不同类型下颌骨髁突骨折的外科手术治疗探讨  

Evaluation of surgical treatment for different types of mandibular condyle fracture

作　　者：郭松松[1,2] 杜一飞[1,2] 戈杰[1,2] 程杰[1,2] 杨蓉[1,2] 李明[1,2] 叶金海[1,2] 江宏兵[1,2] 

机构地区：[1]南京医科大学口腔疾病研究江苏省重点实验室 [2]南京医科大学附属口腔医院口腔颌面外科,江苏南京210029

出　　处：《口腔医学》2015年第3期187-191,共5页Stomatology

基　　金：江苏省高校优势学科建设工程(2014-37)

摘　　要：目的分析不同类型下颌骨髁突骨折的手术入路、复位固定方法、疗效及并发症,为外科手术治疗髁突骨折提供参考。方法收集近3年完成的下颌骨髁突骨折切开复位内固定患者的临床资料及随访资料,根据不同骨折类型分别选择耳屏前/内、耳下颌后或口内切口入路,高位骨折采用长螺钉固定,中位和低位骨折选择小型钛板固定,对骨折类型,手术入路,复位固定方式,术后愈合、开口功能恢复及相关并发症进行相关分析。结果 146例共57侧髁突骨折手术后均未出现钛板/螺钉松动及frey's综合征;面神经受损征7例,均为高位和中位骨折治疗组的面神经颞支暂时性损伤,低位骨折组面神经损伤概率低于高位及中位骨折组(P<0.05)。2各治疗组术前术后的张口度均得到显著改善(P<0.05),平均张口度3.5 cm以上。3高位骨折术后张口偏斜11例,占23.91%;中位骨折术后张口偏斜4例,占8.70%,低位骨折5例,占10.87%,患者张口偏斜均在0.5 cm以内。结论髁突骨折应根据不同类型选择手术入路、复位固定方式;外科解剖学复位可实现早期张口功能训练及良好的咬合关系,患者总体满意度高;髁突高位骨折复位时应尽量避免剥离翼外肌附着,注意关节结构保存;耳前切口入路过度牵拉暴露易致面神经颞支损伤。Objective To analyze the method of ORIF for different types of mandibular condyle fracture. Methods From January 2011 to March 2014,46 adult patients with condyle fractures of the mandible were studied. ALL the patients undergone the ORIF of mandibular condyle fractures and were followed up weekly for 3 weeks and then at 2,3 and 6 months after surgery. The patients accepted CBCT examination 1 week and 3months after operation. Clinical examinations including mouth opening,deviation on mouth opening,occlusion,function of facial nerves,frey syndrome,screw loosing and salivary fistula were conducted. And the satisfaction degree of the patients was checked. Result No screw loosing salivary fistula and frey syndrome were found in the follow-up patients; facial nerve dysfunction was found in 7 patients（ 23. 91%） all in condyle head and subcondyle fracture group. Facial nerve dysfunction in condyle neck group was significantly lower than the other two groups（ P〈0. 05）. Mouth opening outcome in all groups significantly improved over time after surgery（ P〈0. 05）. Of the 46 condyle fractures that were associated with deviation on mouth opening were those of condyle head fracture 11（ 23. 91%）,followed by subcondyle fracture 5（ 10. 87%） and condyle neck fracture 4（ 8. 70%）. 37 of 46 patients expressed high satisfaction degree for the treatment. Conclusions Appropriate incisions,fixation methods and operations should be chosen for different types of mandibular condyle fractures. For condyle head fracture,it will be better to be fixed with titanium screws and the lateral pterygiod muscle should be remain attached to the fractured medial segment. The patients got good mouth opening and occlusion and gave high satifaction degree for the treatment.

关 键 词：下颌骨髁突骨折 坚强内固定 面神经损伤 张口度 咬合关系 

分 类 号：R782.4[医药卫生—口腔医学]