下颌角骨折张力线内固定治疗方法的改进及其效果分析

目的改进口内切开复位治疗下颌角骨折的方法并对其临床效果进行比较探讨。方法下颌角骨折112例患者(115侧),分为A、B、C三组,均使用张力带内固定,B组、C两组分别加用口内切口下颌角外侧面行补偿固定和术后颌间固定,术后随访半年,对术后感染、咬合关系紊乱、体重丧失、颞颌关节异常和张口受限等方面进行综合比较。结果单纯张力带内固定组术后感染率为13.1%,有2例咬合关系紊乱,并有39.4%的病例下颌角下缘出现明显的外骨痂;其它两组感染率为5%、2.9%,咬合关系良好,加用颌间固定的C组体重丧失率和张口受限率为8.74%和47.1%,高于其它两组。结论单纯张力线内固定可治疗下颌角骨折,但存在着较大的局限性,口内切开复位下颌角外侧面补偿固定和术后颌间固定作为两种辅助治疗方法,在避免口外切口的同时,大大增加了治疗效果和适应证。     

不同固定方法对下颌骨骨折治疗效果的比较

目的 评价下颌骨骨折不同固定方法的治疗效果及术后并发症，探讨各种骨折固定方法的优缺点。方法 l18例下颌骨骨折患者分别采用单纯颌间结扎、颌间结扎加钢丝骨内固定、小型钛板坚固内固定，对其术后功能恢复时间、并发症、骨折严重程度与固定方法及并发症的关系进行统计学分析比较。结果 三种不同的骨折治疗方法并发症的发生率不同，其中骨折的严重程度和并发症的发生率高度相关。单纯颌间结扎治疗下颌骨骨折方法简单，但限制开口时间长，功能恢复慢，产生的并发症多；颌间结扎加钢丝骨内固定在一定程度上增加了固定的稳定性，但口外切口增加了面神经下颌缘支误伤的可能性，限制开口时间长；小型钛板坚固内固定方法对牙周及颞下颌关节影响小，不限制开口或早期就开始下颌骨运动，功能恢复快；但如钛板放置不当，会导致牙根或下牙槽神经的损伤及术后咬合紊乱的发生。结论 小型仗板坚固内固定方法治疗下颌骨骨折并发症少，功能恢复快；且口内切口隐蔽无损伤面神经的风险，疗效明显好于单纯颌间结扎或颌间结扎加钢丝骨内固定方法。     

钛板内固定与颌间固定治疗下颌骨骨折59例疗效分析

目的：探讨小型钛板坚强内固定与颌间固定治疗下颌骨骨折的临床效果。方法：59例下颌骨骨折患者随机分为2组，一组采用颌间弹性牵引加小型钛板内固定术(30例)，另一组采用上、下牙弓夹板固定加颌间弹性牵引术(29例)，治疗后对临床效果进行评价。结果：2组术后在感染发生率、骨愈合率方面疗效基本相同：在咬合关系、张口度的恢复及体重改变方面存在明显差异。结论：小型钛板坚强内固定对下颌骨骨折治疗效果肯定，在咬合关系及张口度恢复方面优于颌间固定术。     

两种不同内固定方法治疗下颌骨骨折的效果分析

目的：对钢丝结扎内固定及小夹板内固定的治疗效果进行分析，以帮助医生确定适宜的内固定方法。方法：对86例下颌骨骨折进行上述两种内固定方法治疗。手术方案由主治医师及副主任医师制定。术后追踪随访6周，记录术后咬He关系不良及开口时颌关节疼痛的发生情况，将术后合并症发生率与内固定方法、术者经验及骨折情况等因素一起进行统计学分析。结果：两组不同内固定方法的治疗效果无显著性差异，但在双处骨折中，小夹板内固定的术后合并症发生率明显高于钢丝内固定组。两组医生完成的手术治疗效果无显著性差异，但主治医师完成的小夹板内固定术后合并症发生率明显高于副主任医师组。片层状断面或合并有片层状断面的骨折术后合并症发生率较高。结论：影响下颌骨骨折治疗效果的因素有许多，选择适宜的内固定方法是取得良好治疗效果的关键。     

颌后切口径路在髁突骨折治疗中的应用

目的　讨论总结经颌后切口径路治疗髁突骨折的临床效果。方法　23例(26侧)髁突骨折患者选择经颌后切口径路进行髁突骨折切开复位内固定术。术后对患者的张口型、张口度、咬合关系、面神经功能以及并发症等方面进行评价分析。结果　23例(26侧)经12～24个月随访,未出现关节强直及涎瘘,骨折愈合良好,咬合关系、张口型及张口度均较术前明显改善,术后1周主要并发症包括张口受限、面神经功能减退,经1～3个月均有效恢复。结论　颌后切口径路能治疗不同类型的髁突骨折,术野暴露清晰且切口隐蔽,利于复位固定和面神经保护,术后功能和外形恢复效果明显,并发症较少。     

