微型钛板在下颌骨骨折中的临床应用

目的：评价下颌骨骨折后应用微型钛板坚强内固定的临床效果。方法：50例下颌骨骨折病例行微型钛板坚强内固定术,术后1个月、3个月、6个月复查,观察咬合关系、开口度及骨折线对位愈合情况。结果：50例患者伤口均Ⅰ期愈合,咬合关系恢复良好,开口度≥37mm,X线片示骨折线对位愈合良好。结论：微型钛板坚强内固定治疗下颌骨骨折疗效可靠,是一种较理想的治疗方法。     

小型钛板坚强内固定治疗下颌骨骨折

目的 总结小型钛板坚强内固定治疗下颌骨骨折的临床效果。方法 对106例下颌骨骨折患者行小型钛板坚强内固定术，其中64例单发骨折者，单纯骨内固定59例，骨内固定辅以颌间牵引5例；42例下颌骨多发性骨折行小型钛板坚强内固定复位术加颌间牵引。结果 106例下颌骨骨折均获得良好的疗效，恢复正常咬合功能。结论 小型钛板坚强内固定术治疗下颌骨单发性骨折大都能达到良好复位作用；下颌骨多发性骨折在小型钛板坚强内固定术后辅以颌间牵引同样能恢复正常咬合功能。     

重建板坚强内固定治疗下颌骨粉碎性骨折45例报告

目的：总结下颌骨粉碎性骨折的手术治疗方法。方法：对45例下颌骨粉碎性骨折采用口内或口外广泛切开,充分暴露骨折区全貌,并进行下颌骨的解剖复位,采用重建板坚强内固定。结果：45例下颌骨粉碎性骨折术后44例伤口一期愈合,骨折复位愈合良好,咬合关系恢复良好,张口度正常;1例术后下颌前庭沟黏膜处钛板小部分外露,经局部治疗,保持口腔卫生、预防感染,8个月后手术取出固定钛板螺钉,骨折处对位愈合良好,咬合关系良好,无骨感染、骨不连发生。结论：广泛切开能凊楚显露下颌骨粉碎性骨折的骨折线全貌,方便在直视下准确复位固定各骨折块、恢复下颌骨的解剖结构,获得良好的咬合关系。重建板固定骨折具有良好的稳定性和可靠性,适用于下颌骨粉碎性骨折。     

微型钛板内固定治疗颌骨骨折95例临床分析

目的评价微型钛板内固定治疗颌骨骨折的效果。方法对95例颌骨骨折患者行微型钛板内固定治疗,其中10例多发性或粉碎性骨折者辅以1~2周颌间固定。结果95例患者术后伤口均无感染,2例局部缝线裂开延期愈合,其余均Ⅰ期愈合,1例自觉局部术区不适,于半年后取出钛板。患者的咬合关系及张口度均恢复良好。结论微型钛板内固定治疗颌骨骨折效果可靠,是较为理想的颌骨骨折治疗方法。     

导板外科应用于下颌骨粉碎性骨折精准复位

目的　探讨应用数字化导板辅助重建钛板精准复位及固定下颌骨粉碎性骨折的方法及效果。方法：选取本院2016年1月～2017年12月收治10例下颌骨粉碎性骨折患者作为研究对象,所有患者术前应用数字化外科技术设计手术导板并行3D打印,术中手术导板辅助重建钛板精准复位及固定下颌骨粉碎性骨折,术后行图像融合及临床评价。结果：所用患者均一期愈合,图像融合显示与术前虚拟设计偏差度＜2mm,咬合关系恢复及骨折复位愈合情况良好,张口度未见异常。结论：数字化导板辅助下颌骨粉碎性骨折复位及固定,缩短了手术时间,能精准复位及固定下颌骨粉碎性骨折,临床应用效果确定。     

