髁状突骨折坚固内固定治疗分析

本文就我科近十年收治的髁状突骨折患者中接受了坚固内固定手术治疗 ,经 2年～ 8年随访 ,有完整术前术后影像学资料和临床资料的 19例患者进行分析。一、材料和方法1.1992年至 1998年底共对 42例髁状突脱位骨折作了开放复位内固定术。收集其中 19例经两年以上随访、有完整术前术后临床与影像学资料的患者 ,男性 15例 ,女性 4例。随访时间 2年～ 8年 ,平均 4年。平均年龄 31岁 ( 15岁～ 48岁 ) ,2例伤后 1周至 2周内手术 ,8例在伤后 48小时内手术 ,其它在伤后 3天至 6天手术。合并颏部或下颌体骨折11例 ( 5 7.89% )。2 .放射学分析 :升支高度…     

下颌髁状突骨折治疗的临床研究

目的 :探讨髁状突骨折的治疗方法选择及其疗效。方法 :对我科收治的 6 8例髁状突骨折 ,38例无移位或轻度移位者行保守治疗 ,30例中度或重度移位、脱位、粉碎性或陈旧性骨折行手术治疗。结果 :保守组随访 34例 ,31例获得满意效果 ,7例出现颞颌关节紊乱症 ,1例关节强直 ;手术组随访 2 8例 ,2 6例面形与关节功能正常 ,5例出现关节紊乱症。结论 :无移位或轻度移位宜采用保守治疗 ,中度或重度移位、脱位、粉碎性或陈旧性骨折并影响颌运动者须采用手术治疗     

下颌髁状突骨折治疗的临床研究

目的：探讨髁状突骨折的治疗方法选择及其疗效。方法：对我科收治的68例髁状突骨折，38例无移位或轻度移位者行保守治疗，30例中度或重度移位、脱位、粉碎性或陈旧性骨折行手术治疗。结果：保守组随访34例，31例获得满意效果，7例出现颞颌关节紊乱症，1例关节强直：手术组随访28例，26例面形与关节功能正常，5例出现关节紊乱症。结论：无移位或轻度移位宜采用保守治疗，中度或重度移位、脱位、粉碎性或陈旧性骨折并影颌运动者须采用手术治疗。     

下颌升支合并髁状突游离精确复位再植治疗髁状突高位粉碎性骨折

目的介绍下颌升支合并髁状突游离精确复位再植治疗髁状突高位粉碎性骨折的方法与手术技巧。方法对10例患者16侧髁状突颈部高位粉碎性骨折行下颌升支髁状突游离并准确原位复位钛板固定,术后定期随访检查下颌运动,牙列咬合,张口度并行X线片及CT检查。结果全部伤口一期愈合,随访1～3年患者张口度牙列咬合均恢复至基本正常,无关节疼痛、弹响及明显功能障碍。结论本方法操作简便、损伤较轻、复位准确、固定可靠,并发症较少且轻微,适用于有明显移位的髁突高位粉碎性骨折,升支高度明显变短,无法通过腮腺切口或仅通过下颌下后方切口复位的患者,但髁状突的形态改变和适应性功能改建仍需长期继续观察。     

髁状突游离再植治疗颞下颌关节髁突颈部骨折的临床研究

目的:探讨髁状突游离再植重建颞下颌关节治疗髁突颈部骨折的方法与疗效.方法:15例17侧髁突颈部骨折患者行髁状突游离再植鈦板复位固定的治疗,术后定期复查患者颞下颌关节功能和X线片检查.结果:患者术区伤口均一期愈合,追踪1～5年颞下颌关节无疼痛、弹响及明显功能障碍,2例面神经颞支有影响,1例轻度错牙合畸形. 结论:本法操作简单易行、复位准确、固定可靠,并发症少,适用于移位的髁突颈部骨折.     

