翼外肌-髁突解剖复位内固定治疗髁突颈骨折60例的临床分析  

Clinical analysis of condylar neck fracture by external pterygoid muscle-condyle anatomic reduction and rigid internal fixation in 60 cases

作　　者：周昌龙[1] 王永盛[1] 张建伟[1] 

机构地区：[1]宁波市医疗中心李惠利医院口腔科,宁波315041

出　　处：《口腔医学》2010年第8期491-494,共4页Stomatology

摘　　要：目的探讨髁突颈部骨折时进行髁突-翼外肌解剖复位坚强内固定的适应证、手术方法及术后效果。方法对髁突颈部骨折出现髁头脱位突破关节囊、髁突和髁突颈下骨折移位成角大于30°-45°、下颌支垂直高度降低超过4-5 mm的骨折患者,采用耳屏前绕耳轮脚向上后耳颅沟切口,行翼外肌-髁突肌解剖复位坚强内固定方法治疗。术后1、3、6个月复诊,检查面型、开口度、开口型、牙合关系、咀嚼力、面神经功能,三维CT重建上下颌骨,根据临床和影像学进行评价。结果术后1月,所有患者面型对称、牙合关系好、开口度均较术前增大;无骨折移位、患侧咀嚼力减弱、8例额纹变浅。3月后,所有病例面型对称、开口度≥3.5 cm、开口型无偏斜、骨折一期愈合、髁突表面未见骨质吸收、面神经瘫痪症状恢复、双侧咬合力对称。6月后观察所有项目同术后3月。结论髁突骨折经耳屏前后上绕耳轮脚切口,能较好的保护颞下颌关节区相关血管神经;对髁突颈部骨折行翼外肌-髁突解剖结构开放性复位内固定,是一种恢复解剖形态和关节功能的有效方法,在术后3月内可判定其效果。Objective To investigate the surgical indications,procedures and treatment outcomes of the condylar neck fracture by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation.Methods The cases of condylar neck fracture patients with dislocation of the condlylar head,fracture of condylar neck and subcondylar neck（the degree of displacement greater than 30~45） and decreased vertical height of the ramus（greater than 4~5 mm）,no occlusion by closing reduction were included in the study.Aural-helix foot incision approach was adopted in 60 cases with 73 condylar fractures.The fractures were treated by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation with mini tension band titanium plates.According to the clinical and radiographic results,all the patients were re-examined and evaluated 1 to 6 months after surgery in respects of facial symmetry,mouth opening,types of mouth opening,occulusion,mastication,function of facial nerve and three-dimensional computed tomography scan reconstruct maxillofacial and mandibular bone.Results All the patients had symmetrical face,normal occlusion,and their mouth opening increased than preoperation（28 cases′ return mouth opening ≥ 3.5 cm）,showing no displacement fracture.8 patients showed temporal facial paralysis,and the mastication power decreased in trauma side after 1 month.All the patients had symmetrical face,normal occlusion and mouth opening,showing no displacement fracture and condylar surface absorption,primary bone healing,symmetrical bilateral mastication power,and 8 patients with temporal facial paralysis recovered after conservative therapy after 3 months.All indexes after 6 months were the same as those after 3 months.Conclusion It could preferably protect facial nerve and blood vessel in temporomandibular joint region by aural-helix foot incision in condylar fracture case.Treatment of condylar fracture by external pterygoid muscule-condyle anatomical reduction and internal rigid fixation was an effe

关 键 词：髁突颈骨折 解剖复位 翼外肌-髁突 

分 类 号：R782.4[医药卫生—口腔医学]