髁突骨折两种手术方法的比较

目的:比较耳前进路行髁突骨折-翼外肌解剖复位与改良颌下进路下颌升支垂直截骨髁突游离体外复位固定回植术的优缺点,为髁突骨折合理选择手术方法、手术进路提供临床依据。方法:回顾我科收治的髁突骨折中采用手术治疗的33例(43侧)病例,按骨折位置高低、类型选择了2种不同的手术方法,其中26侧采用耳屏前切口髁突骨折-翼外肌解剖复位,17侧采用改良颌下切口、下颌升支垂直截骨髁突游离体外复位固定回植术。随访12～24月,对比分析2组病例的疗效。结果:全部切口Ⅰ期愈合,无1例关节强直;所有病人术后面部对称性好。发生下颌骨向健侧侧!运动受限的病例中,经下颌升支垂直截骨髁突游离体外复位固定术者5例(占45%),经耳屏前进路翼外肌解剖复位者3例(占14%);术后发生暂时性面瘫患者中,改良颌下进路术式1例(占9.09%),耳屏前进路4例(占18.18%),术后3～6个月均恢复正常;术后患侧关节区张口疼痛患者中改良颌下进路者2例(占18.18%),耳屏前进路者5例(占22.73%),术后3个月症状明显缓解。结论:从功能上看耳屏前进路髁突骨折-翼外肌解剖复位术明显优于下颌升支垂直截骨术;而从并发症发生看前者多于后者。临床上应根据患者具体情况,合理选择术式,以提高髁突骨折的治疗效果。

Comparison of Two Approaches in Surgical Treatment of Condylar Fractures

Objective: To compare the curative effects of two different approaches in the surgical treatment of condylar fracture. Methods: 33 patients (43 sides) with condylar fractures were treated at our department. 17 sides of condylar fractures adapted an approach of improved submandibular incision while the 26 sides of condylar fractures were treated in the approach of preauricular incision. All cases were followed up for 12～24 months. Results: All the wounds healed with first intention. No case complicated with ankylosis. The facial contour were fine in all cases. In those cases improved submandibular incisions, 45% showed a lateral movement restriction; while only 14% manfesteda lateral restuction in preauricular incision cases. As to the incidence rate of temporary facial palsy and TMJ pain, in cases of preauricular incision showed higher than those of submandibular incision. Conclusion: Each treatment approach has its own advantages and disadvantages. The appropiete one should be selected according to the special situation of patients.