可吸收钉板在下颌骨髁突骨折中的应用

目的回顾性分析可吸收钉板在下颌骨髁突骨折中的应用,探讨其在髁突骨折治疗中的适应证、操作难点及注意事项。方法 2012年7月至2018年6月,武汉大学口腔医院口腔颌面创伤与颞下颌关节外科应用可吸收钉板固定下颌骨髁突骨折患者82例(共106侧),其中髁突高位矢状骨折46侧,中位髁颈骨折26侧,低位髁颈下骨折34侧。髁头及髁颈骨折复位术均经耳屏前径路;髁颈下骨折复位术中,多数经耳屏前径路及颌下径路。髁突高位矢状骨折复位后以1~2枚可吸收长螺钉固定,髁颈及髁颈下骨折以2块可吸收板固定。术后随访6个月至3年。结果所有患者术后未诉明显不适,面型基本对称,面部肌肉运动正常,咬合对位良好,开口度恢复,未见明显排斥反应及严重并发症。结论可吸收钉板可应用于髁突高位矢状骨折、中位髁颈骨折、低位髁颈下骨折的开放复位内固定。应用可吸收钉板固定髁突骨较钛板钛钉复杂,需熟练掌握合适的操作技巧及注意事项。

Application of resorbable plates and screws in mandibular condylar fractures

Objective　To retrospectively analyze clinical application of resorbable screws and plates in mandibular fractures，and to explore indications，operation techniques，and consideration of resorbable screws and plates during the treatment of mandibular fractures. Methods　From July 2012 to June 2018，1498 cases of various types of maxillofacial fractures were treated in our department，and 271 cases of mandibular fractures were treated with resorbable screws and plates. Among them，35 cases had mid-facial fractures，160 cases had condylar fractures，3 cases had coronoid fractures and 94 cases were simple mandibular fracture. Of 94 cases，there were 53 symphysis fractures，31 body fractures，40 angle fractures，and 6 ramus fractures；there were 58 cases of single fracture and 36 cases of double fracture；there were 88 cases of simple linear fracture and 6 cases of comminuted fracture. All cases were fresh fractures without bone defects. For each fracture，adults were fixed with 2 resorbable plates，and children were fixed with one resorbable plate，all of which were supplemented with dental arch splints or wires to fix the loosen teeth. The patients were followed up for 6 months to 3 years. Results　All patients had a recovery of postoperative occlusion and a good fracture healing. Slightly displacement was found in 2 cases of angle fractures and 3 cases of symphysis fractures；wound infection was found in 1 case of angle fracture，1 case of body fracture and 1 case of symphysis fracture. Conclusion　The selection of resorbable screws and plates for mandibular fractures requires strict indications and enhanced operating specification. Simple or slightly comminuted mandibular fractures can be fixed with resorbable screws and plates，supplemented with arch bars or wires；intermaxillary traction should be done after surgery，and early weight bearing should be avoided after surgery.