改良耳屏前切口腮腺上入路治疗髁突囊内骨折的临床效果评价  

Clinical evaluation of modified tragus edge and supraparotid approach for intracapsular condylar fractures

作　　者：傅瑜[1] 张平[1] 张玉超[1] 郭松松[1] 李盛 程杰[1] 江宏兵[1] FU Yu;ZHANG Ping;ZHANG Yuchao;GUO Songsong;LI Sheng;CHENG Jie;JIANG Hongbing(Department of Oral and Maxillofacial Surgery,Affiliated Hospital of Stomatology,Nanjing Medical University,Jiangsu Key Laboratory of Oral Diseases,Nanjing 210029,China)

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

出　　处：《口腔医学》2022年第11期990-994,999,共6页Stomatology

基　　金：江苏省自然科学基金面上项目(BK20201350);江苏省高校优势学科建设工程(2018-87)。

摘　　要：目的评价改良耳屏前切口腮腺上入路治疗髁突囊内骨折的临床效果。方法回顾性研究2020年1月至2020年12月在南京医科大学附属口腔医院口腔颌面外科同一治疗组手术的13例16侧髁突囊内骨折病例,采用改良耳屏前切口腮腺上入路行骨折复位固定,术后评价复位效果、咬合关系、下颌运动功能、面神经损伤情况,并进行统计学分析。结果骨折复位效果优14侧,良和差各1侧;13例患者中有3例进行了颌间牵引,牵引时间为3~7 d;所有患者术后3个月咬合关系良好,开口度为(37.46±6.91)mm,前伸运动(6.34±1.21)mm,侧方运动向健侧(5.45±1.54)mm,向患侧(5.65±1.12)mm,与术后6个月相比差异无统计学意义;术后3个月下颌运动及进食时无不适或轻微不适,与术后6个月相比差异无统计学意义;术后出现抬眉困难5侧,其次是上睑下垂1侧。结论改良耳屏前切口腮腺上入路治疗髁突囊内骨折可以有效复位骨折端和关节盘,术后3个月患者咬合关系良好,下颌运动功能正常,面神经损伤症状基本恢复。Objective To evaluate the clinical effect of modified tragus incision supraparotid approach on the treatment of intracapsular condylar fractures.Methods A retrospective study selected 13 cases(16 joints)of intracapsular condylar fractures who underwent surgery in the same treatment group in the Department of Oral and Maxillofacial Surgery,Affiliated Stomatological Hospital of Nanjing Medical University from January 2020 to December 2020.The effect of condyle reduction was evaluated with CBCT postoperatively.Occlusal relationship,mandibular function and facial nerve injury were evaluated at 3 and 6 months after operation.Results It was showed that effects of 14 sides were excellent;1 side was good and 1 side was poor.Intermaxillary traction was performed in 3 of the 13 patients;the traction time was 3 to 7 days.All patients had a good occlusal relationship 3 months after operation;the opening was(37.46±6.91)mm;the forward movement was(6.34±1.21)mm;lateral movement to the healthy side was(5.45±1.54)mm,and to the affected side was(5.65±1.12)mm.Mandibular movement and chewing caused no discomfort or slight discomfort at 3 months after operation.There was no statistical difference of occlusal relationship and mandibular function between 3 months and 6 months postoperatively.There were 6 sides of facial nerve injury after surgery,5 of which were difficulty in raising eyebrows and 1 of which was ptosis.Conclusion The modified tragus edge and supraparotid approach for treatment of intracapsular condylar fractures can effectively restore and fix the displaced fracture and the articular disc.Occlusal relationship,mandibular function and facial nerve injury recover well 3 months after the operation.

关 键 词：髁突囊内骨折 切开复位内固定 下颌运动 面神经损伤 

分 类 号：R782.4[医药卫生—口腔医学]