下颌骨髁突骨折治疗失败原因分析及补救措施  

Cause Analysis of Treatment Failure of Mandibular Condylar Fractures and Amending Procedures

作　　者：王昭领[1] 刘颖[1] 杨璐[1] 黄迪炎[1] 朱国雄[1] 

机构地区：[1]济南军区总医院口腔科,济南250031

出　　处：《临床误诊误治》2015年第6期39-41,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的：分析下颌骨髁突骨折治疗失败的原因，提出防范对策。方法对我院收治并治疗失败的下颌骨髁突骨折17例的临床资料进行回顾性分析，探讨治疗失败的原因。结果本组第2次就诊时间为首次治疗完成后1个月~2年，首次治疗选择非手术治疗9例，手术治疗8例，首次治疗均在外院完成。17例首次治疗方法选择不当10例，其中非手术治疗9例，手术治疗1例，手术方式选择及手术处理不当7例，其中2例同时存在下颌他处合并骨折处理不当。第2次治疗对首次采用非手术治疗骨折段移位明显的9例再手术，恢复盘髁关系；髁突游离再植的6例对局部进行清理，并行关节成形重建术；合并下颌体部及颏部骨折错位的2例再行手术复位内固定；关节强直的2例行关节成形术。所有病例术后下颌功能运动及咬合关系恢复良好，随访半年，效果满意。结论对下颌骨髁突骨折治疗认识不足、随意选择治疗方法是治疗失败的主要原因。规范髁突骨折的治疗可降低失败率。Objective To analyze the causes of treatment failure of mandibular condylar fractures and to suggest the preventive measures. Methods A total of 17 adult cases failed treatment of mandibular condylar fractures before being admit-ted to our hospital and received secondary treatment with good results. All data were retrospectively studied. The causes of treatment failure were analyzed. Results Of these patients, the hospitalization times were 1 month to 2 years after first treat-ment in other hospitals. 9 of them received non-surgical treatment while the other 8 underwent surgery. Of these cases, 10 were due to improper treatment selection including 9 with non-surgery and 1 with surgery, and the other 7 were due to improper surgical methods including 2 with improper management of combined mandibular fractures. During the second treatment, disc-condyle operation was performed again in 9 cases with obvious displacement of fractured fragments after primary non-surgery;debridement and reconstruction of temporomandibular joints were performed in 6 cases undergoing condylar replantation;Reop-eration for reduction of combined mandibular fractures was performed in 2 cases and anthroplasty was conducted in 2 case with ankylosis. All the cases were followed up for 6 months and all achieved satisfactory outcomes with good oral function and oc-clusion. Conclusion Lack of full understanding of mandibular condylar fracture and improper selection of therapeutic method are main causes of treatment failure. Standard treatment of condylar fractures may reduce the failure rate.

关 键 词：下颌骨 髁突骨折 治疗失败 

分 类 号：R782.4[医药卫生—口腔医学]