软组织精准复位提高髁突囊内骨折治疗效果的回顾性对照研究  

A retrospective comparative study of the effects of soft tissue precise reduction on the treatment of intracapsular condylar fractures

作　　者：佘建祯 谢江徽 王乐 曹锋 鲍涵 杨璐颖 徐晓莹 田磊 孔亮 蔡卜磊 SHE Jianzhen;XIE Jianghui;WANG Le;CAO Feng;BAO Han;YANG Luying;XU Xiaoying;TIANLei;KONG Liang;CAI Bolei(State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Clinical Research Center for Oral Diseases,Department of Oral and Maxillofacial Surgery,The Third Affiliated Hospital of Air Force Medical University,China,710032 Xi'an;People's Liberation Army Navy Hospital No.971,Qingdao)

机构地区：[1]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,空军军医大学第三附属医院口腔颌面外科,西安710032 [2]中国人民解放军海军第971医院

出　　处：《实用口腔医学杂志》2025年第1期46-51,共6页Journal of Practical Stomatology

基　　金：国家自然科学基金面上项目(编号:82171009);国家口腔疾病临床医学研究中心专项课题(编号:B2020010);陕西省“杰出青年科学基金项目”(编号:S2023-JC-JQ-0326)。

摘　　要：目的:通过与接受传统切开复位内固定术(T-ORIF)的髁突囊内骨折(ICFs)患者进行对比,评估辅助软组织精准复位的切开复位内固定术(PSTR-ORIF)对ICFs治疗效果的提升情况。方法:纳入行T-ORIF及PSTR-ORIF治疗的ICFs患者各20名,收集术前和术后6个月的全口曲面断层片、CT及MRI影像学资料对比分析,评估颞下颌关节(TMJ)软硬组织的复位情况,用Helkimo指数评估患者TMJ的临床症状及主观症状。结果:PSTR-ORIF组26侧和ORIF组27侧术后6个月骨折段完全解剖复位率分别为96.15%和81.48%,各型ICF关节盘复位整体有效率分别为96.15%和74.07%,PSRT-ORI组对B型骨折患者术后下颌升支高度恢复更好(P<0.05)。术后6个月,PSTR-ORIF组的患者在张口度、下颌前伸距离和侧向运动的恢复程度上均较T-ORIF组有显著提升(P<0.05)。Helkimo指数显示,PSTR-ORIF在主诉症状指数评分和临床症状指数评分上均较T-ORIF组有显著提升(P<0.05)。结论:与T-ORIF相比,PSTR-ORIF对TMJ关节盘及关节囊等软组织进行良好复位,促进髁突骨折愈合,更好地恢复术后TMJ的运动能力并减少术后关节不适症状。Objective:To evaluate the improvement in the outcome of intracapsular condylar fractures(ICFs)treatment with precise soft tissue reduction in combination with open reduction and internal fixation(PSTR-ORIF)by comparson with traditional open reduction and internal fixation(T-ORIF).Methods:40 patients with ICFs were treated by T-ORIF and PSTR-ORIF(n=20)respectively.Preoperative and 6-month postoperative whole-mouth panoramic tomography,CT and MRI imaging data were analyzed,the repositioning of the soft and hard tissues of temporomandibular joints(TMJs),the Helkimo index,clinical symptoms and subjective symptoms were compared between the 2 groups.Results:In PSTR-ORIF(26 sides)and T-ORIF(27 sides)groups,the rate of complete anatomical restoration of fractured segments at 6 months after surgery was 96.15%and 81.48%,and the overall effective rate of ICF articular disc restoration was 96.15%and 74.07%respectively,the height of the ascending mandibular branch was better restored in patients with B-type fracture after surgery(P<0.05).At 6 months postoperatively,patients in the PSTR-ORIF group showed significant improvement in mouth opening,mandibular anterior extension distance,and lateral movement compared with the T-ORIF group(P<0.05).The Helkimo index showed that the PSTR-ORIF group got a significant improvement in the complaint symptom index score and the clinical symptom index score compared with the T-ORIF group(P<0.05).Conclusion:PSTR-ORIF is more effective than T-ORIF in the treatment of ICFs for the healing of condylar fractures,restore postoperative TMJ mobility and reduce the postoperative joint discomfort through good repositioning of soft tissues.

关 键 词：颞下颌关节 髁突 髁突囊内骨折 软组织精准复位 

分 类 号：R782.4[医药卫生—口腔医学]