自攻颌间牵引钉配合小型钛板治疗下颌骨骨折的疗效观察

目的:探讨自攻颌间牵引钉配合小型钛板治疗下颌骨骨折的临床疗效。方法:对48例下颌骨骨折患者采用自攻颌间牵引钉联合小型钛板行坚强内固定术。术后对患者的切口愈合情况、张口度、咬合关系、口腔卫生情况以及骨折愈合情况进行观察。结果:48例患者手术切口均为I期愈合,治疗效果满意,咬合关系良好,3个月后影像学复查示骨折线对位良好。结论:自攻颌间牵引钉配合小型钛板坚固内固定治疗下颌骨骨折是目前治疗下颌骨骨折较为理想的方法。     

口内径路微型钛板内固定治疗闭合性下颌骨骨折

目的：分析下颌骨骨折手术治疗的径路和其优缺点。方法：经口内径路,采用微型钛板坚固内固定技术治疗51例闭合性、线性下颌骨骨折,术后3个月,根据患者开口度,咬合关系,X线骨折对位情况,评价疗效。结果：51例患者伤口全部一期愈合,咬合关系恢复良好,开口度≥38mm,X线示骨折对位良好。结论：口内径路是治疗下颌骨骨折的理想途径,面部无疤痕;微型钛板坚固内固定可以达到良好的疗效。     

口内入路坚强内固定治疗下颌骨体部骨折

目的：探讨下颌骨骨折手术治疗的径路及其优缺点。方法：口内切口采用小钛板坚固内固定技术治疗16例下颌骨骨折。术后1周、3个月、6个月,根据患者开口度,咬合关系,x线示骨折对位,对线情况,评估其愈合情况。结果：16例患者伤口全部I期愈合。15例咬合关系恢复到伤前咬合关系,1例出现局部咬合关系不良。术后张口度≥37mm,X线示骨折线对位良好。结论：口内入路坚固内固定治疗下颌骨骨折疗效确切,避免了面部皮肤瘢痕和面神经损伤,是治疗下颌骨骨折的有效方法。     

90例下颌骨骨折坚强内固定术治疗体会

目的评估坚强内固定术治疗下颌骨骨折的临床疗效。方法回顾分析使用坚强内固定技术治疗的90例下颌骨骨折患者的临床资料,总结临床应用经验。结果90例中85例I期愈合,咬合关系系恢复良好,颌面部外形和咀嚼功能得以恢复,张口度正常;5例出现不同程度感染。造成钛板外露,但经临床处理均达到Ⅱ期愈合。术后3月、6月、1年分别X线片和三维CT复查骨折愈合良好,均未见钛板或钛钉移位、断裂．周围骨质无疏松、吸收等现象。结论微型钛板坚强内固定技术效果确切,但术前评估和手术时机的选择也是至关重要。     

小型钛板联合颌间牵引钛钉在下颌骨骨折中的应用

目的探索小型钛板联合颌间牵引钛钉在下颌骨骨折复位内固定术中的应用及临床效果。方法回顾分析小型钛板联合颌间牵引钛钉,行下颌骨骨折复位内固定术186例的临床资料和应用经验。采用颌间牵引钛钉行颌间牵引,恢复咬牙合关系,经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,小型钛板骨间固定。结果所有患者创口Ⅰ期愈合,张口度正常,咬牙合关系正常,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。结论小型钛板联合颌间牵引钛钉行骨间坚强内固定术,治疗下颌骨骨折,微创,复位准确,简便快捷,效果满意,值得临床推广应用。     

整形美容理念在治疗下颌骨骨折中的临床应用

目的回顾性分析应用整形美容理念治疗下颌骨骨折的临床效果。方法对下颌骨骨折患者采用钛板坚固内固定,复位技术及钛板的固定位置均参考Champy理论;术后根据情况,配合咬殆调整。结果本组共52例患者,术后1例出现局部感染,经清创后愈合,其余51例伤口均Ⅰ期愈合;经6—24个月临床随访,52例患者均恢复到术前的面形及咬胎关系,未出现局部咬殆关系不良,伤口均无明显瘢痕增生。结论采用钛板坚固内固定下颌骨骨折,并在治疗的整个过程中渗入整形美容的理念,效果可靠,患者满意度高。     

儿童下颌骨骨折的治疗及愈后的临床研究

目的：评价手术坚强内固定在儿童下颌骨骨折中的临床效果。方法对28例下颌骨骨折患儿应用紧贴下颌下缘上方的小型钛板双皮质固定+单颌牙弓夹板固定手术切开复位内固定术。结果28例患儿下颌骨骨折均获得良好的解剖复位,骨折Ⅰ期愈合,面形、开口型均正常,张闭口活动正常,口内咬牙合关系良好,未见骨折部位恒牙萌出异常,患儿无不良反应。结论儿童下颌骨骨折采用紧贴下颌下缘上方的小型钛板双皮质坚固内固定联合牙弓夹板固定术,避免了下颌骨张力带钛板固定对恒牙胚的损伤和下颌骨应力带的扭转,不影响颏顶弹性帽固定对下颌的制动。患儿早期即可进食和进行功能锻炼,减少并发症的发生,对下颌骨的整复固定和功能恢复效果良好。     

