下颌髁状突骨折移位的分类——附56例病例分析

目的　用放射学分析进行下颌髁状突骨折的分类 ,并确定髁状突骨折移位与治疗方法选择之间的关系。方法　共诊治 5 6例 72侧髁状突骨折 ,患者在下颌骨髁状突骨折平均 9天后进行检查。常规 X线检查包括曲面体层和后前位片。另外 ,2 0例 2 8侧髁状突骨折患者还进行了矢状及冠状位的 CT检查。根据 X光片发现 ,将髁状突骨折移位进行分类。只有髁状突完全脱出于关节窝外的骨折才进行手术治疗。结果　根据 X线片结果 ,72侧髁状突骨折中 ,6例 ( 11% )无移位 ,10例 ( 18% )斜形骨折 ,6例 ( 11% )移位 ,6例 ( 11% )前脱位 ,3例 ( 5 % )后脱位 ,8例( 14 % )外侧脱位 ,14例 ( 2 5 % )内侧脱位 ,3例 ( 5 % )水平脱位 ( P<0 .0 0 1)。 16例行颌间结扎。大多数患者 ( 71% )有开放复位的指征。 40例 ( 71% )患者进行了术后平均 2年的随访。在进行闭合性复位治疗的患者中 ,并发症如错、下颌不对称、咀嚼功能减退 ,关节与咀嚼肌区的疼痛明显多于手术治疗的病人。结论　骨折髁状突的脱位术前可用曲面体层与后前位 X光片进行诊断 ,而且应行手术治疗

DIFFERENT PATTERNS OF DISPLACEMENT OF CONDYLAR FRACTURES: AN ANALYSIS OF 56 PATIENTS

Purpose The subject of this study is that radiologic analyses was used to classify condylar fractures and to determine correlations between displacement of condylar fractures and choice of treatment methods.Methods Fifty six patients with 72 condylar fractures were given diagnoses and treated in our department between 1988 and 1995. A total of 56 patients with 72 fractures of the mandibular condylar process were examined an average 9 days after the injury. The conventional radiologic examination consisted of panoramic radiograph and posteroanterior radiograph(Townes projection). Twenty patients with 28 fractured condylar process were examinated additionally by Computed Tomography (CT) in the sagittal and coronal projection. According to radiologic findings, displacement of fractured condylar process was classified. Only fractures with total dislocation of condylar out of the articulate fossa were surgically treated.Results According to radiologic findings, fifty six patients with 72 fractures of condylar processes, 6(11%) of them were nondisplaced, 10(18%) deviation at the fracture line, 6(11%) displacement, 6(11%) anterior dislocation, 3(5.0%) posterior dislocation, 8(14%) external dislocation, 14(25%) internal dislocation and 3(5.0%) horizontal dislocation ( P <0.001). MMF was performed in sixteen patients(29%).(class I and class II). A relatively large number of patients(71%) were considered to have an indication for open reductin of the fractures. Fourty patients(71%) were seen at a median of 2 years postoporatively. Complications such as malocclusion, mandibular asymmetry, impaired masticatory function, and pain located to the affected joint or masticatory muscles were seen significantly more frequent in patients treated with closed reduction compared with these treated surgically( P =0.005).Conclusion Displacement of fractured condylar process can often be diagnosed preoperatively by means of panoramic radiograph and posteroanterior position and these cases should be treated surgically.