髁状突骨折耳垂后下径路内固定术的临床观察

对本院于1999-2006年间收治的31例髁状突骨折采用耳垂后下方切口内固定术治疗情况进行回顾性临床观察分析，结果报告如下。 1临床资料 1．1一般资料31例中男性25例，女性6例，男女之比为4．2：1；年龄12～57岁，平均27．8岁；单侧骨折25例，双侧骨折6例，合并下颌骨其他部位骨折的24例；骨折按骨折线的部位分3类，高位（囊内）骨折3例，中位（髁颈）骨折26例，低位（基部）骨折2例；     

CT辅助髁突矢状骨折手术治疗的实验研究

目的：研究CT辅助设计和测量在髁突矢状骨折（SFMC）手术治疗中的应用价值。方法：4只绵羊被制备成SFMC动物模型,分别在截骨术前、切开复位内固定（ORIF）手术前后行颞下颌关节（TMJ）CT扫描。应用Mimics8.1软件设计并测量截骨术前、ORIF术前侧向螺钉钉道的位置和长度,与术中实际制备和测量的钉道长度以及ORIF术后CT测量的侧向螺钉长度进行比较,以SPSS12.0软件包中的两样本t检验和配对t检验对数据进行统计学分析。结果：截骨术前与ORIF术前CT设计、测量的钉道长度无显著差异（P=0.751）,ORIF术前CT设计、测量的钉道长度与术中实际测量的钉道长度无显著差异（P=0.564）,ORIF术后CT测量的螺钉长度与术中实际测量的钉道长度无显著差异（P=0.323）。结论：利用螺旋CT可以在SFMCORIF手术治疗前预测侧向螺钉的钉道长度,为术前选择侧向螺钉的长度和术中准确制备合适的侧向螺钉钉道以及防止意外损伤提供帮助。     

拉力螺钉内固定治疗髁状突骨折的临床应用

目的 对拉力螺钉内固定治疗髁减突骨折的效果进行评价。方法 对6例6侧状突骨折施行了骨折复位拉力螺钉内固定术，术后观察6－9个月。结果 6例伤口Ⅰ期愈合，1例延迟愈合，5例（7侧）均无关节区疼痛、面部不对称且咬合关系良好。结论 拉力螺钉复位内固定治疗髁突骨折可以及时恢复髁状突解剖形态、生理功能，方法简便可行。     

经耳前腮腺小切口径路治疗髁突中位骨折

目的：探讨经耳前腮腺径路治疗髁突中位骨折的方法。方法：回顾性分析经耳前腮腺径路治疗髁突中位骨折26例35侧的临床资料,记录术前、术后的腮腺涎漏、张口受限程度、面神经损伤及咬合紊乱等情况,通过术前、术后曲面断层片评估骨折复位与愈合状况。结果：全部病例手术过程顺利。手术时间平均（1．5±0．3）h;伤口一期愈合;全部病例均获得良好的咬合关系;3例出现涎瘘,经加压包扎后治愈;张口度恢复至3．5 cm。术后1～3个月复查曲面断层片显示骨折复位及愈合良好;4例出现暂时性面瘫,术后3～6个月复查面瘫症状消失。结论：经耳前腮腺小切口径路治疗髁突中位骨折可获得满意效果。     

低位髁状突骨折的手术探讨

目的：探讨低位髁状突骨折手术入路和内固定材料的选择。方法：选择25例低位髁状突骨折患者,采用不同手术入路及钛板内固定。结果：全部伤口一期愈合,经观察3~6个月骨折端对合良好,无明显并发症。结论：各种手术入路均有其优缺点,解剖面神经入路,尤其对斜线型低位骨折效果更佳,小型钛板内固定效果优于微型钛板内固定。     

Evaluation of Retro Mandibular Approach to Open Reduction and Internal Fixation of Condylar Fractures: A Cross-sectional Study

Purpose

The present study was carried out to evaluate the usefulness of mini retromandibular approach on accessibility, scarring and stability in open reduction and internal fixation of sub condylar fractures.

Materials and Methods

Fifteen patients underwent open reduction and rigid fixation of middle and low subcondylar fractures, with mini-retro mandibular approach.

Results

No signs of infection were observed in any patient postoperatively. Surgical scar was imperceptible and esthetically acceptable in all the cases. Out of 15 patients, only one patient had discrepancy in occlusion and after 2 months satisfactory centric occlusion was achieved. Salivary fistula (parotid fistula) was observed in 3 cases within 1 week postoperatively, which was treated spontaneously with the use of hypertonic saline. Transient facial nerve weakness was observed in 2 patients, in one patient it resolved in 4 weeks postoperatively and in second patient 3 months postoperatively. Mouth opening increased in all the patients with time. Average mouth opening at 1 week interval was 19.6 mm, at 2 months interval 28.2 mm, and after 6 months 38.33 mm suggesting that mouth opening gradually increased with time. At the end of 2 months postoperatively none of the patients had any restriction in lateral movements. At 2 months postoperatively 4 patients had deviation but none of the patients had any deviation 6 months postoperatively.

