微切口闭合复位术治疗单纯性颧弓M型骨折的疗效分析

目的 探讨微切口闭合复位术治疗单纯性颧弓M型骨折的临床疗效。方法 回顾性研究。纳入2015年3月-2019年5月解放军联勤保障部队第九〇一医院耳鼻咽喉头颈外科收治的单纯性颧弓M型骨折患者45例,其中男35例、女10例,年龄16~71岁;左侧30例、右侧15例。均采用微切口闭合复位术治疗。术中通过C臂X线机透视观察骨折对位和颧弓弧度情况,以骨折对位良好和颧弓自然弧度恢复、目测最大张口度明显改善为骨折闭合复位满意;术后3~6个月,通过对比手术前后最大张口度的变化和CT测量双侧颧弓突度差值进行疗效评估,采用视觉模拟量表评估患者满意度,并结合临床和CT表现进行疗效评价。结果 45例中,44例经1次复位即获满意效果,另1例经2次复位后满意;无面神经损伤等并发症发生。术后随访3~6个月,CT复查显示45例基本达到解剖复位;最大张口度术前为(2.76±0.37)cm、术后为(3.91±0.15)cm, CT测量双侧颧弓突度差值术前为(4.43±0.28)mm、术后为(0.47±0.09)mm,经配对t检验,差异均有统计学意义(t=23.752、93.281, P值均<0.05)。手术疗效评价为Ⅰ级42例,Ⅱ级3例;依视觉模拟量表评估45例患者满意度为99.50%±2.15%。结论 微切口闭合复位术治疗单纯性颧弓M型骨折是一种安全、高效、易于掌握的方法,值得临床推广应用。

Curative effect analysis of M type zygomatic arch fracture using microincision closed reduction

Objective A study was conducted to explore the curative effect of M-type zygomatic arch fractures using microincision closed reduction.Methods From March 2015 to May 2019, 45 cases of M-type fractures of the zygomatic arch were admitted to the 901st Hospital of the Joint Logistics Support Force of PLA and recruited for the study. There were 35 males and 10 females with age of 16-71 years old, and 30 patients were on the left side, 15 patients on the right side. Thus, surgery was performed by intraoral small incision approach. The reduction effect was preliminarily evaluated with C-arm machine and mouth opening change. The reduction effect and satisfaction assessment of the patients were evaluated with CT and visual analog scale (VAS).Results Among the 45 patients, 44 were successfully reset once, and one patient was reset twice during the operation. No facial nerve injury was observed, and the therapeutic effect was satisfactory. Postoperative follow-up was conducted for 3-6 months. The average preoperative mouth opening was (2.76±0.37) cm, and the average postoperative mouth opening was (3.91±0.15) cm; the differences were statistically significant (t=23.752, P<0.05). The 45 patients who underwent CT evaluation in 3-6 months after the operation achieved anatomical reduction. The differences between the degrees of zygomatic protrusion on both sides were (4.43±0.28) mm preoperatively and (0.47±0.09) mm postoperatively with statistically significant differences (t=93.281, P<0.05). Among these 45 patients, 42 patients and 3 patients had grade Ⅰ and grade Ⅱ healing respectively. The VAS score of postoperative satisfaction was 99.50%±2.15%.Conclusions The treatment of M-type zygomatic arch fractures with microincision closed reduction is a safe, effective and easy to master method, which deserves further clinical application.