单螺钉内固定法在髁突矢状骨折治疗中的应用

目的：探讨单螺钉内固定治疗下颌骨髁突矢状骨折的临床效果和应用价值。方法：对27例髁突矢状骨折病例进行回顾研究，根据治疗方式分为单螺钉内固定组和保守治疗组，比较术后3个月两组患者术后并发症、咬合关系、最大开口度、颞下颌关节功能障碍指数（DI）和肌肉压痛指数（PI）等情况，进行统计学分析。结果：单螺钉内固定组术后未出现关节区疼痛、张口受限和关节强直等严重并发症，DI和PI各指标均优于保守治疗组，两组的差异具有显著统计学意义。结论：单螺钉内固定手术方法是一种行之有效的髁突矢状骨折治疗手段，疗效确切。     

两种不同内固定方法治疗下颌骨骨折的效果分析

目的 :对钢丝结扎内固定及小夹板内固定的治疗效果进行分析 ,以帮助医生确定适宜的内固定方法。方法 :对 86例下颌骨骨折进行上述两种内固定方法治疗。手术方案由主治医师及副主任医师制定。术后追踪随访 6周 ,记录术后咬牙合关系不良及开口时颞颌关节疼痛的发生情况 ,将术后合并症发生率与内固定方法、术者经验及骨折情况等因素一起进行统计学分析。结果 :两组不同内固定方法的治疗效果无显著性差异 ,但在双处骨折中 ,小夹板内固定的术后合并症发生率明显高于钢丝内固定组。两组医生完成的手术治疗效果无显著性差异 ,但主治医师完成的小夹板内固定术后合并症发生率明显高于副主任医师组。片层状断面或合并有片层状断面的骨折术后合并症发生率较高。结论 :影响下颌骨骨折治疗效果的因素有许多 ,选择适宜的内固定方法是取得良好治疗效果的关键。     

单颌钢丝结扎加小型钛板内固定治疗下颌骨骨折

目的 总结应用单颌钢丝结扎加小型钛板内固定治疗下颌骨骨折的临床效果。方法 对下颌骨单发或多发骨折先用钢丝进行单颌结扎，使骨折段复位并力求恢复正常咬合关系。然后用小型钛板进行骨折段的坚固内固定。结果 32例下颌骨骨折应用该技术均获得了较好的疗效。恢复了正常的咬合功能。结论 应用该项技术，避免了凳间结扎对病人造成的进食困难。可以早期进行张口锻炼，从而对颞颌关节的功能影响较小。下颌骨体部及下颌正中部的骨折可从口内黏膜切口，可消除患者对颌下切口形成的瘢痕及面神经损伤造成的顾虑。     

微创法与锤凿法拔除下颌阻生智齿的临床研究

目的:评估微创拔牙技术在阻生牙拔除术中的应用价值。方法:选择342例需拔除下颌阻生智齿患者,随机分成2组,分别采用微创法和锤凿法拔除患牙,记录两种方法平均拔除时间、术后肿胀、疼痛、张口受限、颞颌关节痛、干槽症等并发症发生情况。结果:实验组与对照组相比,平均拔除时间明显缩短(P<0.001);术后疼痛、肿胀、张口受限、干槽症、颞颌关节痛等并发症发生率较对照组明显降低(P<0.005)。结论:随着微创医学的发展及新型拔牙器械的推出,微创拔牙理念和技术将逐渐取代传统的锤凿法。     

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目的评价单钛板张力带内固定辅以颌间固定治疗下颌角骨折的疗效。方法选择2004年2月至2009年5月在安徽省六安市第二人民医院口腔科治疗的下颌角骨折患者63例,随机分为A、B两组。其中A组35例,采用单钛板张力带内固定辅以颌间固定的方法进行治疗;B组28例,仅单纯采用单钛板张力带内固定的方法进行治疗。两组患者术后随访半年,对术后感染、咬合关系紊乱和张口受限等方面的发生情况进行比较。结果 A组患者术后2例发生感染,1例发生咬合关系紊乱,5例发生张口受限;B组患者术后2例发生感染,5例发生咬合关系紊乱,3例发生张口受限。两组患者在术后感染及张口受限的发生方面比较,差异无统计学意义(P>0.05);而在术后咬合关系紊乱的发生方面比较,差异有统计学意义(P<0.05)。结论采用单钛板张力带内固定辅以颌间固定治疗下颌角骨折,可以克服各自单一使用的缺点,有利于术后骨折愈合及恢复正常咬合关系。     