Conclusion

It is evident from the results of our study that open reduction and internal fixation using mini-retromandibular approach is good treatment option in management of mandibular condylar fractures.     

髁突骨折手术治疗的临床研究

目的：探讨手术治疗髁突骨折的适应证、技术要点和并发症的发生因素。方法：回顾分析5年来采用手术治疗的116例髁突骨折病例的临床资料,分别采取切开复位内固定术和髁突摘除术,随访3个月至3年,复查内容包括患者咬合关系、开口度、开口型、神经损伤、颞下颌关节症状、面型和X线检查。结果：外形和功能均显著恢复,113例咬合关系恢复正常,占97.4%;115例张口度恢复正常,占99.1%;X线复查髁突骨折解剖复位率94.8%;15例儿童患者恢复良好,无下颌骨发育障碍等严重并发症发生。结论：坚强内固定技术是治疗髁突骨折的较好方法,严重移位或脱位的儿童髁颈和髁颈下骨折应采用可吸收接骨板进行内固定。     

Open Reduction Internal Fixation of Condylar Head/Diacapitular Fracture of Mandible: Case Series

ObjectiveSurgical management of condylar head is largely deferred due to the lack of appropriate armamentarium or instrumentation, restricted surgical access and risk of iatrogenic complications. Here we delineate open reduction internal fixation of condylar head fracture with various fixation modalities using specialized instrumentation for visualization and providing access for reduction with minimal complications.MethodsA total of 21 patients were reported with condylar head fracture of mandible to the Department of Oral and Maxillofacial Surgery from January 2017 to June 2018. Three patients had bilateral condylar head fracture, making it a total of 24 fractures. All patients had clinical symptoms including deranged occlusion, limited mouth opening, jaw deviation and restricted mandibular movements. The radiological findings were dislocated or displaced condylar head medially or laterally. All patients were treated by open reduction internal fixation using lag screws or standard long screws.ResultsAmong condylar head fractures, 19 of the study population were male and 2 were female. Distribution of age among the condylar head fractures ranges from 19 years to 40 years with the mean being 22 years. At the end of three-month follow-up, all patients had satisfactory results, both clinically and radiologically. The functional outcome of this study was found to be superior.ConclusionWe recommend open reduction internal fixation of condylar head for patients with high risk of ankylosis, and it is possible without complications due to the availability of minimally invasive surgical access system.     

髁突骨折治疗的临床分析

目的:探讨髁突骨折保守或手术两种治疗方法的临床疗效。方法:回顾性分析2002—2009年我院收治,并按时复诊的48例(53侧)髁突骨折患者的临床资料,其中保守治疗31例(34侧),手术治疗17例(19侧),1年后复诊检查记录患者的面型、开口度、开口型,下颌运动、咬合关系以及颞下颌关节功能情况,进行疗效评价,行统计学处理。结果:髁突骨折的两种治疗方法总体疗效均能令人满意,经SPSS 11.0统计处理,P>0.05,无统计学意义结论:髁突骨折治疗的两种方法各有优缺点和适应证,在选择治疗方法时应综合考虑,尽可能恢复患者的咀嚼功能和面部外形,减少后遗症的发生。     

耳前长角形切口在复杂颧骨复合体骨折复位内固定术中的应用

目的：探讨应用耳前长角形切口在复杂颧骨复合体骨折切开复位内固定术中的应用效果。方法：在106例复杂颧骨复合体骨折切开复位内固定术中采用耳前长角形切口,术区皮下肿胀分离后沿皮下翻瓣,在颧弓上方2cm切开颞深筋膜浅层并沿此层深面剥离到颧弓,分离显露骨折部位,直视下行骨折复位内固定术。结果：术后通过临床及影像学检查随访,效果满意,无严重并发症。结论：耳前长角形切口结合皮下肿胀分离技术不但为复杂颧骨复合体骨折复位内固定术提供良好的视野,方便骨折复位固定,而且与头皮冠状切口相比大大减少了损伤和出血,值得临床推广。     

