眶下径路治疗颧骨复合体骨折的临床评价

目的：对眶下径路治疗颧骨复合体骨折的临床疗效进行评价。方法：对65例颧骨得合体骨折作临床分析,经眶下径路作开放整复加微型钛板坚强固定手术。结果：（1）眶下径路术野暴露充分;（2）颧骨复合体骨折复位快,对位精确;（3）微型钛板固定坚固;（4）无面神经损伤等并发症;（5）疗效优良率达96．9％。结论：眶下径路适宜于颧骨复合体骨折的治疗。     

210例颧骨复合体骨折的临床回顾性研究

目的回顾性分析210例颧骨复合体骨折的临床流行病学特点.方法对从1990年11月至2002年12月在武汉大学口腔医院颌面外科救治的资料完整的210例颧骨骨折病例进行回顾性临床研究.结果 210例中,有152例手术复位,其中有108例采用头皮冠状切口,18例采用Gillie's切口,微型切口17例,口内前庭沟切口5例,其余4例采用其它小切口.152例中,118例采用钛板坚固内固定,5例钛板坚固内固定辅以钢丝固定,22例采用单纯钢丝栓结;其余7例未做固定.术后随访平均2年(6～72个月),96.9%的患者取得了良好的治疗效果.结论颧骨骨折的致伤原因主要以交通伤为主,治疗原则已经由"改善功能,兼顾外形"发展到"功能与外形双项标准";坚固内固定效果优于并且已经替代钢丝固定.     

颧骨复合体骨折临床治疗探讨

目的 探讨颧骨复合体骨折临床治疗方法。方法 总结66例颧骨复合体骨折患者，手术入路经验缘下和口内前庭沟切口，直视下解剖复位、固定，眶底缺损用人工骨重建，陈旧性骨折正颌手术治疗，通过临床和X线检查评价治疗效果。结果 63例患者术后功能和面形明显改善。结论 睑缘下和口内联合切口能充分暴露骨折区，利于解剖复位，额上颌合体骨折应早期手术，应用微型钛板固定。     

颧骨复合体骨折处理

目的：探讨颧骨复合体骨折致伤原因、临床特点及治疗方式选择。方法：通过病案记录研究79例患者的临床资料,复位质量及面部外观评价依据临床观察及影像学检查。随访3－12个月。结果：79例患者中87．3％为男性,主要是20－40岁的青壮年,占73．5％。交通伤为主要致伤原因,占58．2％,其次为暴力伤（15．2％）。颧面畸形、眼球内陷、复视、张口受限、咬合错乱发生率分别为83．5％、24．1％、19．0％、60．8％、35．4％。神经损伤以眶下神经为主,占41．8％,其次为面神经,占13．9％。最常用的手术进路为冠状切口＋前庭沟切口（30．4％）,其次为单纯冠状切口（22．8％）。40．5％的患者应用小型钛板坚固内固定,20．3％的患者将小型钛板固定技术与钢丝结扎结合使用。74例患者获得了满意的颧面部外形。3例患者术后仍有轻度复视及眼球内陷。所有咬合错乱的患者均获得功能性咬合。结论：颧骨复合体骨折有多种治疗方法,可根据情况选择使用。应用冠状切口或辅加其它切口进路及小型钛板坚固内固定技术可获得满意的疗效。     

颧骨复合体骨折97例临床分析

目的 对97例颧骨复合体骨折病例进行临床回顾性分析,选择合理的治疗方案.方法 选择2005年～2010年间颧骨复合体骨折的患者97例,对其治疗方法及治疗效果进行回顾性临床分析.结果 交通事故是导致颧骨复合体骨折的主要原因;B型骨折最为多见(60.8％);坚强内固定是首选方案.术后3个月回访,均取得了良好的效果.结论 颧骨复合体骨折主要根据骨折类型以及面部畸形情况等决定手术方法.微型钛板坚强内固定技术效果确切,是治疗颧骨复合体骨折的良好方法.     

颧骨复合体骨折复位径路的临床研究

目的:回顾性分析颧骨复合体骨折的复位径路.方法:对1990-11～2004-12在我院颌面外科救治的资料完整的152例颧骨复合体骨折手术病例进行回顾性临床研究.结果:交通事故是导致颧骨复合体发生骨折的主要因素之一.在152例患者中,有20例单纯采用头皮冠状切口(全冠状切口8例,一侧冠状切口12例),38例采取头皮冠状切口+口腔前庭切口(全冠状切口12例,一侧冠状切口26例),有32例采取头皮冠状切口+口腔前庭切口+眶周小切口(全冠状切口15例,一侧冠状切口17例),有18例采取头皮冠状切口+口腔前庭切口+眶周小切口+其他小切口(全冠状切口10例,一侧冠状切口8例),44例单纯采取局部小切口;术后随访平均3年(6～72个月),152例患者中得到随访的有129例(84.8%),治疗效果1级45例(占34.8%);Ⅱ级72例(占55.8%);Ⅲ级12例(占9.3%).117例(117/129,90.7%)患者取得了良好的治疗效果.结论:冠状切口(必要时附加小切口)和单纯局部小切口在不同适应证中均可获得满意的治疗效果.     

