颌下切口下颌升支垂直截骨在髁突高位骨折手术中的应用

目的:探讨应用颌下切口下颌升支垂直截骨术治疗髁突高位骨折的效果。方法:对16例(19侧)下颌骨髁突高位骨折患者采用颌下切口下颌骨升支后缘垂直截骨取出升支后缘骨块将骨折的髁突游离后取出,体外直视下将骨折片与升支后缘骨块复位固定后再回植,行颞下颌关节重建。结果:于术后6、12、24个月复查全部患者的开口度为30～48 mm,平均34.92 mm。所有患者咬合关系良好,无关节疼痛症状。部分病人有轻度开口偏斜,均<3 mm,有1例患者有关节弹响。结论:颌下切口下颌升支垂直截骨是治疗髁突高位骨折的一种可选择方法,具有操作简便、复位准确、近期疗效满意等优点。

A Submandibular Approach in Treatment of High Condylar Process Fractures Using Vertical Ramus Osteotomy

Objective：To evaluate the effects of vertical ramus osteotomy（VRO） in the fixation and reduction of high condylar fractures.Methods：Sixteen patients（19 fractures） were underwent open reduction and internal fixation through the submandibular approach,vertical osteotomy of mandibular ramus was performed.The fractured condylar head was reducted with titanium miniplate in vitro and reimplanted to the glenoid fossa.Results：Anatomic reduction was achieved in all patients.The range of mouth opening was 30～48 mm（mean 34.92 mm mm）,No TMJ pain or dysfunction were found during the period of follow- up.Ideal occlusion was achieved in all patients.Some cases showed slight mandibular deviation,usually in the sixth postoperative month.TMJ click was observed in 1 patient.Conclusion：Vertical ramus osteotomy（VRO） for high condylar fractures has its own advantages and disadvantages.The appropriate one should be selected according to the special situation of patients.