微型钛板坚强内固定治疗下颌骨骨折38例临床观察

目的：观察微型钛板坚强内固定治疗F颌骨骨折的临床疗效。方法：对38例下颌骨骨折的患者行切开复位,微型钛板坚强内固定术,辅以1周颌间弹性牵引,术后X线片检查和临床咬合关系及张口度检查。结果：38例患者手术切口均I期愈合,咬合关系均恢复到伤前的状况,术后张口度≥37min,X线片复查显示骨折愈合良好。结论：微型钛板坚强内固定具有良好的稳定性,术后辅以1周颌间弹性牵引能恢复正常的咬合关系,手术方法简单,治疗效果满意,是目前治疗下颌骨骨折的较好方法。     

微型钛板在下颌骨骨折中的应用

目的评估微型钛板内固定在下颌骨骨折中的效果及可靠性.方法对84例共110处骨折行微型钛板内固定术.结果82例伤口一期愈合,2例二期愈合,术后2周观察70例张口度＞30mm,14例＜30mm,6例出现轻度咬合不良.术后无并发症发生.6月后复查52例张口度均＞35mm,.结论下颌骨骨折微型钛板内固定安全可靠,操作简便,经口入路避免了面部疤痕,对颞下颌关节影响小,较传统的骨折处理方法有明显的优越性.     

下颌骨粉碎性骨折38例临床疗效分析

目的:探讨下颌骨粉碎性骨折的治疗修复措施.方法:对38例下颌骨粉碎性骨折采用牙弓夹板颌间牵引复位外固定+切开复位钛板内固定术治疗.结果:术后第二天、1月、3月X线片示全部骨折病例复位良好.伤口Ⅰ期愈合36例,另2例出现软组织伤口局限性感染延迟愈合,经对症处理抗感染治疗后痊愈.6例病员少量调磨咬合,1例病员因关节受损、面...     

重建板坚固内固定治疗感染性下颌骨骨折

目的总结感染性下颌骨骨折的临床特点和手术治疗方法。方法对35例感染性下颌骨骨折采用重建板坚固内固定患者,回顾分析其骨折部位、病因、诊断、手术方法和结局,并对感染性下颌骨骨折手术要点和重建板坚固内固定进行讨论。结果35例感染性下颌骨骨折病例,34例手术后一期愈合,骨折复位良好,咬合关系恢复正常。1例颏部初始感染性骨折重建板固定术后2个月,颏部皮肤凹陷,可扪及骨缺损。二次手术时：植入髂骨块,重放重建板1块,小钛板1块固定,最终二期愈合。结论对感染性下颌骨骨折,重建板具有良好的稳定性和可靠性;重建板坚固内固定是预防粉碎性骨折感染最重要的措施。     

外伤致多发性颌骨骨折50例临床分析

目的探讨外伤致多发性颌骨骨折咬合关系恢复的方法。方法通过对50例外伤致多发性颌骨骨折的住院患者行微型钛板坚强内固定术,其中6例术中配合行牙弓夹板外固定,术后行颌间弹性牵引术,恢复咬合关系。结果50例患者除1例上下颌骨骨折复杂的患者采用内外固定结合的方法达到良外,其余采用内固定术的32例上下颌骨折患者、12例单纯下颌骨骨折患者及采用内外固定结合的5例上下颌骨骨折复杂的患者均达到优。结论微型钛板坚强内固定术治疗外伤性多发性颌骨骨折疗效肯定,对个别极复杂的多发性颌骨骨折配合辅助牙弓夹板外固定术联合应用治疗则会取得更理想的临床效果。     

Superior border plating technique in the management of isolated mandibular angle fractures: a retrospective study of 50 consecutive patients.

