翼外肌-髁突解剖复位内固定治疗髁突骨折的探讨

目的:探讨髁突骨折进行解剖复位和小型钛板坚强内固定的手术适应证、方法和治疗效果。方法:以髁头脱位骨折、髁颈和髁颈下骨折移位角度大于30°～45°、下颌支垂直高度降低超过4～5mm为适应证,对收治的23例28侧髁突骨折患者采用改良耳颞部"拐杖"型切口或颌后进路,行翼外肌-髁突解剖复位及张力带小型钛板坚强内固定。术后3～6个月复诊,检查面型、开口度、开口型、咬合关系、咀嚼力,并以此进行疗效评价。结果:所有患者面型对称,开口度较术前明显增大,开口型显著改变。2例术后错牙合患者经1周颌间牵引,恢复正常。影象学检查示髁突无移位,骨折无错位。钛板无移位,髁突表面无明显吸收现象。患者咀嚼有力。2例面瘫患者经治疗后3个月恢复。结论:选择合适病例,进行翼外肌-髁突开放性解剖复位固定,是一种既能恢复解剖形态又能恢复咀嚼功能的有效方法。

Treatment of condylar fracture by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation with mini titanium plates

PURPOSE: To investigate the surgical indications, procedures and treatment outcomes of condylar fracture by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation with mini titanium plates. METHODS: Patients with dislocation of the condylar head, fracture of the condylar neck and subcondylar neck (the degree of displacement greater than 30 to 45) and decreased vertical height of the ramus (greater than 4 to 5mm) were included in the study. Modified aural-temporal stick-shaped incision or retromandibular approach was adopted in 23 cases with 28 condylar fractures. The fractures were treated by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation with mini tension band titanium plates. All the patients were re-examined and evaluated 3 to 6 months after surgery in respects of facial symmetry, mouth opening, types of mouth opening, occlusion and mastication. RESULTS: All the patients had symmetrical face, mouth opening increased from 26.7+/-7.2 (before surgery) to 38.4+/-5.6 (3 months after surgery) and 37.2+/-4.5 mm(6 months after surgery). 2 patients with postoperative malocclusion had intermaxillary distraction for 1 week and their occlusion returned to normal. Radiographic check-up showed the condyle and titanium plates without displacement. No absorption was noted on the condylar surface. The patients had normal mastication. 2 patients with temporal facial paralysis recovered 3 months after conservative therapy. CONCLUSION: Treatment of condylar fracture by external pterygoid muscle-condyle anatomical reduction and internal rigid fixation with mini titanium plates in selected patients is an effective procedure for recovery of anatomical positions and masticatory function. Supported by Research Fund from Science and Technology Bureau of Jining city.