| 改良耳颞切口联合颌下切口在髁状突囊内骨折术中的应用研究 |
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| 引用本文： | 王倩倩,韩瑞,丁翔,丁丹丹,徐涛,徐锦程. 改良耳颞切口联合颌下切口在髁状突囊内骨折术中的应用研究[J]. 中华全科医学, 2020, 18(9): 1446. DOI: 10.16766/j.cnki.issn.1674-4152.001529 |
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| 作者姓名： | 王倩倩 韩瑞 丁翔 丁丹丹 徐涛 徐锦程 |
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| 作者单位： | 蚌埠医学院第一附属医院口腔科, 安徽 蚌埠 233004 |
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| 基金项目： | 安徽省教育厅自然科学基金资助项目(KJ2016A480) |
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| 摘 要： | 目的 分析与探讨髁状突囊内骨折患者行坚强内固定术中采用改良耳颞切口联合颌下切口的临床疗效。 方法 选择2017年1月—2019年6月就诊于蚌埠医学院第一附属医院口腔颌面外科的髁状突囊内骨折患者共15例,计18侧,其中有三侧行保守治疗,余均经改良耳颞切口联合颌下切口行手术治疗,术后随访6~12个月,观察患者术后是否出现面神经损伤症状,有无张口度和(或)张口型的改变,有无颞下颌关节弹响的发生,有无双皮质螺纹钉的松脱、吸收等。 结果 14例患者均无面瘫、涎瘘发生,1例患者出现短暂的额纹消失,给予鼠神经生长因子(2 mL注射用水溶解,肌肉注射、1次/d、1支/次,2个疗程)支持治疗,3个月内恢复正常,15例患者咬合关系和张口度恢复良好(双脚规测量张口度≥3 cm),无关节弹响、开口型偏斜、咬合紊乱等并发症的发生,术后CT示双皮质螺纹钉固定在位、无松脱,骨折断端复位良好。术后6个月三维CT(水平位和冠状位)结果示:髁突头与关节盘位置关系恢复较好,无明显关节粘连、髁突头吸收等。 结论 经改良耳颞切口联合颌下切口行髁状突囊内骨折坚强复位内固定术时能在直视下行复位固定,具有视野暴露清晰、较少面神经损伤、极少损伤关节盘和关节软骨等优点,可为髁状突囊内骨折的手术治疗提供一定的参考。
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| 关 键 词： | 髁状突囊内骨折 坚强内固定 改良耳颞切口 颌下切口 |
| 收稿时间： | 2020-02-18 |
Study on the application of modified auriculotemporal incision combined with submaxillary incision in intracapsular condylar fracture |
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| Affiliation: | Department of Stomatology,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China |
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| Abstract: | Objective To investigate and discuss the efficacy of modified auriculotemporal incision combined with submaxillary incision in rigid internal fixation of intracapsular condylar fractures. Methods Total 15 patients with intracapsular condylar fractures in the Department of Oral and Maxillofacial Surgery at the First Affiliated Hospital of Bengbu medical college from January 2017 to June 2019 were selected, including 18 sides, 3 of which were treated conservatively, the rest were treated by modified auriculotemporal incision combined with submaxillary incision. The patients were followed up for 6-12 months to observe whether there were symptoms of facial nerve injury, whether there were changes of mouth opening degree and/or mouth opening type, whether there was temporomandibular joint bounce, whether there was loosening and absorption of double cortical screw. Results Total 14 patients had no facial paralysis and salivary fistula, 1 patient had a short disappearance of frontal striae, and was treated with rat nerve growth factor(2 mL of water for injection, intramuscular injection, once a day, once a branch, two courses) to restore normal within 3 months. Total 15 patients had a good restoration of occlusal system and mouth opening degree(foot measurement mouth opening degree ≥3 cm). There was no joint bounce, open deflection, malocclusion and other complications. After operation, CT showed that the double cortical screw was fixed in place without looseness, and the fracture end was restored well. After 6 months of operative, three-dimensional CT(horizontal and coronal) showed that condylar head and joint plate location relationship was good, no obvious articular adhesion, condylar head absorption, etc. Conclusion The modified auriculotemporal incision combined with submaxillary incision in rigid reduction and internal fixation of intracapsular condylar fractures has the advantages of clear visual field exposure, less facial nerve injury, less damage to articular disc and articular cartilage, which can provide certain reference for the surgical treatment of intracapsular condylar fractures. |
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