髁突的测量分析与骨折发生的关系

目的 通过对上海地区153名成年人下颌骨髁突内外径、前后径、及,髁突颈部最窄径的测量,探讨其与骨折发生的关系。方法 取上海地区成年人下颌骨:男74例,女79例,以髁突直径为内外径,髁突最厚处为髁突前后径,并测出髁突颈部的最窄径。同时收集上海市第九人民医院1997年1月至2003年6月下颌骨骨折病历273份,分析其不同部位骨折的发病率。结果 髁突内外径男女分别为:19.04mm、18.85mm;髁突前后径男女分别为9.03mm、8.59mm;髁突颈部最窄径男女分别为:6.98mm、5.94mm。下颌骨髁突骨折的发生率在下颌骨骨折中:男性占23.33％,女性占27.27％,其中合并颅脑损伤的为25例。结论 将所测得的髁突内外径、前后径数值分别和髁突颈部最窄径数值在男性与女性间进行统计学分析,经t检验,P<0.01。因此,无论男性或女性髁突颈部最窄径和髁突内外径及髁突前后径均有明显差异。由此可知髁突颈部为下颌骨最细处,无论遭受直接或间接暴力的打击,该处均可引起骨折。同时通过对临床下颌骨骨折发病率的分析发现:髁突是临床下颌骨骨折的好发部位之一。     

大鼠髁状突颈部骨折不同处理对下颌骨生长发育的影响

作者对两组年幼大白鼠髁状突颈部骨折分别采用非骨间固定与骨间固定，观察比较两种处理方法对下颌骨生长发育的长期影响．结果表明：两种处理均对下预骨生长发育产生了一定的影响。表现为髁头较小．髁颈增厚，下领骨体较长；喙突较短。但下颌骨生长发育基本完成。除固定组升枝较短于健侧外。其余左右侧基本对称。两种处理间各项比较均无显著性差异．本研究结果提示对年轻者髁状突颈部骨折可采取保守治疗。     

髁状突颈部内弯骨折手术方法改进

下颌骨髁状突颈部内弯骨折手术复位方法很多,但都是在分离下髁状突,在离体情况下将髁状突复位固定。作者介绍一种不分离髁状突行髁状突骨折复位内固定术,取得满意效果。 病例介绍 患者女性,44岁,临床表现为外伤后左耳屏前疼痛,张口受限,(牙合)关系错乱,下颌骨X线正侧位片显示左下颌骨髁状突颈部骨折,呈水平内弯。手术方法:左颌下切口,显露下颌骨升支到乙状切迹及骨折断端,可见到髁状突,但不能夹住使其复位。用骨锯从骨折断端垂直向下到下颌角纵形截开下颌骨升支,并取出升支后缘骨质,用钳子很容易伸入夹住髁状突,使     

大白鼠髁状突颈部骨折后不同处理对髁状突生长发育的影响

本文用年幼大白鼠研究比较髁状突颈部骨折后非固定与复位骨间固定处理对髁状突生长发育的影响。结果表明两种处理均对髁状突生长发育产生了一定的影响，髁状突头部较小，颈部增厚，但髁状突生长发育基本完成，左右侧对称。两种处理间比较无显著性差别。本研究结果提示对年幼者髁状突颈部骨折宜保守治疗。     

保留髁状突翼外肌附着行坚固内固定治疗髁颈部骨折

髁状突颈部是下颌骨的薄弱部位，受到直接或间接撞击后易发生骨折，约占下颌骨骨折的２５％〔１〕。髁状突又是颞下颌关节的重要组成部分，其治疗的好坏直接影响面部的外形和功能。髁颈部骨折后，折断的髁状突受翼外肌的牵拉会向前、内移位，严重时从关节窝内脱出，保守治...     

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。     

43例成人髁状突骨折术后2年临床观察

髁状突颈部骨折的发病率约占下颌骨骨折的25％。若治疗不及时,会产生骨折段错位愈合,导致颞颌关节疾病的产生。1995～2003年我科收治43例成人髁状突颈部骨折病例。     

髁突矢状骨折的临床诊断及治疗

下颌骨骨折为口腔颌面外科常见病，髁状突颈部骨折约占下颌骨骨折的25％，而下颌骨髁状突矢状骨折(sagittal fracture of the mandibular Condyle，SFMC)报道却较少。我院1998年1月～2003年7月收治的98例下颌骨骨折的患者，确诊为SFMC的共5例，治疗效果满意，现报告如下。     

不同方法处理大白鼠髁颈部骨折对髁突软骨的影响

不同方法处理大白鼠髁颈部骨折对髁突软骨的影响李令超，东耀峻，张国志对于髁突骨折采用保守治疗还是手术治疗一直存在争议。以往的研究仅注重髁突形态及下颌骨功能，而对髁突骨折后，髁突软骨的研究未见报道。我们通过动物实验，观察骨折后不同方法处理对软骨中碱性磷酸...     

