关节盘复位锚固术在下颌骨髁突囊内骨折伴关节盘移位治疗中的应用研究  

Clinical application of disc reduction and anchorage for diacapitular condylar fracture with disc displacement

作　　者：郭梁影 孟献斌 吴志刚 GUO Liangying;MENG Xianbin;WU Zhigang(Department of Stomatology,the First Affiliated Hospital ofBengbu Medical College,Bengbu Anhui,233004,P.R.China)

机构地区：[1]蚌埠医学院第一附属医院口腔颌面外科,安徽蚌埠233004

出　　处：《中国修复重建外科杂志》2022年第5期587-591,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨关节盘复位锚固术治疗下颌骨髁突囊内骨折伴关节盘移位的临床疗效。方法2019年6月—2021年6月,采用关节盘复位锚固术联合骨折内固定术治疗下颌骨髁突囊内骨折伴关节盘移位20例(27侧)。男15例,女5例;年龄8~65岁,中位年龄40岁。致伤原因:高空坠落伤3例,交通事故伤3例,摔伤14例。其中,单侧骨折13例,双侧骨折7例;骨折分型:A型5侧,B型22侧。单纯髁突囊内骨折14侧,髁突囊内骨折伴下颌颏部骨折12侧、下颌角骨折1例。最大开口度5~20 mm,平均9.7 mm。受伤至手术时间4~20 d,平均11.6 d。术后影像学检查评价骨折复位及关节盘复位情况。记录患者术后6个月最大开口度,通过Helkimo指数中的临床功能障碍指数(clinical dysfunction index,Di)评价颞下颌关节功能。结果术后切口均Ⅰ期愈合。20例患者均获随访,随访时间6~10个月,平均8个月。术后影像学复查示26侧骨折达解剖复位、1侧达基本复位;关节盘复位达优25侧、良1侧、差1侧,关节盘复位锚固术有效率达96.3%。患者咬合关系稳定程度基本达到伤前水平,切口瘢痕隐蔽。开口度较术前明显改善,术后6个月最大开口度达32~40 mm,平均36.8 mm;17例最大开口度≥35 mm。末次随访时,关节功能评价Di 0级8侧、DiⅠ级18侧、DiⅡ级1侧。术后出现2例开口偏斜、1例关节弹响、2例暂时性患侧额纹消失,经对症处理后恢复正常。结论对于伴有关节盘移位的下颌骨髁突囊内骨折,骨折复位内固定同时采用关节盘复位锚固术,可获得较好临床效果。Objective To investigate the effectiveness of disc reduction and anchorage in treatment of diacapitular condylar fracture with disc displacement.Methods Between June 2019 and June 2021,20 patients(27 sides)with diacapitular condylar fractures with disc displacement were treated with disc reduction and anchorage combined with internal fixation.There were 15 males and 5 females with a median age of 40 years(range,8-65 years).The fractures were caused by falling from height in 3 cases,traffic accident in 3 cases,and falling in 14 cases.Among them,there were 13cases of unilateral fracture and 7 cases of bilateral fractures.Five sides were type A fractures and 22 sides were type B.There were 14 simple diacapitular condylar fractures,12 diacapitular condylar fractures combined with mandibular chin fractures,and 1 diacapitular condylar fracture combined with mandibular angle fracture.The maximum opening was 5-20 mm(mean,9.7 mm).The time from injury to operation was 4-20 days,with an average of 11.6 days.The postoperative imaging examination was performed to evaluate the reduction of fracture and disc.The maximum opening at 6 months after operation was recorded,and the clinical dysfunction index(Di)of Helkimo index was used to evaluate the temporomandibular joint function.Results All incisions healed by first intention.All 20 patients were followed up 6-10months(mean,8 months).Postoperative imaging examination showed that 27 fractures were well reduced,of which 26were anatomically reduced and 1 was basically reduced;the reduction of the temporomandibular joint disc was excellent in 25 sides,good in 1 side,and poor in 1 side,and the effective rate of disc reduction and anchorage was 96.3%.The occlusion relationship of the patient was stable and basically reached the pre-injury level,the incision scar was hidden,and the mouth opening significantly improved when compared with the preoperative level.The maximum mouth opening was32-40 mm(mean,36.8 mm)at 6 months after operation.Maximum opening was more than 35 mm in 17 cases.

关 键 词：下颌骨 髁突囊内骨折 关节盘复位锚固术 骨折复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]