钛网塑形在15例下颌骨粉碎性骨折中的应用

目的：探讨一种下颌骨粉碎性骨折的治疗方法。方法：本组病例15例,其中13例术中依据骨折复位后的颌骨形态即刻塑形钛网;2例术前通过计算机扫描三维重建骨折区颌骨形态制作个性化钛网修复体,术中复位骨折后固定。其中5例患者术中行游离碎骨再植,恢复颌骨形态,术后观察骨折愈合情况、面型、咬合关系及张口度。结果：14例创口Ⅰ期愈合,9例患者术后随访6个月～3年,面型恢复良好、咬合关系及张口度恢复正常,总体效果满意。结论：钛网塑形固定下颌骨粉碎性骨折较重建板容易塑形,易与骨面贴合,是一种简单有效的方法。     

小型钛板技术治疗下颌骨骨折45例探讨

目的：探讨小型钛板技术在下凳骨骨折治疗中的应用,术后应注意的事项。方法：口内切口进路小型钛板坚固内固定系统治疗下颌骨骨折。结果：术后患者咬He及面部形态恢复良好。结论：应用小型钛板坚固内固定系统治疗下颌骨骨折,固定可靠,术后无需作颌间结扎,确保患者保持良好的口腔卫生,口内切口进路避免面部遗留瘢痕和影响美观。     

微型钛板在下颌骨骨折坚强内固定术的临床应用

目的微型钛板作为下颌骨骨折内固定材料在临床应用中的价值。方法手术切开复位,应用微型钛板作下颌骨骨折内固定材料,并与其他固定方法进行对比,结合临床给予评价。结果27例创口均一期愈合,其中26例术后咬牙合关系恢复良好,1例咬牙合关系恢复较差。结论通过临床应用微型钛板是下颌骨骨折较为理想的固定材料,生物相容性好,方便实用,稳定可靠。     

发际缘切口在颧上颌复合体骨折治疗中的应用

目的：探讨发际缘切口联合附加小切口行颧上颌复合体骨折坚强内固定术的,临床应用价值。方法：本组35例患者采用发际缘切口联合附加小切口行颧上颌复合体骨折解剖复位,微型钛板坚强内固定术。结果：35例均一期愈合,面部畸形得到明显改善,咬合关系恢复正常,无面神经损伤。结论：采用发际缘切口联合附加小切口的坚强内固定技术治疗颧上颌复合体骨折,复位准确、固定可靠,使面中部解剖结构得以重建,且术后无明显面部畸形等,具有良好的美观效果。     

Manually provided temporary maxillomandibular fixation in the treatment of selected mandibular fractures.

OBJECTIVE: To report the occlusal outcomes of manually provided temporary intraoperative maxillomandibular fixation (MMMF) for the open repair of selected mandibular fractures. STUDY DESIGN/SUBJECTS AND METHODS: A retrospective chart review of the patients who underwent open reduction and internal fixation of mandibular fractures with MMMF was performed. RESULTS: Twenty-six patients underwent open reduction and internal fixation with MMMF. Postoperative data were available for only 16 patients who kept their follow-up appointments. With the exception of one patient who experienced minimal cross-bite in the right molar region, all of the patients had their original normocclusion. CONCLUSION: Preliminary results of MMMF suggest that satisfactory postoperative occlusal outcomes may be obtained without the use of wire-based maxillomandibular fixation methods in selected mandibular fractures.     

Prospective Comparative Study of the Range of Movement of Temporomandibular Joints After Mandibular Fractures: Rigid or Non-rigid Fixation

Temporomandibular joints (TMJ) are negatively affected by trauma and disuse. In this prospective study, 103 patients with mandibular fractures were evaluated for the influence of trauma and maxillomandibular fixation on the TMJ. A total of 54 patients were treated by maxillomandibular fixation and 49 by titanium miniplate fixation. Those patients with condylar fractures and multiple mandibular fractures and malocclusion at presentation were not included in the study. The control group consisted of 44 randomly-selected healthy people with no past history of mandibular fracture or symptoms referable to the TMJ. Trauma was a major factor leading to TMJ dysfunction and maxillomandibular fixation increased the incidence and severity of TMJ dysfunction.     

Prospective comparative study of the range of movement of temporomandibular joints after mandibular fractures: rigid or non-rigid fixation.

Temporomandibular joints (TMJ) are negatively affected by trauma and disuse. In this prospective study, 103 patients with mandibular fractures were evaluated for the influence of trauma and maxillomandibular fixation on the TMJ. A total of 54 patients were treated by maxillomandibular fixation and 49 by titanium miniplate fixation. Those patients with condylar fractures and multiple mandibular fractures and malocclusion at presentation were not included in the study. The control group consisted of 44 randomly-selected healthy people with no past history of mandibular fracture or symptoms referable to the TMJ. Trauma was a major factor leading to TMJ dysfunction and maxillomandibular fixation increased the incidence and severity of TMJ dysfunction.     