Complications of orthognathic surgery: a comparison between wire fixation and rigid internal fixation

This retrospective review compares the results of using rigid internal fixation (RIF) and wire fixation for orthognathic surgery patients. The records of two groups of demographically similar patients who underwent comparable surgery, performed by the same four attending surgeons at the same institutions during the same time period (1983 to 1986), were evaluated for complications and unanticipated treatment results. The most striking finding of this study is the general similarity between the two groups. However, differences in frequency of excessive weight loss and persistent restriction of mandibular opening suggest a benefit from early mobility of the mandible that comes with RIF. Because there was no concomitant increase in complications or unexpected results of treatment, the introduction of RIF for orthognathic surgery may offer patients some potential advantages.     

Superior repositioning of the maxilla combined with mandibular advancement: mandibular RIF improves stability.

Postsurgical changes in 24 patients who had rigid internal fixation (RIF) of the mandible with screws after combined superior repositioning of the maxilla and mandibular advancement were compared with 53 patients who underwent the same surgery but who had intraosseous wire fixation, skeletal suspension wires, and 8 weeks of maxillomandibular fixation (MMF). During the first 8 weeks after surgery, the mean posterior relapse of the mandible was greater in the MMF group than in the RIF group (for example, -1.1 mm versus 0.15 mm at B point), and the percentage of patients with clinically significant vertical and horizontal changes was greater in the MMF group. By 1 year, there had been slight additional mean relapse in the MMF group (-1.5 mm net relapse at B point, with 42% of the patients showing 2 mm or more relapse). In the RIF group, the mandible was more likely to be repositioned forward than posteriorly (net mean change at B point, 0.7 mm forward; 33% had 2 mm or more forward movement). In the RIF group, all but one of the patients (96%) were judged to have an excellent clinical result; in the MMF group, the corresponding figure was 60%.     

Fixation of mandibular fractures: a comparative analysis of rigid internal fixation and standard fixation techniques

This study used a prospective design to compare standard therapy (closed or open reduction with 4 weeks of maxillomandibular fixation) to rigid internal fixation (RIF) for the treatment of mandibular fractures. Ninety-two patients with 143 fractures were evaluated and treated. There was no statistically significant difference in the treatment results between the two groups, despite a bias in the distribution of study variables that favored the standard therapy.     

下颌骨双侧升支矢状劈开坚强内固定的生物力学研究

目的:研究下颌骨升支矢状劈开小型钛板和双皮质固位螺钉内同定生物力学特性,为临床提供理论上的指导。方法:用螺旋CT断层扫描技术及ANSYS有限元软件在计算机上建立下颌骨升支矢状劈开小型钛板及3种双皮质同位螺钉内固定的三维有限元模型;计算4种固定方法在三种咬合情况下颌骨的应力、内固定系统的应力以及骨劈开处的位移,对比这些固定方式的固定效果以及不同咬合情况对固定稳定性的影响。结果:在相同咬合情况下,颌骨的应力、劈开处的位移从大到小排列顺序为:2mm双皮质同位螺钉直线形内固定、小型钛板内固定、2mm双皮质同位螺钉倒"L"形内固定、2.7mm双皮质固位螺钉倒"L"形内固定。相同固定方式情况下,颌骨的应力、内固定系统的应力以及劈开处的位移从大到小排列顺序为:前牙咬合、前磨牙咬合、磨牙咬合。结论:下颌骨双侧升支矢状劈开双皮质固位螺钉倒"L"形内固定的固定稳定性要强于小型钛板内固定;直线形内固定固定稳定性相对较差。前牙咬合对同定的不良影响很大,应尽量避免。     

Fixation of subcondylar fractures of the mandible: a randomized clinical trial comparing one trapezoidal plate with two miniplates

Subcondylar fracture of the mandible accounts for 25–35% of all mandibular fractures. In the past, most subcondylar fractures were managed non-surgically. The traditional method of fixation for subcondylar fractures uses two miniplates; however some bench studies have reported that trapezoidal plates are superior. The aim of this study was to compare the outcomes of subcondylar fractures fixed either with two non-parallel straight miniplates or with one trapezoidal plate. A randomized clinical trial was designed and implemented. Fifty-two consecutive patients with subcondylar fractures were recruited. All patients underwent surgery via a retromandibular approach. The time taken for fixation of the plate after fracture reduction and postoperative outcomes and complications were compared between the groups. The trapezoidal plates were superior in terms of ease of adaptation and time taken for fixation (P =  0.0001). Plate fracture was observed only in the two miniplates group, in four (16%) patients. Outcomes were similar in the two groups in terms of occlusion, mouth opening, protrusion, and lateral excursion. In conclusion, both systems – two miniplates and the trapezoidal plate – provide functionally stable fixation. The outcome was significantly better for the trapezoidal plate than for two miniplates regarding the time taken for insertion and ease of adaptation, but not for other parameters.     

