改良型弹力颌帽颅颌牵引外固定治疗儿童下颌骨骨折的临床研究  

Clinical Research on Craniofacial Traction External Fixation with Improved Elastic Jaw Cap in the Treatment of Mandibular Fracture in Children

作　　者：黎祺[1,2] 陈朝兴 黄颖怡 LI Qi;CHEN Chaoxing;HUANG Yingyi(Stomatology College of Zhaoqing Medical College,Zhaoqing 526020,China;不详)

机构地区：[1]肇庆医学高等专科学校口腔医学院,广东肇庆526020 [2]肇庆医学高等专科学校口腔医院(广东省肇庆市口腔医院)

出　　处：《中国医学创新》2021年第10期149-154,共6页Medical Innovation of China

基　　金：教育部高等职业教育创新发展行动计划应用技术协同创新中心项目(教职成函[2019]10号);广东省专业领军人才项目配套基金(肇医专[2018]20号);广东省肇庆市科技创新指导类项目(201904031209)。

摘　　要：目的:探讨利用改良型弹力颌帽颅颌牵引外固定治疗儿童下颌骨骨折的临床效果。方法:选择2016年1月-2019年12月本院收治的下颌骨骨折患儿38例,均采用自主创新研发的改良型医用弹力颌帽颅颌牵引外固定进行治疗,随访6个月观察颌面形态、咬合关系、张口程度恢复情况和骨折愈合情况。结果:38例患儿均完成颅颌牵引固定3周,治疗后3个月,35例(92.11%)达到完全复位愈合(complete reduction and healing,CRH)。15例不同程度下颌骨颏部骨折移位者和14例无移位者CRH率均为100%,9例髁状突骨折者中CRH为6例(66.67%),基本复位愈合(basic reduction and healing,BRH)为3例(33.33%),该3例均为单侧髁状突骨折且髁状突向前内侧成角畸形大于45°者,治疗后3个月髁状突成角畸形已小于45°。16例颌面畸形、7例中线偏移及11例Ⅰ度张口受限者完全恢复(complete recovery,CR)率均为100%。24例咬合关系错乱者CR为21例(87.5%),不完全恢复(incomplete recovery,IR)为3例(12.5%)。Ⅱ度张口受限15例中CR为13例(86.67%),IR为2例(13.33%);Ⅲ度张口受限5例中CR为4例(80.00%),IR为1例(20.00%)。开口偏斜7例中CR为4例(57.14%),IR为3例(42.86%)。上述IR病例均为单侧髁状突骨折且髁状突向前内侧成角畸形大于45°者,治疗后3个月其咬合关系、张口情况均较治疗前明显好转但未完全恢复正常,继续随访观察3个月,其咬合错乱、张口受限和开口偏斜均完全恢复。结论:改良型弹力颌帽颅颌牵引外固定治疗儿童下颌骨骨折效果显著,不同部位及类型的下颌骨骨折愈合情况均较为理想,可有效改善患儿颌面形态、咬合关系及张口程度,是一种有效、安全、方便的治疗方法。Objective:To explore the clinical efficacy of craniofacial traction external fixation with improved elastic jaw cap in the treatment of mandibular fracture in children.Method:A total of 38 children with mandibular fracture admitted to our hospital from January 2016 to December 2019 were treated with self-innovated craniofacial traction external fixation with improved elastic jaw cap.The recovery of maxillofacial morphology,occlusal relationship,degree of mouth opening and fracture healing were observed after 6 months of follow-up.Result:All 38 patients completed cranial and maxillary traction and fixation for 3 weeks,and 35 patients(92.11%)achieved complete reduction and healing(CRH)at 3 months after treatment.The CRH rate of the 15 patients with different degrees of mandibular chin fracture displacement and the 14 patients without displacement were 100%.Among the 9 cases of condylar fractures,6 cases(66.67%)had CRH,and 3 cases(33.33%)had basic reduction and healing(BRH).The 3 cases with BRH were all unilateral condylar fractures with condylar anteromedial angulation greater than 45°,and the condylar angulation was less than 45°at 3 months after treatment.The complete recovery(CR)rate was 100%in 16 cases of maxillofacial deformity,7 cases of midline deviation and 11 cases ofⅠdegree limitation of mouth opening.In 24 patients with malocclusion,CR was 21 cases(87.5%),and incomplete recovery(IR)was3 cases(12.5%).CR and IR were 13 cases(86.67%)and 2 cases(13.33%)respectively in 15 patients withⅡdegree mouth opening restriction,and 4 cases(80.00%)and 1 case(20.00%)respectively in 5 patients withⅢdegree mouth opening restriction.In the 7 cases of opening deviation,CR was in 4 cases(57.14%)and IR was in 3 cases(42.86%).All the above IR patients were unilateral condylar fracture with condylar anteromedial angulation of more than 45°.After 3 months of treatment,the occlusal relationship and mouth opening were significantly improved,but not completely restored to normal.After 3 months of follow-up,the occlusal diso

关 键 词：弹力颌帽 颅颌牵引外固定 儿童下颌骨骨折 

分 类 号：R782.4[医药卫生—口腔医学]