全面部骨折开放复位固定的手术入路

目的探讨全面部骨折开放复位内固定的各种手术入路方法。方法对37例全面部骨折根据骨折部位、类型、损伤程度设计口内或口外手术入路,切开复位坚强内固定治疗。结果 37例中6例采用头皮冠状切口+口内上下颌前庭沟切口;5例采用眶周切口+口内上颌前庭沟切口+下颌下、颌后切口;26例采用口内上下颌前庭沟切口+口外局部切口,线型骨折处辅助内镜、90°侧壁螺丝刀复位固定。术后随访3个月至2年,骨折复位愈合良好,咬合关系、张口度及面形恢复较好。结论全面部骨折开放复位固定的手术入路,应在影像学诊断、特别是CT三维重建指导下,明确骨折位置、形态、移位情况,遵循显露好、操作方便、复位固定可靠、切口隐蔽、注重美观的手术原则,综合设计具体选用。

Surgical approaches in open reduction and fixation for panfacial fracture

Objective To discuss various surgical approaches in open reduction and fixation for panfacial fracture.Methods Design different intraoral or extraoral surgical approaches for 37 cases of panfacial fracture based on the location,type and degree of injury of fracture,and carry open reduction and internal fixation.Results scalp coronal incision + intraoral maxillomandibular vestibular groove incision for 6 cases,periorbital incision + intraoral maxillary vestibular groove incision + submandibular and retromandibular incision for 5 cases,intraoral maxillomandibular vestibular groove incision + extraoral partial incision for 26 cases.Auxiliary endoscope and 90° angular screwdriver were used for the reduction and fixation of lineal fracture.Follow-up reviews are made for a period of 3 to 24 months after the surgery,and reduction and union of fracture was good.In addition,occlusal relationship,mouth-opening degree and facial recovery obtain better effects.Conclusion Physicians shall design and apply the suitable surgical approaches in open reduction and fixation for panfacial fracture based on the location,shape and displacement of fracture through iconography diagnosis,especially CT 3D reconstruction.It shall be assured that the operation will be conducted easily through a hidden cutting,obtaining reliable reduction and fixation result.Appearance is also an important point.