髁状突骨折手术治疗的临床研究  

Clinical study of surgical treatment in condylar fractures

作　　者：邓书海[1] 钟凡[1] 关崧华[1] 赵继刚[1] 郭毅[1] 

机构地区：[1]南方医科大学附属南海医院口腔科,广东佛山528200

出　　处：《临床口腔医学杂志》2011年第5期307-309,共3页Journal of Clinical Stomatology

摘　　要：目的:探讨髁状突骨折手术方式和疗效。方法:45例髁状突骨折患者,年龄16～65岁,全部采用下颌后切口,切口长约4cm,在腮腺筋膜鞘表面潜行剥离皮瓣,在耳屏至耳垂之间前方,上下方向切开腮腺筋膜,以开窗的方式向深层钝性剥离腮腺,牵开面神经,从咬肌后方切开骨膜,髁状突断端和翼外肌解剖复位,以钛板固定;冲洗关节腔,严密缝合骨膜及切开的关节囊,囊内注射透明质酸钠2.0mL;术后进行早期功能锻炼。结果:45例患者经过6个月～4年的随访观察,骨折全部愈合,面型对称,开口度达到3.0～3.7cm,张口型均正常;咬合关系完全满意42例,基本满意3例;咀嚼功能完全满意41例,基本满意4例;术后出现感染1例,经过切开引流、抗炎后治愈;出现面神经功能异常患者2例,2个月后完全恢复;出现关节弹响不适症状患者1例,治疗后好转。结论:成人髁突骨折,应首选开放手术治疗;下颌后入路手术方式是治疗髁状突骨折较好的方法。Objective： To ivstigate the efficacy and modality of surgical treatment in condyar fractures .Method： 45 patients （the ages between 16 to 65）with condyar fractures were included in this study. We all used the Behind mandibular incision which were 4cm long. Slit the skin, subcutaneous tissue, and then peeled the skin flap by sneaking on the surface of the parotid fascia sheath. Use the retractor to touch the flap,then slit the Parotid fascia sheath.lnfront the place between the tragus to ear lobe. Use the fenestration to blunt dissection parotid in deep. Draw the facial nerve,periosteal incision behind the masseter muscle, reduction the condyle stump and wing muscles anatomicaly.,and fixed with titanium plate. Finally, flushing joint cavity, suture periosteum and joint capsule incision tightly, Intracystic injection 2.0ml hyaluronic acid. We would give the patients functional exercise in early postoperative. Result： After 6 months-4 years of follow-up study, all the patients had fracturess healed and facial symmetry. Ringent distance was about 3.0-3.7 cm,Ringent shape was normal. Fully satisfactory of occluding relation in 42 cases, and basically satisfied in 3 cases. ; Fully satisfactory of masticatory function in 41 cases,and basically satisfied in 4 cases; 1 case emerge postoperative infection,but healed by the incision,drainage,and anti-intlammator： 2 cases emerge facial nerve dysfunction, but restored completely after 2 months.1 case emerge symptoms of Joint snapping, Improved after the treatment. Conclusion： We try to use the open surgery in the treatment of adult condyar fractures, and our surgical treatment of condylar fractures is one of the better methods.

关 键 词：髁状突骨折 下颌后切口 腮腺开窗 钛板固定 功能锻炼 

分 类 号：R782.4[医药卫生—口腔医学]