Current therapy: complications associated with rigid internal fixation of facial fractures

Rigid internal fixation (RIF) is commonly used for the anatomical reduction and fixation of facial fractures. This technique has many advantages over more traditional methods, such as wire osteosynthesis and maxillomandibular fixation. Properly placed RIF ensures a stable anatomical reduction and allows for immediate or early restoration of function. RIF has a number of complications associated with its use in facial trauma surgery including metal sensitivity, infection, neurologic injury, dental trauma, stress shielding, and malocclusion. Complication rates appear to be inversely proportional with operator skill and experience when using RIF.     

Fixation methods in sagittal split ramus osteotomy: a systematic review on in vitro biomechanical assessments

The aim of this systematic review was to assess the stability of rigid internal fixation (RIF) techniques in sagittal split ramus osteotomy (SSRO) based on in vitro biomechanical assessments, with particular interest in large mandibular advancements. In general, RIF methods can be divided into three groups: bicortical screws, miniplates, and a combination of the two. An electronic search of the PubMed, CINAHL, and Embase databases was performed, and studies published between January 2003 and March 2018 were screened for inclusion. Comparative studies with an in vitro experimental design, using biomechanical assessments to measure the stability of RIF methods in SSRO, were included. Of 104 unique studies identified in the initial search, 24 were included. Twenty-two of these 24 studies analyzed an advancement of the mandible of 7 mm or less. The use of a single four-hole or six-hole miniplate was less stable than the use of bicortical screws, hybrid techniques, double miniplates, or grid plates. Two studies analyzed advancements of 10 mm, for which two miniplates placed in parallel and a grid plate showed most stability. Although there was agreement between studies with regard to results, more biomechanical studies are required to quantify the stability of fixation methods in larger mandibular advancements.     

Evaluation of mandibular setback after bilateral sagittal split osteotomy with the hunsuck modification and miniplate fixation.

PURPOSE: This study was conducted to evaluate neurosensory disturbances (NSDs) and jaw movement after bilateral sagittal split osteotomy (BSSO) with the Hunsuck modification and miniplate fixation to correct mandibular prognathism. PATIENTS AND METHODS: A total of 63 patients who underwent Hunsuck-modified BSSO to correct mandibular prognathism were studied. Both 3-month and 6-month postoperative Schuller's temporomandibular joint (TMJ) views tracing the 63 patients were studied to analyze mandibular movement. The patients' NSD and TMJ symptoms were recorded. Data were analyzed using 1-way analysis of variance. RESULTS: The mean TMJ was 9.6% with clicking before surgery. At the evaluation 6 months after surgery, the clicking had reduced to 3.1%. The lip neuorsensory deficit increased to 23.8% at 6 months after surgery. The jaw position measurements before and after surgery showed statistically significant differences in mouth opening and jaw advancement (P < .05). The changes in mandibular lateral movement were not statistically significant (P > .05). CONCLUSIONS: The results of this study show reduced TMJ clicking, the presence of NSDs, and reduced mouth opening after Hunsuck-modified BSSO.     

A retrospective study of mandibular fracture in a 40-month period

This retrospective study evaluated the epidemiology, treatment and complications of mandibular fracture associated, or not associated, with other facial fractures, when the influence of the surgeon's skill and preference for any rigid internal fixation (RIF) system devices was minimized. The files of 700 patients with facial trauma were available, and 126 files were chosen for review. Data were collected regarding gender, age, race, date of trauma, date of surgery, addictions, etiology, signs and symptoms, fracture area, complications, treatment performed, date of hospital discharge, and medication. 126 patients suffered mandibular fractures associated, or not, with other maxillofacial fractures, and a total of 201 mandibular fractures were found. The incidence of mandibular fractures was more prevalent in males, in Caucasians and during the third decade of life. The most common site was the condyle, followed by the mandibular body. The therapy applied was effective in handling this type of fracture and the success rates were comparable with other published data.