颧骨复合体下颌骨联合骨折的临床治疗研究

目的探讨颧骨复合体下颌骨联合骨折临床治疗的有效方法。方法通过对128例颧骨复合体下颌骨联合骨折病例的复位径路和固定方法进行回顾性总结分析,评价其治疗效果。结果在本组所有病例中,有108例采取头皮冠状切口(必要时附加小切口)+下颌骨切口;20例采取局部小切口,即皮肤小切口、睑缘下切口或上颌口腔前庭切口+下颌骨切口;固定方式中,应用坚固内固定有70例,坚固内固定联合钢丝固定28例,单纯钢丝骨间栓结30例。经出院时临床观察和术后6～72个月的随访,失访23人,在随访的105例患者中:甲级25例(占23.8%),乙级65例(占61.9%),丙级15例(占14.3%)。结论头皮冠状切口联合局部小切口可以充分暴露骨折区,利于解剖复位和骨折固定;坚固内固定效果确切,是临床上颧骨复合体下颌骨联合骨折良好且可靠的固定方法。     

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。     

小钛板内固定治疗下颌骨骨折112例的临床观察

目的观察小钛板内固定治疗下颌骨骨折的疗效。方法选择下颌骨骨折患者112例,将骨折解剖复位后,用1~2块小钛板行骨断端坚固内固定,其中40例多发性或粉碎性骨折辅以1~2周颌间固定牵引。观察骨折段复位、咬合关系、颌面形态恢复情况。结果112例患者术后均无感染,术后3个月X线检查骨折端复位良好,骨痂形成,颌面外形满意,咬合功能良好。结论小钛板内固定治疗下颌骨骨折疗效可靠,是较为理想的颌骨骨折治疗方法。     

颌面部骨折355例临床治疗分析

目的：总结颌面部骨折病因、骨折类型以及临床诊疗方法。方法：收集355例颌面部骨折患者的临床资料,对其年龄构成、致伤原因、骨折类型及治疗方法进行统计分析。结果：355例颌面部骨折患者中,20～39岁者最多,占47.32%,交通事故伤为主要致伤原因,占52.12%,大部分病例伤后2周以内进行治疗,占67.61%,下颌骨骨折为主要受伤类型,占46.48%,多发性骨折其次,占29.86%,治疗方法以开放复位内固定为主,占75.49%,部分联合颌间牵引、颅颌固定治疗,术后绝大多数患者取得了满意的面形和功能疗效。结论：颌面部骨折好发于青壮年男性,交通事故伤为主要致伤原因,下颌骨骨折占受伤类型多数,多发性骨折居其次,治疗以开放复位内固定为主,可以达到精确、稳定复位,病人痛苦少,疗效可靠。     

颌面部骨折微型夹板坚强内固定18例报告

目的 :总结颌面部骨折开放复位 ,微型夹板坚强内固定的临床疗效。方法 :18例颌面部骨折病例进行开放复位 ,微型夹板坚强内固定。其中颧骨颧弓骨折 3例、上颌骨LefortI型骨折 3例、下颌骨多发性骨折 10例、下颌骨粉碎性骨折 2例。结果 :18例颌面部骨折病例手术后均达到解剖复位 ,咬合关系恢复正常 ,外观及功能均获得满意效果 ,无一例并发症发生。结论 :应用微型夹板在颌面部骨折中进行坚强内固定 ,可使骨折达到解剖复位 ,获得满意临床疗效。     

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。     

颌面部骨折142例临床报告

目的:总结分析颌面部骨折的病因、临床特点及治疗方法。方法:对中国医科大学附属口腔医院2004年10月-2005年9月收治的142例颌面骨骨折患者,分别从其年龄、性别、病因、骨折类型、全身损伤、治疗及手术并发症等各方面,进行综合分析研究。结果:颌面部骨折好发于男性,20～50岁为好发年龄段;交通事故损伤最常见(59.15%);多见下颌骨骨折(50.00%)及颧骨复合体骨折(29.58%);常伴发全身损伤(35.21%);治疗中复位后坚固内固定术是最佳方法(81.65%);手术切口以口内为主(58.72%);术后神经损伤及感染极少见。结论:颌面部骨折以青壮年居多,最主要病因是交通事故,除复位颌间牵引保守治疗外,复位后坚固内固定是现今临床最常用的治疗方法。     