颧骨复合体骨折的临床分析

目的：分析颧骨复合体骨折临床特征,以提高其诊治水平。方法：回顾分析2001～2005年收治的20例颧骨复合体骨折病历资料。男16例,女4例,年龄20～50岁。结果：手术采用头皮冠状切口入路15例,头皮冠状切口加口内切口入路4例,1例另加睑下缘切口,术后1、2、6月追踪观察面部外形,开口度及咬合关系恢复情况良好。结论：三维CT重建是颧骨复合体骨折最佳检查方法,头皮冠状切口头皮是颧骨复合体骨折复位理想的手术方式。     

颧骨复合体骨折手术路径探讨

目的:总结颧骨复合体骨折复位术的手术路径和效果。方法:对2005-11—2011-05在我院颌面外科救治的资料完整的76例颧骨复合体骨折手术病例的手术路径及治疗效果进行回顾性分析。在76例患者中,有4例颞部切口,有2例前庭沟切口,有26例单纯采用头皮冠状切口,有18例采取头皮冠状切口+下睑缘切口,有9例采取头皮冠状切口+结膜囊切口,有5例采取头皮冠状切口+口腔前庭沟切口,有12例采取头皮冠状切口+口腔前庭切口+下睑缘切口。术后随访平均3年(6～48个月)。结果:76例患者中随访3年的有61例(80.2%),治疗效果Ⅰ级22例(占36.0%);Ⅱ级35例(占57.3%);Ⅲ级4例(占6.3%)。55例(55/61,90.1%)患者取得了良好的治疗效果。结论:冠状切口(必要时附加小切口)和单纯局部小切口在不同适应证中均可获得满意的治疗效果。     

颧骨复合体骨折手术治疗临床研究

[摘要] 目的 探讨颧骨复合体骨折治疗的手术方式,切口选择、固定部位、固定方式与骨折类型的关系。方法 58例颧骨复合体骨折患者分别采用口内前庭沟切口+头皮冠状切口+睫毛下切口、头皮冠状切口+口内前庭沟切口、口内前庭沟切口+原始创口入路、口内前庭沟切口+眶周小切口、单纯前庭沟切口和颞部切口进行手术复位,复位后采用微型钛板、钛钉行骨折固定,单纯涉及颧弓的粉碎型不稳定骨折采用口内切口复位+个性化外固定模板辅助固定。结果 58例患者过3～6个月的随访,外形满意度95%,无开口受限,无遗留上唇麻木,CT片示骨折对位线良好。结论 颧骨复合体骨折的手术方法选择应考虑骨折类型、术者对各种术式适应证的理解、患者的偏好,做好术前与患者充分沟通,在功能和外形双标准的前提下,个性化治疗方案应是最终的目标。     

三点稳定性固位治疗颧骨复合体骨折的临床分析

目的 探讨颧骨复合体(ZCF)手术复位的径路与固定部位的选择.方法 回顾性总结分析56例ZCF患者的切口选择,接骨板固定部位,术后随访1～6个月,按疗效评价标准评价手术效果.其中包括面容和功能的恢复、创口愈合、X线和CT随访以及围手术期并发症.结果 软组织手术切口均Ⅰ期愈合.其中愈合优秀51例,达91.07％(51...     

颧骨复合体骨折固定方法和固定部位的临床研究

目的:回顾性分析152例颧骨复合体骨折的固定方法和部位特点。方法:对从1990-11～2004-12在武汉大学口腔医院颌面外科救治、资料完整、行手术治疗的152例颧骨复合体骨折病例进行回顾性临床研究。结果:交通事故是导致颧骨复合体发生骨折的主要因素之一。在152例手术复位固定患者中,有108例采取头皮冠状切口(必要时,附加小切口),44例单纯采取局部小切口;有123例采取钛板坚固内固定,22例采用单纯钢丝栓结;其余7例未做固定。固定部位:共应用328块钛板,其部位分布为颧额缝96块、颧颌缝及颧牙槽嵴45块、颧颞缝92块,骨折断端95块。术后随访平均3年(6～72个月),96.9%的患者取得了良好的治疗效果。结论:冠状切口(必要时候,附加小切口)可获得满意的治疗效果。颧骨复合体骨折的固定方式:坚固内固定逐渐替代了钢丝固定;固定部位主要集中于颧骨复合体区的水平力柱和垂直力柱上。     

内固定技术在颧骨颧弓骨折治疗中的应用

目的 研究内固定技术在颧骨、颧弓骨折治疗中的应用。方法 对资料完整的１３０例颧骨、颧弓骨进行了分类,对不同类型骨折的治疗方法,固定方式、效果等进行了总结分析。结果 Ⅲ类骨折颧颌缝区和颧额缝区两处固定,Ⅳ、Ⅴ、Ⅵ类骨折颌缝区、颧额和眶下缘区三处固定可获得优良的复位效果。结论 根据骨折类型选择固定部位与固定方式,两处以上内固定可使Ⅲ－Ⅳ类型骨折复位获得良好的稳定性。     

