儿童髁突囊内骨折治疗方法选择的影响因素分析

目的:探讨影响儿童下颌骨髁突囊内骨折治疗方法选择的因素,并对手术和保守疗法的临床效果及影像学表现进行对比。方法:对新疆医科大学一附院2008年1月~2013年10月经曲面断层片、冠状CT等确诊为囊内骨折的住院及门诊患者78例103侧进行分类,并对所有患者均行MRI检查确定关节盘的损伤及移位情况。对治疗后的患者行临床及影像学随访1～3年,评价其愈后疗效。结果:影像学检查:手术组髁突完全重建率为78.9%;保守组为72.4%,差异无统计学意义;手术组下颌骨对称率为93.1%;保守组为80.0%,差异无统计学意义;临床检查:手术组并发症少于保守组,差异有统计学意义(P<0.05)。两种治疗方式对于髁突囊内骨折愈后髁突改建及功能恢复均具有较高治愈率。结论:经临床验证,1)下颌支高度有无明显缩短;2)关节盘有无损伤及移位;3)有无明显张口受限及咬合紊乱;4)是否伴翼外肌附着丧失;以上几方面对于儿童髁突囊内骨折治疗方式的选择具有重要影响。

Analysis of Influencing Factors on the Treatment of Intracapsular Condylar Fracture in Children.

Objective: To investigate the influencing factors on the treatment of intracapsular condylar fracture, and compare the clinical and radiographic outcomes between operative and conservative treatments of condylar fractures of mandible in children. Methods: Between January 2008 and October 2013, 78 patients with 104 sides of intracapsular condylar fracture diagnosed by panoramic and CT scan in the first Affiliated Hospital of Xinjiang Medical University were selected. All patients received MRI to check the presence or absence of injury and the position of TMJ disc. Follow up period ranged from 1 to 3 years. The clinical information and data of treatment outcome were collected and analyzed. Results: Radiological examination: The completely rehabilitative rate was 78.9% in the operation group, and 72.4% in the conservative group. No significant difference was found between two methods. The mandibular symmetry rate was 93.1% in the operation group, and 80.0% in the conservative group, no significant difference was found either between two groups. Clinical examination: The complications of operation treatment were significantly less than those of the conservative treatment (P<0.05). Both treatment methods showed high cure rate of condylar remodeling and functional recovery to intracapsular condyle fracture. Conclusion: Based on the present investigation, 1) the presence or absence of obvious shortening of mandibular ramus 2) the presence or absence of injury and displacement of TMJ discs 3) the presence or absence of limited mouth opening and malocclusion 4) the presence or absence of attachment loss to lateral pterygoid have important influences on the treatment choice and plan for the intracapsular condylar fracture.