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。     

257例下颌骨骨折的临床分析

目的:通过对257例下骨骨折病例临床分析,探讨下颌骨骨折的病因及治疗。方法:收集2005年1月～2011年12月收治的下颌骨骨折病例257例,对其受伤原因、骨折部位及治疗方法进行分析。结果:257例中多发年龄为18～30岁;男性多于女性,交通事故伤居第一位;骨折部位多见于颏部;颌面部其他部位骨折为最常见的合并伤,颌间牵引复位固定后行坚强内固定术是常用的治疗方法,且临床效果好。结论:下颌骨骨折多见于青年男性,多因交通事故引起,颏部骨折多见,常合并颌面部多发性骨折,坚固内固定术是目前治疗下颌骨骨折的好方法。     

下颌骨髁突骨折手术治疗的临床观察

目的:探讨下颌骨髁突骨折患者手术适应证与临床处理技术要点。方法:开放性手术治疗髁突骨折患者25例。其中19例骨折片复位后采用坚强内固定;6例髁突粉碎性骨折者,行髁突摘除,且其中4例行带血管蒂的颞筋膜瓣关节成形术。对比患者手术前后临床症状及X线结果,评价骨折愈合情况。结果:优19例(76%),良6例(24%)。结论:对伴有移位或错位的髁突骨折,开放性手术及坚强内固定术,可获得较好的疗效。     

A retrospective comparative study of mandibular fracture treatment with internal fixation using reconstruction plate versus miniplates

PurposeThis study compared the clinical success rates of mandibular fracture treatment using reconstruction plates or miniplates and clarified the selection criteria for reconstruction plates.MethodsAll patients who had surgically-treated mandible fractures from 2008 to 2017 with sufficient follow-up were retrospectively analyzed for information about the fracture condition, treatment, and outcomes.ResultsA total of 126 surgically-treated mandible fractures without mandibular condylar fracture in 105 patients (76 male, 29 female) were included. Reconstruction plates were used in 32 fractures with very good postoperative occlusal function. Four cases with complications requiring reoperation were treated using only miniplates. Variables that were statistically associated with follow-up surgery included simple versus comminuted mandible fracture, and the absence of teeth that could be used for intermaxillary fixation (P < 0.05). In the miniplates treatment for comminuted fracture, there was a significant difference in the treatment outcome depending on the number of free bone-fragments and the presence of bone-fragments requiring removal within 1 cm (P < 0.05).ConclusionReconstruction plates provided better treatment outcomes for comminuted fractures and fractures without teeth. Selecting a reconstruction plate that is capable of sufficiently overloading is important in comminuted fractures with multiple free bone-fragments and bone-fragments requiring removal.     

75例下颌骨粉碎性骨折的治疗效果评价

目的:提出一种针对下颌骨粉碎性骨折的分类方法,并尝试将其用于临床评价.方法:回顾75例下颌骨粉碎性骨折患者,按照下颌骨是否伴有节段性骨缺损、下颌骨形态、下颌骨的粉碎程度、可否恢复稳定的咬合关系对其进行分类.按照严重程度,进行保守治疗或使用小型钛板、钛网或重建板进行手术.其中,44例按照分类及治疗策略进行治疗(实验组),...     

Treatment of complex mandibular fractures using titanium mesh.