颧骨颧弓骨折的分类与治疗方法的选择

目的 研究颧骨颧弓骨折的临床分类与应用。方法 参照Ｋｎｉｇｈｔ和Ｎｏｒｔｈ分类方法,对１３０例颧骨颧弓骨折病例进行分类。结合不同类别、手术切口入路、治疗方法和治疗效果总结分析。结果 Ⅱ类骨折龈颊沟切口入路,Ⅲ－Ⅳ类附加冠状切口、眉弓外切口、眶下眶周切口入路。复杂或陈旧颧骨颧弓骨折应选用半冠状切口入路。结论 根据不同类型骨折的特点,选择正确的手术入路是达到完善解剖复位及精确内固定的保证。     

A study on coronal incision for treating zygomatic complex fractures

Objective  To study the value of coronal incisions for treating zygomatic complex fractures and evaluate the advantages, indications and complications associated with it. Method  In this prospective study, 12 patients were randomly selected regardless of age, sex requiring open reduction and internal fixation of communited zygomatic complex fractures with or without other associated fractures of the midface. Patients were all treated by coronal approach for open reduction and internal fixation of fracture of the zygomatic complex. Other local incisions were used if required. Results  In all cases postoperative complications were relatively minor except in one case were the temporal branch of facial nerve weakness persisted at 3 months. Whereas 5 cases reported with slight weakness of the temporal branch of the facial nerve which resolved at the end of 3 months. The time taken for exposure of the fracture site via the coronal incision had a mean of 28.7 minutes. There were no cases of flap infection and just 1 case of stitch abscess reported. The same case later reported with a hypertrophic scar formation of greater than 0.5cm at 3months. In all other cases scar formation was negligible and well hidden within the hairline. There were no reported cases of paraesthesia at the operated site or hollowing of the temporal fossa. Conclusion  The coronal incision provides excellent access to the zygomatic arch and zygomatic complex, aiding in good anatomical reduction and also has the added advantage of the scar hidden in the hairline. It also has disadvantages like long operating time, risk of facial nerve injury, scarring in patients with male pattern baldness, paraesthesia of operated site etc. Therefore the incision should be judiciously used and not overused and indications strictly applied.     

三维定位面弓的设计及其在颧骨骨折复位中的应用

目的:设计研制三维定位面弓,并对其用于颧骨骨折的术前诊断、术中复位校准以及术后效果进行评价。方法:设计并制作可用于测量颧骨突度、面侧方宽度以及眼球突度的三维定位面弓,用于颧骨颧弓粉碎性骨折和陈旧性颧骨骨折共5例,评价其临床应用效果。结果:开发并研制出可用于测量颧骨前突度、面宽和眼球突度的三维定位面弓,通过对5例颧骨骨折患者的临床应用,效果满意。结论:三维定位面弓是颧骨不对称畸形的定量测量工具,可用于术前颧面部软组织畸形诊断、术中复位指导和校准,以及术后面部对称性评价,还可用于眼球突度的测量。     

The clinical and radiographical characteristics of zygomatic complex fractures: A comparison between the surgically and non-surgically treated patients

BackgroundIn this retrospective study we evaluated the epidemiological data and the clinical and radiographical differences between surgically and non-surgically treated patients with zygomatic complex fractures at their initial assessment in our clinic over a period of 5 years. More knowledge of the clinical similarities and/or differences between the non-surgical and the surgical group will provide us a more complete view and may help physicians to develop any future methods in clinical decision making or even methods in distinguishing patients benefiting from a surgical treatment.MethodsSurgically and non-surgically treated patients were included in the study, if clinical and radiographical confirmation of zygomatic complex fractures were present at initial assessment. The patient groups were divided into surgically treated zygomatic complex fractures, and non-surgically treated fractures, with and without displacement. The groups were compared according to age, gender, degree of fracture displacement and clinical signs.ResultsIn total 283 patients were diagnosed with zygomatic complex fractures, with a mean age of 43 years (±20 years) and a domination of male patients. The mean age was higher in the non-surgically treated group and contained more female patients. Overall type C fractures and the majority of the type B fractures were treated surgically. Only 2.1% of the type A fractures were treated surgically. Overall facial swelling and paraesthesia of the infraorbital nerve were found as most common clinical findings. Additionally, malar depression and extraoral steps were frequently found in the surgically treated group, as in the non-surgically treated group only facial swelling was found frequently, whether there was fracture displacement or not. The clinical characteristics 'extraoral steps', 'intraoral steps', and 'malar depression' were found to be significantly related to surgical treatment.ConclusionExtraoral steps, intraoral steps, and malar depression were significantly related to surgical treatment. The group of non-surgically treated zygomatic complex fractures is a valuable group to investigate as this group also consists of patients with displaced fractures (i.e. surgical indication) and thus, could provide us more insight in future clinical decision methods. Therefore, we highly recommend more research of the non-surgically treated group.