth trauma, enamel and dentin fracture was the most common (24.7%), followed by concussion (20.5%), sub-luxation (17.9%) and complicated crown fracture (14.4%). And among the primary teeth trauma, subluxation was the most common (31.1%), followed by concussion (14.5%) and lateral luxation (9.5%). 19.7% of the children and adolescent dental trauma patients were also suffered maxillofacial soft or hard tissue injury. Conclusion: The incidence of dental trauma in children and adolescents is higher than that in adults. There were two age peaks among the children and adolescents patients. Primary teeth and young permanent teeth were usually suffered. Clinical treatment should be considered along with the characteristics of child tooth growth. In order to prevent the occurrence of dental trauma, early orthodontic intervention should be carried out in children with severe overjet. Families, schools and nursery institutions should strengthen the protection against dental trauma.

Key words: Tooth injuries, Emergencies, Adolescent, Child

中图分类号:

R782.4

杨雪,孙伟,王哲,姬爱平,白洁. 儿童和青少年牙外伤急诊患者临床分析[J]. 北京大学学报（医学版）, 2021, 53(2): 384-389.

YANG Xue,SUN Wei,WANG Zhe,JI Ai-ping,BAI Jie. Clinical analysis of children and adolescents emergency dental trauma cases[J]. Journal of Peking University (Health Sciences), 2021, 53(2): 384-389.

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Position	Number	Percentage
Right upper central incisor	2 118	37.1%
Left upper central incisor	2 115	37.0%
Left upper lateral incisor	415	7.3%
Right upper lateral incisor	382	6.7%
Right lower central incisor	217	3.8%
Left lower central incisor	200	3.5%
Right lower lateral incisor	93	1.6%
Left lower lateral incisor	84	1.5%
Canine	59	1.0%
Premolar	23	0.4%
Molar	5	0.1%
Total	5 711	100.0%

Position	Number	Percentage
Right upper central incisor	1 672	37.7%
Left upper central incisor	1 664	37.5%
Left upper lateral incisor	311	7.0%
Right upper lateral incisor	287	6.5%
Left lower central incisor	125	2.8%
Right lower central incisor	123	2.8%
Left lower lateral incisor	50	1.1%
Right lower lateral incisor	45	1.0%
Canine	121	2.7%
Molar	37	0.8%
Total	4 435	100.0%

Number of teeth	Patient number	Percentage
1	2 624	47.7%
2	1 898	34.5%
3	501	9.1%
4	336	6.1%
5	66	1.2%
6	44	0.8%
7	22	0.4%
8	8	0.1%
9	4	0.1%
10	2	<0.1%
11	1	<0.1%
Total	5 506	100.0%

Diagnosis	Age group/years					Total	Percentage
Diagnosis	3-5	6-8	9-11	12-14	15-17	Total	Percentage
Enamel-dentin fracture		565	535	197	116	1 413	24.7%
Concussion	6	533	359	166	107	1 171	20.5%
Subluxation	18	491	303	125	83	1 020	17.9%
Complicated crown fracture		267	381	108	69	825	14.4%
Complicated crown-root fracture		68	113	51	41	273	4.8%
Avulsion		73	88	63	28	252	4.4%
Lateral luxation		57	36	52	45	190	3.3%
Luxation		46	61	20	29	156	2.7%
Enamel infraction		34	46	22	13	115	2.0%
Intrusive luxation		57	32	14	6	109	1.9%
Root fracture		35	33	20	21	109	1.9%
Enamel fracture		18	18	6	5	47	0.8%
Uncomplicated crown-root fracture		13	9	7	2	31	0.5%
Total	24	2 257	2 014	851	565	5 711	100.0%

Diagnosis	Age group/years					Total	Percentage
Diagnosis	0-2	3-5	6-8	9-11	12-14	Total	Percentage
Subluxation	314	871	177	16		1 378	31.1%
Concussion	159	408	68	6		641	14.5%
Lateral luxation	124	254	41	3		422	9.5%
Avulsion	108	192	99	14	3	416	9.4%
Complicated crown fracture	208	88	6			302	6.8%
Root fracture	36	241	16			293	6.6%
Intrusive luxation	137	100	5			242	5.5%
Complicated crown-root fracture	159	80	8			247	5.5%
luxation	24	152	57	2		235	5.3%
Enamel-dentin fracture	142	82	5	1		230	5.2%
Enamel infraction	11	3				14	0.3%
Enamel fracture	6	6				12	0.3%
Uncomplicated crown-root fracture	3					3	0.1%
Total	1 431	2 477	482	42	3	4 435	100.0%