成人髁突骨折闭合性治疗的疗效评价

目的评价成人髁突骨折闭合性治疗的治疗效果，为髁突骨折选择治疗方法提供依据。方法分析研究48例（55侧）经闭合性治疗的成人髁突骨折患者的病例资料及临床随访资料，包括咬合关系、面部对称性、最大开张口度、开口型、关节功能紊乱症状及影像学资料。随访时间为6个月-5年，平均32个月。其中，囊内骨折9侧，髁颈部骨折21侧，髁颈下骨折19侧，矢状骨折6侧；6侧无移位，29侧轻度移位，20侧严重移位。43例患者颌间固定，5例弹性颅颌绷带固定。结果48例（55侧）患者中，17例患者（35％）张口受限、开张口型偏斜或牙合关系不佳；仅5例患者（10％）需进一步治疗。影像学显示约30％患者髁突改建，其余患者髁突骨折错位愈合，出现髁突畸形、关节面变平或吸收、下颌支高度降低等表现。结论髁突骨折闭合性治疗预后临床效果总体良好，但难以恢复髁突正常形态；对髁突骨折伴脱位、双侧髁突骨折及骨折后下颌支高度降低超过5mm者建议首选手术治疗。

Close treatment of condylar fractures in adults: clinical results

Objective The aim of the study was to investigate the results of close treatment of condylar fractures in a group of 48 patients with 55 condylar fractures,in order to establish a protocol to select patients for surgical treatment or non-surgical treatment of condylar fractures.Methods Retrospective study of 48 patients with a total of 55 condylar fractures was performed,including clinical analysis of occlusion,facial asymmetry,maximum interincisal distance,signs of TMJ-dysfunction and radiographic data.Results There were 17 patients(35%)with a lateral deviation during mouth opening exceeding 2 mm,crepitation,restriction of protrusion and medial movement and occlusal disturbances.43 patients(90%)had none or only minor signs of TMJ-dysfunction not requiring further treatment.Only 5 patients(10%)had an unacceptable malocclusion or considerably limited mouth opening requiring further treatment.A re-modelling process was observed in only one third of the cases.The other cases showed malalignment,flattening of the articular condylar surface,resorption,or shortening of the ramus.Conclusion The overall prognosis of joint function after close treatment of condylar fractures is good except condylar shape.Only in selected patients with considerable displacement of the condylar fragment,bilateral fractures and/or shortening of the ascending ramus of 5 mm or more,surgical reduction and rigid internal fixation should be considered.