PURPOSE: To determine the complication rate for patients presenting with isolated mandibular angle fractures treated by open reduction and internal fixation using a single superior border miniplate technique. PATIENTS AND METHODS: This is a retrospective study of consecutive patients with isolated mandibular angle fractures treated using a specific protocol at a Regional Oral and Maxillofacial Department between January 1998 and December 2004. Patient demographics, fracture etiology, length of hospital stay, removal of third molar, and postoperative complications were recorded. Preoperative and postoperative inferior alveolar nerve function was recorded. Objective sensory testing and patient interviews were conducted to determine the incidence of postoperative sensory deficit. RESULTS: The study population included 50 patients presenting with isolated mandibular angle fractures, 6 patients (12%) experienced complications requiring bone plate removal. These complications were minor and occurred after fracture healing as follows: 4 patients (8%) experienced superficial soft tissue infection associated with the bone plate, treated with oral antibiotics, 1 patient (2%) experienced bone plate exposure, and a further patient (2%) presented with a fractured bone plate. All 6 patients (12%) were treated by bone plate removal under general anesthesia as elective day case surgery. Thirty-nine (78%) patients had long-term sensory follow-up, mean 37 months (2 to 84 months). Permanent inferior alveolar sensory deficit (>12 months) was present in 4 (8%). Five of 26 (19%) patients with normal postinjury/preoperative sensory function had a postoperative sensory deficit. All patients in this group reported recovery of normal sensation within 6 months. CONCLUSIONS: The results of this study suggest that the complication rates associated with the treatment of isolated mandibular angle fractures using a superior border plating technique, in this patient population, is relatively low (12%). The complications were all minor in nature. There was a permanent (>12 months) inferior alveolar sensory deficit in 4 (8%) patients.     

Rigid internal fixation of mandibular fractures. An analysis of 270 fractures treated using the AO/ASIF method.

The results are reported on 214 patients treated for 270 mandibular fractures, using rigid internal fixation. Of these, 172 fractures (63.7%) in 131 patients had been re-evaluated at final follow-up in connection with plate and screw removal, on average 15.2 months, postoperatively. Although one-third of the patients had a history of alcohol abuse, and 86% were treated with a delay of more than 24 h (mean 3.2 days), good primary bone healing was observed in 93.9% of the patients. Infections, seen in 6.1% of the patients, were related exclusively to inadequate stability of the fracture. Malocclusion, observed in 18.2% of 159 dentate patients, was caused by incorrect plate bending and insufficient fracture reduction. Immediate postoperative dysfunction of the inferior alveolar nerve in 58.1% of the cases, and of the mandibular branch of the facial nerve in 12.7%, was followed by almost total recovery 1 year after operation. It is concluded that rigid internal fixation is a reliable method of treatment, especially indicated for patients with reduced healing capacity and poor co-operation.     

数字化技术结合导板在下颌骨粉碎性骨折复位内固定术中的应用

目的 探讨数字化技术、3D打印模型结合导板在下颌骨粉碎性骨折中的应用。方法 选取下颌骨粉碎性骨折患者19例,进行1.0 mm层厚三维CT扫描,数据通过DICOM格式导出,利用软件进行虚拟手术复位骨折,复位后3D打印出下颌骨模型及咬合导板。在下颌骨模型上进行钛板预弯及制作复位导板,术中引导骨折块复位固定。结果 术后19例患者手术切口均无感染征,创口隐蔽美观,骨折对位精确,钛板与骨折段贴合;术后6月随访骨折对位愈合情况好,无明显移位。患者下颌无偏斜,无张口、咬合疼痛,咬颌关系良好,未见明显张口受限。结论 数字化技术、3D打印模型结合导板能让下颌骨粉碎性骨折精确复位,简化手术过程,是一种精准、可预测的手术辅助方式。     

微型钛板与生物可吸收板在下颌骨骨切开术固定中的应力比较

目的 比较微型钛板和生物可吸收板在下颌骨骨切开术固定中的应力分布。方法 建立下颌骨切开术不同内固定系统三维模型,进行三维有限元分析,比较相同加载力条件下,不同植入物的应力分布以及骨折段位移的改变情况。结果 钛板上受的最大应力值为49.8 MPa,可吸收板的最大应力值为4.42 MPa;钛板的最大应力值远远超过可吸收板的最大应力值,但所受应力均小于各自的屈服极限。相对移位对比可见,微型钛板固定下颌骨时,最大位移值为0.1 mm;应用可吸收板固定时,最大位移值为0.2 mm,两者的相对位移均较小。结论 生物可吸收固定系统的刚度和内部强度足以支持下颌骨切开术部位的骨愈合。     

