全面部陈旧性骨折16例临床治疗与分析

目的：探讨全面部陈旧性骨折特点及治疗原则，评估本医院治疗措施的效果。方法：回顾分析西安交通大学口腔医院口腔颌面外科自2005年1月～2012年6月诊治的全面部陈旧性骨折16例。术前术后的调查评估内容包括年龄、性别、病因、延误治疗的原因、骨折部位、治疗措施、术后面部畸形、咬合关系、张口度、并发症、复发等内容。结果：所有患者均发生面中份骨折，12例伴有下颌骨骨折，10例伴有额骨骨折，14例伴有颧骨骨折，10例伴鼻眶筛骨折。LeFort I型截骨术应用于所有患者。术后颌间固定、调颌或义齿修复应用于所有患者，4例患者接受正畸治疗，其中3例为扩弓治疗。1例患者术后仍存在眼球内陷，视力障碍。2例患者因软组织缺损，导致面部畸形。所有患者张口度均恢复正常，无明显手术并发症。结论：LeFort I型截骨术与分段截骨术是治疗全面部陈旧性骨折骨的基本方法。对于上颌骨矢状骨折，手术不能完全恢复咬合关系者，术后扩弓是一种有效的方法。术后的辅助治疗是有必要的，包括正畸治疗、义齿修复、调颌等。

Analysis and treatment of 16 patients with delayed panfacial fractures

Objective The aim of this study was to investigate the characteristics and treatment sequence of delayed panfacial fractures,and evaluate the results of our institution＇s treatment. Methods From January 2005 to December 2011 in department of Oral and Maxillofacial Surgery, Stomatological Hospital,Xi＇an Jiaotong University, a retrospective analysis of 16 cases with delayed panfacial fractures was performed. Data analyzed included age,gender,etiology,fracture locations, clinical treatment,postoperative facial deformity, occlusion, mouth opening,complications,and recurrence. Results All 16 cases had midface fractures,12 were complicated by mandibular fractures,10 by frontal fractures,14 by zygomatic fractures,10 by naso-orbito-ethmoid （NOE） fractures.A variety of surgical approaches were used.Le Fort I osteotomy,maxillomandibular fixation, occlusion adjustment,prosthodontics were used to all patient.Orthodontic treatment was used to four patients,three case was maxillary expansion.There was one case that still had vision problems,two cases had facial deformity.All of the 16 cases had a normal mouth opening, without any obvious complications. Conclusion Le Fort I osteotomy and segmental osteotomy are basic ways to treat delayed panfacial fractures. To sagittal fracture of the maxilla, when surgery cannot make a normal occlusion,postoperative maxillary expansion is an effective way.Postoperative adjuvant therapy is necessary,including sorthodontic treatment, prosthesis,occlusion adjustment.