坚固内固定术治疗下颌骨骨折的利弊分析

下颌骨骨折是常见的颌面部损伤。应用微型合金夹板行坚固内固定术是治疗下颌骨骨折的有效方法。近年来该技术已广泛应用于临床。该方法具有许多独特的优点,受到学者们的高度重视。本文通过对我科近几年利用坚固内固定技术治疗下颌骨骨折68例的临床总结,分析讨论了应用坚固内固定术治疗下颌骨骨折的利与弊。     

下颌骨骨折口内进路坚强内固定12例分析

目的 应用坚强内固定原理治疗下颌骨骨折,探索口内进路的手术方法。方法 采用口内进路暴露下颌骨骨折部位(除升支及髁状突骨折),恢复咬合关系后,用小型钛夹板作单层骨皮质固定,术后不行颌间结扎。结果 11例伤口一期愈合,1例伤口二期愈合,全部病例咬合关系正常,无异常动度,无并发症。结论 下颌骨骨折(除升支及髁状突骨折)应采用日内进路的单层骨皮质坚强内固定,术后不需颌间结扎。     

钛板坚强内固定治疗下颌骨骨折136例报告

目的：总结钛板坚强内固定术治疗下颌骨骨折的临床疗效。方法：收集1998～2004年136例下颌骨骨折病例,行钛板坚强内固定术治疗,分别在手术后1个月、3个月、6个月复查,拍摄X线片,观察骨折线对位愈合情况、咬合关系及开口度等功能恢复情况。结果：136例中134例一期愈合,2例延期愈合。X线片示骨折线对位良好,咬合关系及开口度均恢复良好。结论：钛板坚强内固定术治疗下颌骨骨折效果好,方法可靠,操作简单。     

下颌骨骨折的坚固内固定治疗

下颌骨骨折是颌面部常见损伤 ,根据临床统计 ,占颌面部骨损伤的 5 0 %～ 70 %。交通事故是下颌骨骨折的主要原因 ,其次为工伤、跌伤和暴力伤。传统的治疗方法是开放复位骨间内固定 ,加颌间固定 (IMF) 6～ 8周 ,或采用外固定。随着骨折固定材料和治疗方法的研究 ,下颌骨骨折的治疗发生了很大变化 ,出现了坚固内固定技术 (RIF)和以钛接骨板为代表的主流接骨材料。由于该技术具有操作简便实用 ,容易掌握 ,损伤小等优点 ,故很快得到广泛推广 ,迅速取代了一些传统的治疗技术 ,如骨间钢丝结扎固定、克式针固定和外固定等方法 ,象颌间结扎固定这…     

坚固内固定术治疗下颌骨骨折的临床疗效研究

目的 :评价小型钛板坚固内固定术对下颌骨骨折的临床疗效。方法 :对 10 6例下颌骨骨折用小型钛板做坚固内固定术 ,术后作即刻及随访临床综合效果评价 ,包括骨折复位准确性、固定稳定性、骨折愈合、伤口愈合、咬合关系等。结果 :10 6例术后感染 3例 ,缝线局部裂开 5例 ,咬合关系有 3例不正常 ,有 4例发生局部咬合关系不良 ,2例发生偏向咬合。其余均Ⅰ期愈合 ,咬合关系正常 ,术后张口度 >36mm。结论 :小型钛板做下颌骨坚固内固定是一种现代而符合生理的治疗方法 ,较传统治疗有明显的优点     

坚固内固定术治疗下颌骨骨折28例临床分析

目的探讨应用坚固内固定原理治疗下颌骨骨折的手术切口、治疗方法及优缺点。方法采用口内进路对28例下颌骨骨折复位后用小型钛板坚固内固定。结果28例患者术后伤口均Ⅰ期愈合,咬合关系恢复良好,随访半年,张口度均正常。结论小型钛板坚固内固定治疗下颌骨骨折疗效肯定,口内手术入路避免了面部瘢痕及面神经损伤的风险。     

经口内切口行坚固内固定治疗下颌角骨折62例

目的研究经口内切口行坚固内固定治疗下颌角骨折的临床疗效。方法收集下颌角骨折患者62例,经口内切口行骨折复位,用小型钛板固定。术后1周及1、3、6个月随访,检查患者面形、张口度及咬合关系恢复情况,X线全景片观察骨折复位、固定及愈合情况。结果术后1周所有患者面形均恢复正常,张口度大于3cm,咬合关系恢复良好;X线全景片示骨折处钛板固定良好,钛钉无松脱。术后1个月所有患者咀嚼功能恢复正常。术后3个月及6个月所有患者骨折愈合未发现异常。结论经口内切口行坚固内固定治疗下颌角骨折,创伤小,并发症少,易于被患者接受。     

下颌骨骨折坚强内固定术的临床评价

目的:评价微型钛板在下颌骨骨折坚强内固定术中的应用及临床效果.方法:采用隐蔽微创切口或原开放性创口将下颌骨骨折断端解剖复位,恢复咬(邪)关系,回顾分析微型钛板螺钉行骨间坚强内固定术186例的临床资料和应用经验.结果:本组186例患者,创口Ⅰ期愈合,张口度正常,咬(邪)关系正常,面部外型、咀嚼功能恢复良好.临床治愈率100％.x线片示:骨折愈合良好,未见钛板螺钉松动、移位、断裂,周围骨质无疏松及吸收现象.结论:微型钛板骨间坚强内固定技术,治疗下颌骨骨折,操作简便,效果确切,值得临床广泛应用.     