INTRODUCTION: The treatment of complex fractures with miniplates is often difficult and unsatisfactory. Such fractures include extremely atrophic mandibles, discontinuity defects, and marked comminuted fractures. AIM: With this paper we want to call to mind once more that titanium mesh is useful for the treatment of such fractures and its use can reduce the number of complications. PATIENTS: Between January 1996 and December 1998 we treated with titanium mesh 17 patients with fractures of extremely atrophic mandibles, mandibular discontinuity defects or comminuted fractures. RESULTS: Union occurred without complication in 70% of fractures treated with titanium mesh. In 20% there were minor complications such as postoperative haematoma. In only one case did infection occur, a more severe complication. CONCLUSION: Because of its geometry and the excellent physical and biomechanical properties, titanium mesh helps to achieve better stabilization of complex mandibular fractures than conventional miniplates do. Complications such as infection and non union can largely be avoided and bony continuity of the mandible can be restored.     

Miniplate osteosynthesis of fractures of the edentulous mandible

This study was performed to analyze treatment of fractures of the edentulous mandible and to discuss this method in relation to the mandibular height at the fracture site. Fifteen fracture sites in 11 patients with an edentulous mandible were retrospectively examined. These fractures were located: nine fractures in the mandibular body, three in the paramedian region, and three in the mandibular angle. Fractures in a mandible measuring more than 10 mm in the vertical height were treated with one miniplate. Fractures in an extremely atrophic mandible with 10 mm or less were treated using one or two miniplates, also using a modified Champy plate with 1.3 mm in thickness. A mandibular fracture with a height of 5 mm was treated with a combination of a microplate on the buccal side and a miniplate on the inferior border of the mandible with additional direct circumferential wiring. Oblique or splitting fractures were treated with direct circumferential wiring or a Herbert screw, at one fracture site each, respectively. Complications, including infection, fibrous union, nonunion and trismus, were not seen. In one patient, hypesthesia of the lower lip was, however, persistent 1 month after surgery. Miniplate osteosynthesis is the less invasive treatment, and it is suitable for fractures of the atrophic edentulous mandible, except for comminuted or defect fractures. To obtain stable fixation in severely atrophic mandibles, we need to consider the use of two miniplates or a combination with microplates.     

Treatment of comminuted fractures of the mandible

Management of comminuted mandible fractures requires careful planning. Treatment is based on a thorough understanding of the medical management of severely injured patients, biology of these injuries, the biomechanics of the mandible, and principles of fracture fixation.     

Resorbable Plates for Fixation of Complicated Mandibular Fractures in Children

Purpose

The purpose of this article was to review our experience in the treatment of complicated mandibular fractures in children using resorbable plates.

Patients and Methods

Records of 14 patients who sustained and presented to our department with complicated fractures of the mandible, and were treated with resorbable plates were retrieved. Permission was sought from and granted by the institution ethical committee. Data extracted included patients’ gender, age, etiology of fracture, nature of fracture and site of the fracture.

Results

Of the 14 patients, there were 10 males and 4 females with a male to female (M:F) ratio of 2.5:1. Their ages ranged from 6 to 15 years, with a mean of 10.14 years. The etiology of the fractures included road traffic accidents (n = 11) and falls (n = 3). Most of the fractures were sustained on the body of the mandible. Majority of the patients had displacement of the fracture segments; 2 patients had comminuted fractures. All the fractures were treated using resorbable plates and healed uneventfully.

Conclusion

Whereas the number of patients in this case series was small, it is worth noting that children sometimes present with complicated fractures of the mandible, thereby necessitating open reduction and internal fixation. Resorbable plates when available and affordable, are an effective option for open reduction and internal fixation of such fractures.     

49例下颌骨粉碎性骨折临床回顾分析

目的: 探讨下颌骨粉碎性骨折的治疗方法。方法: 回顾总结49例下颌骨粉碎性骨折患者的临床信息、治疗方法及随访结果。结果: 49例患者中,男33例,女16例;31%为交通事故伤,术后10例发生感染,1例咬合紊乱,1例关节强直,1例骨不连,并发症率为26.5%。结论: 下颌骨粉碎性骨折可采用多种方法治疗,但仍有较高的感染率,治疗效果不甚理想。