下颌骨骨折加压与非加压内固定的评价

目的：观察加压固定和非加压固定下颌骨骨折的组织愈合差异，对两种固定形式的临床应用作出评价，方法：采用加压和非加压接骨板固定犬下颌骨骨折，对两种固定的的组织学，X线特点进行观察，对98例下颌骨骨折患者采用两种方法进行治疗，术后观察X线，咀嚼效率恢复和一般情况，结果：加压接骨板固定的骨折愈合形式为一期愈合，而小钛板为传统的骨愈合形式；临床应用表明加压接骨板在骨折愈合早期有明显的优势。结论：两种式方法均是下颌骨骨折良好的固定方式，小钛板使用方便，适应证广，加压接骨板固定骨折愈合快，但操作技术要求较高。     

腮腺前缘咬肌入路固定髁状突中低位骨折

目的：探讨腮腺前缘咬肌表面面神经间入路复位固定下颌骨髁突中低位骨折的方法。方法：37例43侧髁突中低位骨折患者随机分为两组,A组：16例19侧耳前切口穿腮腺入路复位固定骨折;B组：21例24侧髁状突中低位骨折患者采用绕下颌角皮肤切口,腮腺前缘、咬肌表面面神经间入路,直视下复位固定骨折。对两组的临床疗效进行比较。结果：B组术后第2d咬合关系恢复情况,涎瘘发生情况及术后1月下颌运动时关节局部牵拉不适感等方面均优于A组,差异有统计学意义（P＜0．05）;面神经功能障碍、术后CT三维重建骨折断端对位及术后1月患者主观满意度等方面差异无统计学意义（P＞0．05）。结论：腮腺前缘、咬肌表面面神经间入路可获得较为理想的术野,直视下保护面神经、复位固定骨折,不需分离腮腺,发生涎瘘和面神经损伤的危险性大大降低,并能用于下颌支粉碎性骨折等较为复杂的骨折的治疗,是安全有效的手术路径之一。     

超高分子量聚D、L乳酸小型接骨板在下颌骨骨折治疗中的应用

目的:评价国产超高分子量聚D、L乳酸小夹板螺钉内固定系统在下颌骨骨折内固定中的疗效。方法:根据随机数字表法,将57例下颌骨单纯线性骨折分为2组,分别行PDLLA小夹板骨折内固定及小型钛板骨折内同定,术后行颌间牵引固定0-14d,观察伤口愈合、骨折段复位及咬合关系恢复等情况。结果:31例PDLLA小夹板骨折内固定患者,术后伤口无感染,未发现非特异性炎症;术后骨折段的稳定性好,骨折愈合正常,除4例出现轻度咬合关系紊乱外,其余患者咬合关系恢复良好,与小型钛板内固定疗效相似(X2检验,p>0.05)。结论:在下颌骨单纯线性骨折治疗中,PDLLA小夹板螺钉是一种可选择的骨折内固定材料,优点是不需要二次手术取出。     

A prospective trial of poly-L-lactic/polyglycolic acid co-polymer plates and screws for internal fixation of mandibular fractures

The aim of this study was to test the performance of poly-L-lactic/polyglycolic acid (PLLA/PGA) co-polymer plates and screws in the fixation of mandibular fractures. Following clinical and radiographic examination, internal fixation was achieved with PLLA/PGA co-polymer plates and screws in 31 patients. Elastic maxillomandibular fixation was maintained for 4 weeks and a blenderized diet for 6 weeks. Patients were followed up at 1 week, 6 weeks, and 3, 6 and 12 months post surgery, and evaluated clinically for swelling, pain, mucosal discoloration and occlusal relation. Segment stability, fracture healing and screw-hole ossification were assessed radiographically. Of the 29 patients who completed the trial, 20 had an uncomplicated postoperative period, resulting in complete bone union. Radiographic evidence of screw-hole ossification was noted in several patients, with considerable site-dependent rate variation. Nine patients developed complications ranging from minor dehiscence (4 patients) to frank sepsis requiring plate removal (5 patients), resulting in a 22.5% complication rate. There were no cases of non-union at the end of the fixation period. The reported complication rate following titanium internal fixation of mandibular fractures is 13.7%-43%. PLLA/PGA co-polymer plate and screw fixation of mandibular fractures, although technically more challenging and costly, is a viable alternative to traditional metal devices in selected patients.