口内切口与牵引钉暂时颌间刚性牵引固定治疗下颌骨骨折45例分析

目的:评价术中利用颌间牵引螺丝暂时牵引,经口内切口进行整复并坚强内固定治疗45例下颌骨骨折的效果。方法:对45例54处下颌体及下颌角区线性骨折,先分别在上、下颌中切牙之间、尖牙与第一前磨牙之间、第一与第二磨牙之间的根向植入颌间牵引螺丝,骨折复位后,进行颌间结扎固定,恢复咬合关系及下颌骨的弓型。自下颌前庭沟、翼下颌皱襞切开黏骨膜,显露骨折处并复位后,在张力线上用小型钛板进行坚强内固定术。术毕拆除颌间结扎,7d后将颌间牵引螺丝拆除。分别于术后第1天和第90天进行临床和X线检查,评价其咬合关系、骨折复位及愈合情况。结果:45例54处下颌骨骨折均获得良好的复位和骨性愈合,咬合关系良好,无明显并发症。结论:经口内途径行小型钛板坚强内固定术,结合颌间牵引螺丝暂时刚性牵引结扎,对下颌体及下颌角骨折的整复固定和功能恢复效果良好。     

Mandibular angle fractures treated with a single miniplate without postoperative maxillomandibular fixation: A retrospective evaluation of 50 patients

Objective: This retrospective study evaluated the use of a single miniplate for the treatment of mandibular angle fractures (MAF).

Methods: Fifty patients with 53 MAF were treated by open reduction and internal fixation with the use of a single miniplate and were analyzed in this study.

Results: Five patients with MAF had postoperative complications that required additional procedures. Three patients had postoperative infection, one patient complained of malocclusion in the first postoperative week, and one patient had miniplate exposure three months after surgery. Every additional procedure was performed in the office under local anesthesia without disruption of the initial fracture treatment. Postoperative maxillomandibular fixation (MMF) was performed in four patients. Treatment of MAF using a single miniplate was effective, with low morbidity and with low rates of postoperative complications. MAF can be treated without MMF, and stability is improved when long miniplates are used.

Conclusions: The use of a single miniplate is therefore encouraged. However, postoperative MMF should be considered with the presence of little contact between bone segments, malocclusion, or extensive tooth loss.     

Effects of maxillomandibular fixation and rigid internal fixation on pulmonary function in patients with mandibular fractures

Closed reduction and maxillomandibular fixation (MMF) is associated with airway obstruction. The ventilatory effect of open reduction and rigid internal fixation (ORIF) as an alternative treatment has not been determined. The aim of this study was to compare the effects of MMF and ORIF on pulmonary function (PF) in patients with mandibular fractures. Using a computer-generated simple randomization protocol, 40 eligible participants were allocated to MMF and ORIF treatment groups. PF tests were done preoperatively and at 24 hours, 1, 6, and 7 weeks postoperative in all participants in both groups, using a portable office spirometer (Spirobank G). Forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), FEV₁/FVC, and peak expiratory flow rate (PEFR) were determined. At 6 weeks postoperative, PF tests were performed after the release of MMF. PF tests in the MMF and ORIF groups were similar preoperatively. At 24 hours postoperative, FEV₁/FVC was significantly lower in the MMF group than in the ORIF group (p < 0.001). Values of FEV₁ (p = 0.022), FEV₁/FVC (p = 0.001) and PEFR (p < 0.001) were significantly lower in the MMF group than in the ORIF group at 1 week postoperative. While MMF negatively impacted on PF, ORIF had no adverse effect on PF.     

Transoral 2.0-mm miniplate fixation of mandibular fractures plus 2 weeks' maxillomandibular fixation: a prospective study.

PURPOSE: We conducted a study to assess the efficacy of intraoral treatment of mandibular fractures using a 2.0-mm miniplate and 2 weeks of maxillomandibular fixation (MMF). PATIENTS AND METHODS: Forty-four mandible fractures in 31 patients with a mean of 15 days of MMF were included in this study. A 2.0-mm miniplate was adapted along Champy's lines of ideal osteosynthesis and secured with four 8.0-mm monocortical screws. All patients were followed for at least 8 weeks after surgery. The incidences of bone or soft tissue infections, wound dehiscence, nonunion, malunion, malocclusion, plate fractures, and iatrogenic neurosensory deficits were prospectively evaluated. RESULTS: Primary bone healing was achieved in 100% of cases. No soft or hard tissue infection, malocclusion, malunion, nonunion, dental injuries, plate fracture, or iatrogenic nerve injuries were observed. Two (4.52%) minor complications-intraoral wound dehiscences-were noted. CONCLUSIONS: The use of a single 2.0-mm miniplate adapted along Champy's line of ideal osteosynthesis and stabilized with 4 monocortical screws plus 2 weeks of MMF was a viable treatment modality for mandibular fractures.     

