近中骨折端稳定的颧骨、颧弓骨折的简略复位固定技术

目的 颧骨、颧弓骨折通常需要冠状切口、下睑切口和口内切口进路,逐一进行裂开骨折段的复位固定。本文旨在探索一种简便而可靠的修复方法。方法 针对颧骨、颧弓骨折其内侧相邻的上颌骨结构稳定、颧骨的近中骨折端移位不明显的6例患者,采取半冠状切口,按顺序复位固定的方法,由后向前做颧弓骨折段的复位固定,核查眶外壁颧额缝和颧蝶缝的衔接无误,最后完成颧额缝处骨折的固定。不需做下眼睑、口内切口以及眶下缘颧上颌缝的固定和口内颧牙槽嵴的骨折固定。结果 本组6例病例均顺利完成骨折复位与固定。术后CT扫描显示各个骨折断端,包括上颌窦后外壁、眶外壁等,都获得精确的解剖复位和牢固固定。两侧面部宽度和颧骨突度基本对称,面形恢复满意。开、闭口功能正常。未发生颞下颌关节损伤、视力损害及面神经额支损伤。结论 应用近中骨折端稳定的颧骨骨折的简略复位固定技术,可恢复颧骨、颧弓的解剖位置。

Reduction and fixation of tetrapod zygomatic fractures with a stable medial end of fracture segment

PURPOSE： Zygomatic fractures usually need reduction and fixation of all the fracture segments through coronal, subciliary, or transconjunctival, and intraoral approach. The purpose of this paper was to explore a technique of fracture management without subciliary and intraoral approach and fixation for certain type of tetrapod zygomatic fracture. METHODS： In cases of type B zygomatic fractures by Zingg classification, with a stable maxillary structure inward and an inconspicuously displaced medial end of fracture segment, half-coronal approach was used. Sequential reduction and fixation was performed in zygomatic arch posterior-anteriorly. Alignment of fracture segments at the site of fronto- zygomatic suture was checked, and then synthesis was done. There was no need for subciliary, intraoral approach and fixation at infraorbital edge and zygomaticomaxillary buttresses. RESULTS： Reduction and fixationn of fractures was accomplished successfully in a series of 6 patients, postoperative CT scan showed anatomical reduction of the bone segments and firm fixation in all patients. Facial width and zygomatic prominence recovered symmetry and facial configuration restored satisfactorily. Mouth opening was normal. No injury was found in temporomandibular joint, eyes and facial nerves. CONCLUSIONS： Anatomical reduction and firm fixation of the bone segments could be achieved by this simplified management in certain type of tripod zygomatic fractures with a stable maxillary structure inward and an inconspicuously displaced medial end of fracture segment.