髁突骨折498例临床分析

目的:对本院1984-2003年20a间498名髁突骨折患者进行临床流行病学回顾性研究。方法:研究20年 间498名髁突骨折患者年龄、性别、致伤原因、骨折特点以及合并损伤情况。结果:髁突骨折男性多于女性,发病 年龄高峰为21-30岁,原因以交通事故居多,占47.99％。髁突颈部是最常见骨折部位,骨折片成角移位达56. 03％,下颌骨颏部是伴发髁突骨折最常见的部位。结论:髁突骨折中男性好发,交通事故是首要原因,髁突颈部最 易发生骨折。     

下颌骨髁突骨折临床30例病例观察

目的:对30例(38侧)髁突骨折临床资料分析,探讨髁突骨折的临床特点。方法:选取大连市口腔医院口腔颌面外科2004-05─2007-10收治的资料完整的30例(38侧)髁突骨折病例,对髁突骨折的发生年龄、性别、致伤原因、骨折类型、全身损伤、治疗方案及手术并发症进行分析,并以开口度、开口型、咬合关系、咀嚼力、面型等5个方面作为术后评价标准,进行综合评价分析。结果:髁突骨折男性多于女性,交通事故伤为最主要致伤原因;髁突骨折42.11%发生在髁突基部,36.84%发生在髁突颈部。主要治疗方法是坚固内固定,正颌手术方法(下颌升支垂直截骨术)等。并发症主要为开口型偏斜(4例),开口度30mm以下(1例),术后髁突吸收(1例)。结论:髁突骨折好发于髁突颈部及基部,坚固内固定是最常用手术方法,牵引成骨技术也应用到陈旧性髁突骨折中。     

Long-term results of nonsurgical management of condylar fractures in children

Twenty-five patients with 28 condylar or subcondylar fractures, sustained during their growth period and treated nonsurgically, have been followed for an average period of 15 years. The fractures were classified as intracapsular, high condylar neck and low condylar neck fractures. In 5 patients, two weeks of intermaxillary fixation, followed by elastic traction in order to achieve a proper occlusion, was applied. All the other patients were treated by instruction, exercises and observation. In 4 patients, subsequent orthodontic treatment was provided. It is not advocated to perform orthodontic aftercare as a routine action in all patients. Satisfaction with the treatment results, as measured on a visual analogue scale (VAS), was very high. The masticatory function of all patients at last follow-up was good to excellent. From this study, it appears that especially the commonly occurring high condylar fractures (64%) show good regeneration tendency as observed on radiographs. Low condylar and intracapsular fractures may give rise to some asymmetry. In 4 cases this asymmetry was clearly visible to the experienced observer, but did not concern the patient. One patient (low condylar neck fracture) showed obvious malocclusion and facial asymmetry, which needed to be corrected by orthognathic surgery. Unfortunately, it is impossible to predict which type of fracture is at risk of facial asymmetry. It is concluded that nonsurgical management of condylar fractures of the mandible in children is still the method of choice.     

儿童下颌骨髁突骨折的治疗进展

儿童髁突骨折是常见的骨折类型之一,占下颌骨骨折的40％～67％.对儿童髁突骨折治疗方法的选择一直存在着争议,仍无统一观点.治疗方法一般分为闭合性治疗和开放性复位.由于儿童髁突骨折的特点,其治疗结果会影响下颌骨和颌面部的发育.此外,治疗导致的并发症如颞下颌关节紊乱或强直等也是目前争论的焦点.本文通过回顾与结合相关文献,就儿童的定义、儿童髁突骨折的特点、分类及治疗进展等相关内容作一综述,以期对临床实践提供参考和帮助.     

The retromandibular transparotid approach for reduction and rigid internal fixation using two locking miniplates in mandibular condylar neck fractures

We evaluated the safety, efficacy, and morbidity associated with the treatment of displaced mandibular condylar neck fractures using a retromandibular transparotid approach to reduce and rigidly fix using two 2.0-mm locking miniplates. Our surgical inclusion criteria were: patient selection of open reduction and fixation, displaced unilateral condylar fractures with derangement of occlusion, and bilateral condylar fractures with an anterior open bite. The study group consisted of 19 patients who underwent surgery for 19 mandibular condylar neck fractures; patients were analyzed prospectively, with more than 6 months of follow-up, and were evaluated in terms of functional results, scar formation, postoperative complications, and stability of fixation. The results showed that functional occlusion identical to the preoperative condition and correct anatomical reduction of the condylar segments in centric occlusion, followed by immediate functional recovery, was achieved in all patients. No patient suffered from any major or permanent complication postoperatively, although there were two cases (11%) of temporary facial nerve palsy, which resolved completely within 3 months. Surgical scars were barely visible. The retromandibular transparotid approach with open reduction and rigid internal fixation for displaced condylar neck fractures of the mandible is a feasible and safe, minimally invasive surgical technique that provides reliable clinical results.     