Use of specialized bone screws for intermaxillary fixation

Fixation of the injured mandible to the maxilla is a proven method of stabilizing mandibular fractures and ensuring proper occlusion. The authors report their results with new specialized intraoral bone screws (IMF Screw System; Howmedica Leibinger, Inc., Carrollton, TX) that are designed for the purpose of achieving intermaxillary fixation (IMF). Nineteen patients were placed into rigid IMF using IMF screws alone. Indications were nondisplaced mandibular fractures; symphyseal, body, and angle fractures; midfacial fractures requiring temporary IMF; and edentulous patients with any of these fracture types and an adequate prosthesis. All procedures were performed with the patient under general anesthesia. The authors found that the operative time was markedly shorter than with standard IMF techniques, patient satisfaction was high, and there were no infections related to the screws. All 19 patients remained in stable, accurate occlusion and had adequate healing. One patient continues to have paraesthesias in the mental nerve distribution after screw removal. Although there is the potential for tooth and nerve injury when screws are placed improperly, the IMF Screw System seems to be a safe and reliable method of achieving secure mandibular fixation.     

Monocortical non-compression miniplate osteosynthesis of mandibular angle fractures

The technique of monocortical non-compression miniplate fixation of mandibular angle fractures is reviewed. A study of our first 50 patients treated using this technique reveals that consistent reduction and stabilization of these mandibular fractures can be achieved without the requirement for intermaxillary fixation. Such results were produced with minimal postoperative morbidity.     

Rigid internal fixation vs. traditional techniques for the treatment of mandible fractures

Treatment results were compared between mandibular fractures repaired with vitallium miniplates versus intermaxillary fixation (IMF) and wire osteosynthesis in 79 patients treated over a 4-year period. The postoperative courses of 35 patients treated with 46 plates were compared to those of 44 individuals treated with traditional reduction techniques. The plated group contained nine complications (26%) versus ten (23%) in the non-plated group. This difference was not statistically significant, despite the presence of more severe fractures in the plated group. Major complications (nonunions, malocclusions) were noted in only three (8%) of the plated group; there were six complications (14%) in the non-plated group. We conclude that the plating of mandibular fractures incurs no greater overall risk of complications than traditional methods of fixation, and a lower risk of major complications, and that the advantages of plate fixation, including decreased time of intermaxillary fixation and cost effectiveness, make this the method of choice in complex mandibular fractures, even in a high-risk population.     

Plate and screw fixation of selected condylar fractures of the mandible.

The majority of condylar fractures can be treated with closed reduction and intermaxillary fixation. In this study, we examine the use of open reduction with plate and screw fixation for the treatment of condylar fractures. Fourteen patients with 18 subcondylar fractures underwent open reduction and fixation using miniplates (12 patients) and lag screws (two patients). Thirteen patients and 16 condylar fractures had adequate follow-up for analysis of results. The follow-up period ranged from 7 to 46 months with a mean of 24 months. Bony union was obtained in all fractures with no permanent facial nerve injuries and good mandibular opening (average of 45 mm). We conclude that condylar fractures can be opened and fixed with plates and screws with good results without the use of intermaxillary fixation. This technique can be an effective approach for the treatment of selected condylar fractures.     

Bone-screw mandible fixation: An intraoperative alternative to arch bars

OBJECTIVES: Bone-screw mandible fixation (BSMF) is evaluated as an alternative to intraoperative arch-bar maxillomandibular fixation before plating of mandibular fractures. BSMF is achieved by wire ligation of opposing bone-screws placed in the maxilla and mandible. METHODS: A retrospective evaluation of 23 patients with 40 mandibular fractures who underwent mandibular fracture repairs. BSMF was used instead of arch bars to ensure proper dental occlusion. All fractures were then plated, after which BSMF was removed before termination of anesthesia. RESULTS: Normal occlusion was observed in 21 patients (91.3%), Class II malocclusion was noted in 1 patient (4. 3%), and 1 patient was edentulous. No complications related to the use of BSMF were observed. CONCLUSION: BSMF can serve as a viable alternative to arch-bar maxillomandibular fixation for obtaining temporary intraoperative occlusion. BSMF produces acceptable malocclusion rates and offers the advantages of decreased intraoperative time, lower risk for percutaneous and mucosal wire punctures, and ease of use.     

下颌骨多发性骨折67例临床分析

目的:探讨下颌骨多发性骨折的临床特点及治疗措施。方法:收集我科2000～2006年间住院治疗的下颌骨多发性骨折患者共67例,对其一般临床资料及治疗方法进行分析总结。结果:下颌骨多发性骨折患者男性多于女性,交通事故为第一损伤原因;伤口I期愈合、骨折对位良好、面型及功能恢复正常者64例,占95%。结论:下颌骨多发性骨折以颏正中合并髁状突、下颌角部发生较多,三维CT成像及坚固内固定技术在多发性骨折的诊断与治疗中起了较大的作用,选择合适的美学切口切开复位坚固内固定治疗效果可靠,优点明显。