聚左旋乳酸可吸收接骨板在下颌骨骨折内固定术中的应用价值

目的评价聚左旋乳酸(PLLA)可吸收接骨板应用于下颌骨骨折内固定术的临床价值。方法回顾性分析2017年1月—2018年11月陆军军医大学大坪医院口腔颌面头颈外科收治下颌骨骨折患者54例,男性31例,女性23例;年龄15~65岁,平均41.4岁。根据所选固定材料不同分为接骨板组(25例)和钛板组(29例),接骨板组采用PLLA可吸收接骨板固定,男性11例,女性14例;年龄15~52岁,平均37.2岁;钛板组采用传统金属钛板固定,男性20例,女性9例;年龄22~65岁,平均45.6岁。观察两组术后1、2~4周伤口恢复、血常规、咬合关系恢复情况及术后3个月的咀嚼效能,同时观察术后1年骨折线消失情况。结果两组患者术后2周伤口均一期愈合,未出现感染现象,复查血象均无异常,大部分患者咬合关系恢复良好,PLLA可吸收接骨板未出现断裂现象。术后4周拆除颌间牵引时,测定两组患者咀嚼效能,接骨板组低于钛板组,差异有统计学意义(P<0.01)。术后3个月两组患者咀嚼效能差异以及术后1年骨折线均消失,差异无统计学意义(P>0.05)。结论PLLA可吸收接骨板应用于下颌骨骨折,固定强度好,可自行降解,无需二次手术取出,并且可免除患者二次手术的痛苦及术区相关神经的风险。但对骨折断端移位过大、复位困难者,可在伤后即给予颌间弹性牵引,并在术后增加牵引时间。

Application of poly-L-lactic acid absorbable bone-setting plate in internal fixation of mandibular fractures

Objective To evaluate the clinical value of poly-L-lactic acid absorbable bone-setting plate in internal fixation of mandibular fracture.Methods From Jan.2017 to Nov.2018,54 patients(31 males and 23 females,aged 15-65 years,with an average of 41.4 years old)with mandibular fracture were admitted to the Department of Oral Maxillofacial Head and Neck Surgery of Daping Hospital.Based on the selected fixation materials,the patients were divided into two groups:25 cases in the PLLA plate group and 29 cases in the titanium plate group.The patients in regular plate group were fixed with PLLA absorbable plate.There were 11 males and 14 females,aged 15-52 years,with an average of 37.2 years old.In the titanium plate group,traditional metal titanium plate was used for fixation,and there were 20 males and 9 females,with an average age of 45.6 years(22-65 years).The recovery of wound,re-examination of hemogram,occlusal relationship were evaluated at 1week,2-4 weeks after operation,and the masticatory efficiency at 3 months after operation and the disappearance of fracture line was observed at 1 year after operation.Results At two weeks after operation,the wounds of the two groups achieved primary healing.No infection occurred,and no abnormal hemogram was found.The occlusal relationship of most patients recovered well,and the absorbable PLLA plate did not break.The masticatory efficiency of PLLA plate group was lower than that of titanium plate group after removal of intermaxillary traction at 4 weeks after operation(P<0.01).There was no significant difference in masticatory efficiency between the two groups after 3 months,and the fracture line disappeared at 1 year after operation,without statistical significance(P>0.05).Conclusion PLLA absorbable bone-setting plate can be used in mandibular fracture with good fixation strength,is self-degradable,does not need for second operation,and can avoid the pain of patients and the risk of nerves damage in the operation area.However,for patients with large displacement of the fractured end and difficulty in reduction,it is better to give intermaxillary traction immediately after injury,and the intermaxillary traction time can be increased after operation.