下颌关节髁状突骨折的手术治疗  

Surgical therapy for tempomandibular joint condylar fracture： analysis of 18 cases

作　　者：韩泽民[1] 郝玉梅[1] 蒋书勤[1] 周彪[1] 陈思果[1] 柴晓红[1] 

机构地区：[1]中国人民武装警察部队医学院附属医院口腔颌面科,天津300162

出　　处：《中国急救复苏与灾害医学杂志》2010年第7期627-628,631,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的对下颌关节髁状突骨折手术和非手术治疗的临床病例进行比较，探讨手术治疗的适应证。方法经临床体检和CT检查确诊的18例髁状突骨折伤员，单侧骨折13例，双侧骨折5例，共23侧髁状突骨折；复杂伴有骨折片移位的11例伤员行手术治疗，骨折复位和坚强内固定。非手术保守治疗7例；其中2例粉碎性骨折因伴有颈椎损伤被迫保守治疗，6个月后因关节强直行关节成形术。病例随访时间3～12个月。结果18例伤员中17例无关节区疼痛症状，开口度基本满意，丌口型正常。5例单线性骨折保守治疗均未出现开口受限和开口型异常，骨折复位坚强内固定11例开口度为（36．1±1．8）mm，显著大于单线性骨折保守治疗者[（34．0±3．7）mm，P〈0．05]，单线性骨折保守治疗者的开口度显著大于粉碎性骨折经保守治疗者[（32．1±3．6）mm，P〈0．05]。骨折复位坚强内固定11例的治疗周期为[（16±1．8）d]，显著短于单线性骨折保守治疗者[（42±3．8）d]和粉碎性骨折伤员经保守治疗者[（222±2．2）d，均P〈0．05]；单线性骨折保守治疗者的治疗周期亦显著短于粉碎性骨折伤员经保守治疗者（P〈0．05）。结论下颌髁状突骨折单纯的线性骨折不伴骨折片移位者非手术治疗可取得较好的疗效。对于粉碎性骨折或伴有骨折片移位者则需要手术治疗，骨折复位坚强内同定以减少关节腔积血。[Abstract] Objective To investigate the effect of surgical therapy tor tempomandibular joint condylar fracture. Methods Eighteen patients were diagnosed as with tempomandibular joint condylar fracture, 13 cases being unilateral and 5 cases being bilateral, involving 23 condyles in total. The 11 cases of complex fracture with chip displacement were treated by fragment replacement and rigid internal fixation. Seven cases underwent conservative therapy. Two cases of eomminuted fracture could not but receive conservative treatment because of combining with damage of cervical vertebrae, and then underwent arthroplasty because of ankylosis. The patients were followed up for 3-12 months. Results Seventeen of the 18 patients didn＇t have pain in the joint area and showed satisfactory mouth opening degrees and normal mouth opening styles. The treatment cycle of the 11 cases of complex fracture with chip displacement was （16±1.8） days, significantly shorter than that of the conservative therapy group [（42±3.8） days, P 〈0.05] and that of the 2 cases with comminuted fracture [（222±2.2） days, P〈0.05]. The opening index of the 11 cases of complex fracture with chip displacement was （36.1 ± 1.8） ram, significantly larger than that of the patients with linear fracture [（34.0±3.7） mm, P 〈0.05], and the latter was significantly larger than that of the 2 cases with comminuted fracture [（32.1 ±3.6） mm, P 〈0.05]. Conclusion Conservative therapy is effective for simple condylar linear fracture. Rigid internal fixation can be used for complicated cases with fracture fragment displacement to avoid hemarthrosis.

关 键 词：髁状突骨折 手术 坚强内固定 

分 类 号：R782.05[医药卫生—口腔医学]