髁状突颈部骨折手术疗法和保守疗法近期疗效评价

目的 总结髁状突颈部骨折的临床特点,探讨其治疗方法的选择。方法 对25年来72例髁状突颈部骨折患者临床资料进行分析。并对手术疗法和保守疗法的疗效进行比较。结果 手术疗法16例,开口度改善100%,咬合关系改善93.8%;保守疗法48例,开口度改善76.9%,咬合关系改善94.8%。结论 手术疗法适用于骨折段移位显著伴严重功能障碍的陈旧性骨折患者,配合术后开口训练可获得理想效果。保守疗法适用于骨折段移位不明显和儿童髁状突颈部骨折,可有效纠正1个月内骨折患者各种类型的咬合紊乱。     

不同形状小型钛板在髁突骨折固定中的效果评价

目的评估3种不同形状小型钛板固定髁状突颈骨折的临床效果。方法回顾分析采用1块小型钛板治疗22例29侧髁状突颈骨折患者,其中用I形钛板固定10侧,L形钛板固定8侧,X形钛板固定11侧。结果在应用I板或L形板固定的病例中,2侧出现螺钉松动,5侧出现骨折段移位。而在应用X形板固定的病例中,未出现螺钉松动和骨折段的移位。结论应用1块X形钛板行髁状突颈骨折内固定,不仅具有双板的固定效果,而且有创伤相对较小,手术时间相对减少,节省费用等优点。     

颌间牵引钉在髁突高位骨折中应用的护理配合

目的:总结颌间牵引钉治疗髁突高位骨折的护理方法。方法 :对应用颌间牵引钉行颌间牵引治疗的髁突高位骨折21例患者,进行护理要点总结。结果:21例患者外形和功能均恢复良好,骨质愈合好,效果满意。结论:颌间牵引钉治疗髁突高位骨折为一种安全有效、简便易行的治疗手段,精心的护理是保证手术成功的关键之一。     

Static bone cavity in the condylar neck and mandibular notch of the mandible

This study presents the radiographic findings of two cases of static bone cavity in the inferior aspect of the condylar neck and mandibular notch of the mandible. On plain CT, a soft tissue mass was observed in each cavity. The submandibular gland and the other glands were not found in each cavity. On contrast-enhanced CT, the soft tissue in the cavity in the inferior aspect of the condylar neck had marked linear enhancement and dilated vasculature structure was observed in the cavity. On the contrast-enhanced MRI, the soft tissue in the cavity of the mandibular notch had marked enhancement and flow void was detected in the cavity. In the inferior aspect of the condylar neck, the cavity size had enlarged radiographically over a period of three years. Vascular lesions were found in the cavity located in the inferior aspect of the condylar neck and mandibular notch of the mandible by both CT and MRI. The vascular lesion might explain the enlargement of the static bone cavity.     

青少年髁突骨折诊治的回顾性分析

目的:探讨青少年髁突骨折的临床特点及治疗方法。方法:对1990-2002年间收治的52例(75侧)青少年(2～18岁)髁突骨折病例的临床和随访资料进行回顾性分析。结果:青少年髁突骨折主要由着力于颏部的间接创伤引起,多为颈部的中高位骨折,大部分骨折断端移位较轻,骨块均是向前下内方向移位。保守治疗和手术治疗都取得了较好效果。主要的后遗症是下颌骨发育不良、开口偏斜和轻度张口受限。结论:着力于颏部的外伤要仔细检查有无髁突骨折。治疗上应尽可能采用保守治疗;对于严重移位而难以复位的、粉碎性的髁突骨折,以及不能进行保守治疗的病例,主张手术复位固定。     

下颌骨不同部位骨折患者上气道间隙及舌骨位置变化的X线头影测量分析

目的:通过对颌面部创伤导致下颌骨骨折患者的头颅侧位片进行测量分析,探讨不同部位骨折患者上气道间隙及舌骨位置的变化情况,为治疗方案的选择提供参考。方法:210名研究对象均拍摄标准X线头颅定位侧位片,将髁突骨折组、下颌角骨折组、下颌体骨折组、颏/颏旁骨折组分别与正常组做比较,分析4种下颌骨骨折上气道间隙及舌骨位置的变化情况。结果:与正常组比较,不同部位骨折对上气道间隙的影响不同,尤其是双侧下颌体骨折和颏/颏旁粉碎性骨折对下口咽气道间隙、喉咽气道间隙影响显著,影响患者通气功能,重者易发生通气障碍。结论:下颌骨不同部位骨折与患者的上气道结构及舌骨位置的变化密切相关,双侧下颌体骨折和颏/颏旁粉碎性骨折对下口咽气道间隙影响显著。