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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。     

坚固内固定治疗髁突中低位骨折15例报告

目的:探讨手术切开复位坚固内固定治疗髁突中低位骨折的治疗效果.方法:对15例髁突中低位骨折病例施行开放复位行小型钛板坚固内固定治疗,记录手术前后张口度、面神经损伤及咬合关系恢复情况及术后颞颌关节功能状况,手术前后全颌曲面断层片及CT对比骨折复位与愈合状况.结果:所有患者张口度均＞3 cm,咬合关系良好.关节区疼痛和弹响2例,面神经暂时性损伤4例.影像学检查显示髁突外形良好.结论:髁突中低位骨折明显移位者应用微型钛板内固定可获得满意效果.     

In vitro mechanical assessment of 2.0-mm system three-dimensional miniplates in anterior mandibular fractures

This study constituted a comparative assessment of the mechanical resistance of square and rectangular 2.0-mm system three-dimensional miniplates as compared to the standard configuration using two straight miniplates. 90 polyurethane replica mandibles were used for the mechanical trials. Groups 1, 2, and 3 simulated complete symphyseal fractures characterized by linear separation of the central incisors; groups 4, 5, and 6 simulated parasymphyseal fractures with an oblique configuration. Groups 1 and 4 represented the standard method with two straight miniplates set parallel to one another. Square miniplates were used in groups 2 and 5, and rectangular miniplates in groups 3 and 6. A universal testing machine set to a velocity of 10 mm/min and delivering a vertical linear load to the first left molar was used to test each group. Maximum load values and load values with pre-established dislocation of 5 mm were obtained and submitted to statistical analysis using a calculated reliability interval of 95%. The mechanical performances of the devices were similar, except in the case of rectangular plates used in the parasymphyseal fractures. The innovative fixation methods used showed significantly better results in the case of symphyseal fractures.     

Three-dimensional versus standard miniplate fixation in the management of mandibular angle fractures: a systematic review and meta-analysis

The aim of the present study was to test whether there is a significant difference in the clinical outcomes between standard and three-dimensional (3D) miniplate fixation in the management of mandibular angle fractures (MAFs). An electronic search without date and language restrictions was performed in October 2013. Inclusion criteria were studies in humans including randomized controlled trials, controlled clinical trials, and retrospective studies, with the aim of comparing the two techniques. Six studies were included. The meta-analyses revealed statistically significant differences for the incidence of hardware failure and postoperative trismus. There were no significant differences in the incidence of postoperative infection, malocclusion, wound dehiscence, non-union/malunion, or paresthesia. The cumulative odds ratio was 0.42, meaning that the use of 3D miniplates in the fixation of MAFs decreases the risk of the event (postoperative complication) by 58%. The results of this meta-analysis showed lower postoperative complication rates with the use of 3D miniplate fixation in comparison with the use of standard miniplate fixation in the management of MAFs.     

Complications after different methods for fixation of mandibular angle fractures: network meta-analysis of randomized controlled trials

The aim of this review was to compare mandibular angle fracture fixation methods that were evaluated through randomized clinical trials considering postoperative complications. Additionally, different treatment methods were ranked based on their performance. A systematic review was performed based on the Cochrane and PRISMA guidelines. The quality of evidence and network meta-analysis were conducted using the GRADE tool and R software, respectively. Four databases were searched, and the papers were selected based on the PICOS strategy. A total of 3584 papers were found. After screening 15 papers were included. One plate placed on lateral border (tension zone) presented lower risk than one plate placed on superior border (tension zone) for infection [risk ratio (RR): 0.48, 95% confidence interval (CI): 0.33 to 0.71] and plate removal necessity (RR: 0.44, 95% CI: 0.28 to 0.69), with moderate quality of evidence. There were no significant differences among the mandibular angle fracture treatments for malocclusion and paraesthesia outcomes. In conclusion, one plate placed on the lateral border in the tension zone is the best choice regarding postoperative infection and plate removal necessity when fixing mandibular angle fractures. None of the tested fixation methods were associated with a significant risk of malocclusion and paraesthesia events.     

Frequency and type of dental traumas in mandibular body and condyle fractures

Abstract Dental injuries in association with 207 mandibular fractures were evaluated from patient files and radiographs. It was shown that 32% of the dentulous patients with condylar fractures had dental injuries, approximately 3.7 traumatised teeth per patient, most of which were dental hard tissue injuries and situated typically in the maxillary molar region. Dental injuries were diagnosed in 30% in association with mandibular corpus fractures, approximately 3.6 traumatised teeth per patient, and injuries were more often dental luxations in the anterior part of the mandible. It was found that 143 teeth were involved in the line of mandibular corpus fracture of 105 patients (1.4 per patient). More than half of the fracture lines were diagnosed as passing the periodontal ligament.