Open versus closed treatment for unilateral mandibular extra-capsular condylar fractures: A meta-analysis

PurposeTo compare the functional outcomes between open reduction and internal fixation (ORIF) and closed reduction (CR) for unilateral mandibular extra-capsular condylar fractures in patients over 12 years old.Materials and methodsA comprehensive electronic search of PubMed, Embase and the Cochrane Library databases was conducted up to October 31, 2018. The evaluated functional outcomes included malocclusion, temporomandibular joint (TMJ) pain, protrusion, laterotrusion, maximum inter-incisal opening and lateral deviation during maximum inter-incisal opening.ResultsFourteen studies appeared to meet the inclusion criteria. Statistically significant differences between ORIF and CR treatment were observed for the outcomes of malocclusion (P = 0.001), maximum inter-incisal opening (P = 0.0008), lateral deviation during maximum inter-incisal opening (P = 0.007) and laterotrusion (P < 0.0001), but not for the outcomes of protrusion (P = 0.33) and TMJ pain (P = 0.29).ConclusionsORIF treatment of unilateral mandibular extra-capsular condylar fractures provides better functional outcomes in comparison to CR treatment with regard to occlusion, maximum inter-incisal opening, lateral deviation during maximum inter-incisal opening and laterotrusion, whereas there was no statistically significant difference between ORIF and CR group with regard to protrusion and TMJ pain.     

穿腮腺入路治疗髁颈及髁突基底部骨折

目的：探讨穿腮腺入路治疗髁颈及髁突基底部的安全性及有效性。方法：对15例（21侧）髁颈及髁突基底部骨折患者选择穿腮腺入路切开复位内固定术。结果：15例患者,21例侧髁突骨折行手术治疗。19例侧髁突骨折选择2块接骨板固定,2例侧选择1块接骨板固定。所有患者伤口均一期愈合,术后复查全口曲面断层片或三维CT示骨折断端对位良好。除1例患侧后牙暂时性轻度开外,所有患者咬合关系恢复良好。术后1个月复查,张口度32～45mm（平均38mm）。3例侧出现面神经损伤症状,术后3个月内均恢复正常,无1例出现永久性面瘫。所有患者均未出现涎瘘、感染等并发症。结论：相对于髁突骨折的颌后及颌下入路,穿腮腺入路行髁突骨折切开复位内固定术,容易暴露,可直视下完成骨折复位固定,是治疗髁颈和髁突基底部骨折安全有效的手术入路。     

Evaluation of Mechanical Resistance After Fixation of Mandibular Condylar Fracture with Single and Double Miniplates: A Comparative In Vitro Study

Objectives

1. To evaluate the efficacy of two plating system in comparison with single plating system
2. To study the biomechanical behaviour of single and two plating system when compression load is applied.

Materials and Methods

Twenty hemimandibles were divided into two groups A and B of ten each. A subcondylar fracture was created. Group A was stabilized by single adaptation plating technique and group B by double adaptation plating technique and both the groups were tested for stability by using universal testing machine.

Results

Higher mean displacement was observed in Group A compared to Group B, but the difference in mean displacement between the two groups was not statistically significant (p > 0.05). Higher mean load was recorded in group B compared to group A and the difference in mean load between them was found to be statistically significant (p < 0.001).

Conclusion

The present study demonstrated that double adaptation plating technique had greater resistance to compression load than single adaptation plating technique and it shows more favorable biomechanical behavior.     

526例下颌骨髁状突骨折临床病例回顾性研究

目的:探讨下颌骨髁状突骨折的发生特点。方法:通过对526例髁状突骨折病案资料的调查,对髁状突骨折的发生年龄、性别、致伤原因、骨折类型、合併伤、治疗及后遗症进行分析?峁?髁状突骨折好发于20~30岁;男性多于女性,交通事故伤(47.97%)为主要致伤原因;髁状突骨折60.59%发生在髁颈部;49.62%合并颏部骨折;儿童髁状突骨折69.85%采用保守治疗,高位(囊内)骨折69.52%摘除骨折断端;3.23%继发关节强直。结论:髁状突骨折好发于髁颈部,髁状突矢状骨折及髁颈部骨折伴骨折断端和关节盘移位严重的骨折处理不当易发生关节强直。