成人髁突骨折保守治疗与手术治疗的系统评价

目的：评价保守治疗或手术治疗成人髁突骨折的疗效。方法：运用循证医学方法，选用开口度、咬合关系2个结局变量，利用SPSS11．0软件包中R×C列联表的妒检验对不同骨折部位治疗方法的选择是否相同进行假设检验。综合评价国内外已公开发表的关于成人髁突骨折经保守治疗或手术治疗的疗效研究。总样本361例，手术例数共246例，非手术例数115例。其中，高位骨折手术例数49例，非手术例数71例；中位骨折手术例数70例，非手术例数19例；低位骨折手术例数127例；非手术例数25例。结果：（1）高位骨折，手术组开口度恢复情况好于非手术组；中位骨折，手术组开口度恢复情况与非手术组相同；对于低位骨折，手术组开口度恢复情况与非手术组亦相同。（2）高位骨折，手术组咬合关系恢复率高于非手术组：中位骨折，手术组咬合关系恢复情况与非手术组相同：低位骨折．手术组咬合关系恢复情况与非手术组相同。结论：髁突高位骨折经手术治疗后，开15度及咬合关系均优于非手术治疗：中位骨折及低位骨折经手术治疗与非手术治疗后，开口度及咬合关系无显著差异。

Surgical versus conservative management of unilateral condylar process fractures in adults: systematic review

PURPOSE:To evaluate the effectiveness of conservative treatment and surgical treatment in adult patients with condylar fractures.METHODS:The relative studies that had been published between 1980 and 2006 were reviewed based on inclusion and exclusion criteria.The non-quantitative synthesis software SPSS 11.0 was used for integration.The eventually variables such as maximal mouth opening, malocclusion were selected.Each variable was analyzed.Totally 361 patients were classified into two groups with open reduction treatment group of 246 cases and closed treatment group of 115 cases.RESULTS:In comparisons of maximal opening between open reduction and closed treatment according to the fracture line.Greater mouth opening was found in open reduction group than in closed treatment group for high level condylar fracture, while no difference between open reduction group and closed treatment group for condylar neck fracture and subcondylar fracture.In comparisons of occlusion between open reduction and closed treatment according to the fracture line, better occlusion was found in open reduction treatment group than in closed treatment group for high level condylar fracture, while no difference was noted between open reduction treatment and closed treatment group for condylar neck fracture and subcondylar fracture.CONCLUSION:For high level condylar fracture, the recovery of occlusion and maximal opening in open reduction treatment group is better than that in closed treatment group, but for condylar neck fracture and subcondylar fracture, the recovery of occlusion and maximal opening has no significant difference between open reduction treatment group and closed treatment group.