全面部骨折临床治疗的研究  

Research on the clinical treatment of panfacial fracture

作　　者：黄宏[1] 荣小乔 李文丽[1] 郑志勋[1] 

机构地区：[1]东莞市黄江医院口腔科,广东东莞523750

出　　处：《临床口腔医学杂志》2011年第4期232-233,共2页Journal of Clinical Stomatology

基　　金：东莞市2009年度科技计划项目(200910515000210)

摘　　要：目的:探讨全面部骨折临床治疗的最佳手术方案。方法:对26例全面部骨折病例采用螺旋CT三维重建定位,设计术式,切开复位,钛板坚强内固定治疗,线型骨折处辅助内镜、90°侧壁螺丝刀从口内或口外隐蔽小切口进路复位固定,术后CT三维重建、牙颌模型复查与术前对比观察。结果:26例术后骨折复位良好,面部外形突度和对称性恢复良好、无明显疤痕。23例咬合关系恢复良好,张闭口运动、咀嚼功能恢复正常;3例咬合关系有后牙早接触,经颌间牵引和调牙合后基本恢复正常。结论:螺旋CT三维重建能显示全面部骨折的立体结构和骨折线的全貌,精确定位分析、设计手术方式,使术中有明确的路经和程序。辅助内镜、90°侧壁螺丝刀,可从口内或口外隐蔽小切口进路复位固定线型骨折,减少组织损伤及避免面部瘢痕,符合微创和美学手术原则,适用于下颌角、升支、颧骨颧弓的线型骨折。Objective：To discuss the clinical treatment method of panfacial fracture.Method：For 26 cases of panfacial fracture,apply spiral CT 3D reconstruction to locate,analyze and design the surgery manner.Cut the reduction titanium plate and perform rigid internal fixation.For linear fracture,apply endoscope and 90° side screw driver as supplement for reduction and fixation through the small and concealed incision inside or outside the mouth.After the surgery,apply CT 3D reconstruction and double check the jaw model to make comparison and observation.Result：26 cases experienced great reduction of fracture.The protrusion and symmetry of the facial profile recovered well without any obvious scar.The occlusion relationships of 23 cases wherein were well reduced.The opening,closing and chewing functions of the mouth recovered to normal situation.For the other 3 cases,slight premature contacts occurred.After intermaxillary traction and occlusal adjustment,the occlusion relationships were recovered normally.Conclustion：The spiral CT 3D reconstruction is able to display the stereochemicl structure of the panfacial fracture as well as a complete picture of the fracture line.It can accuratly locate,analyze and design the surgery manner,to guarantee definite route and procedure during the surgery.With the supplement of the endoscope and 90° side screw driver,the linear fracture may be reduced and fixed through the small and concealed incision inside or outside the mouth,which will reduce the damage of tissue,avoid the occurance of facial scar and comply with the principle of Minimally Invasive Surgery and aesthetics.It is applicable to the liner fracture of the lower mandible angle,the ascending limb as well as the arch of zygomatic bone.

关 键 词：全面部骨折 三维CT 坚强内固定 内窥镜 90°侧壁螺丝刀 

分 类 号：R782.4[医药卫生—口腔医学]