颌面部骨折治疗失败后二期治疗探讨:附51例报告  

The Secondary Treatment for Maxillofacial Fractures after the Unsuccessful Primary Treatment:a Report for 51 Cases

作　　者：王岳森[1,2] 郭治辰 龚忠诚[1] 李宏[2] 姜德奇 

机构地区：[1]新疆医科大学第一附属医院颌面肿瘤外科 新疆医科大学口腔医学院 新疆维吾尔自治区口腔医学研究所,乌鲁木齐830054 [2]河南科技大学第一附属医院口腔颌面外科,河南洛阳471000 [3]新疆维吾尔自治区人民医院颌面外科,乌鲁木齐830002

出　　处：《临床误诊误治》2017年第7期34-38,共5页Clinical Misdiagnosis & Mistherapy

基　　金：国家自然科学基金(31260229);新疆维吾尔自治区青年科技创新人才培养工程项目(2014721046)

摘　　要：目的探讨颌面部骨折治疗失败后的二期治疗原则和方法。方法对一期治疗失败的颌面部骨折51例的临床资料进行回顾性分析。结果本组于外院首次治疗失败或不理想而转我院,就诊原因:术后感染20例,咬合关系紊乱14例,张口受限11例,颜面畸形6例。二期治疗39例拆除原固定钛板,其中21例重新行钛板坚固内固定;12例陈旧性错位愈合骨折行正颌外科矫正治疗。31例术后行颌间弹性牵引2~3周,配合正畸、调合治疗,并行张口锻炼。51例术后骨断端均愈合良好,其中47例术后咬合关系、咀嚼功能均恢复满意,面形对称;4例咬合关系基本满意,需进一步行颜面畸形矫治;4例咬合关系欠佳,需继续辅以正畸或调合治疗。术后随访49例,5例术后3个月中度张口受限;7例伴发神经损伤,术后3~6个月症状逐渐消失。结论拆除原固定钛板或重行坚固内固定可解决颌面部骨折术后相关并发症,正颌外科手术在陈旧性错位愈合骨折矫治中的效果肯定,复杂的上下颌多发骨折术后并发症需多次手术方可达满意效果。Objective To investigate principle and methods of secondary treatment for maxillofacial fractures after the unsuccessful primary treatment. Methods Clinical data of 51 maxillofacial fractures patients with unsuccessful primary treatment was retrospectively analyzed. Results All the 51 patients were transferred to our hospital for the unsuccessful primary treatment, Among the 51 patients, there were 20 patients with postoperative infection, 14 patients with occluding relation dis-orders, 11 patients with limitation of mouth opening and 6 patients with facial deformity. During the secondary treatment, 39 patients were gotten rid of the primary titanium plates, in whom 21 patients underwent internal fixation with new plates, and 12 patients with old malunion fractures underwent orthognathic surgical correction therapy. After the operation, the 31 patients underwent intermaxillary elastic traction for 2-3 weeks combined with orthodontic and occlusal adjustment treatments, and patients were training in opening and closing mouth regularly. All the 51 patients had good healing of osteotomy segments, in whom 47 patients had satisfied occlusal relationship, masticatory function and face form symmetry after operations; 4 patients with general satisfaction for occluding relation and further plastic reconstruction for facial figure; 4 patients had poor occluding relation, and postoperative orthodontic treatment or occlusal adjustment treatments were required. After operation, 49 patients were followed-up, in whom 5 patients had moderate limitation of mouth opening in 3 months after surgery; 7 patients had nerve injury, and the symptoms disappeared gradually in postoperative 3-6 months. Conclusion Postoperative complications can be treated by getting rid of old plates or performing internal fixation with new plate. Orthognathic surgical correction in treatment of old malunion fractures can achieve good effect, and postoperative complications of complex upper and lower maxillofacial fractures need multiple surgeries to achieve

关 键 词：颌骨骨折 治疗失败 二期治疗 

分 类 号：R782.4[医药卫生—口腔医学]