下颌升支垂直截骨内固定术治疗髁突高位骨折

目的:比较手术和非手术方法治疗单侧下颌骨髁突高位骨折的临床效果。方法:19例髁突高位骨折患者,其中10例行下颌升支截骨内固定术+颌间牵引术(手术组),其余9例单纯行颌间牵引术(非手术组),随访0.5～1年。结果:手术组和非手术组之间比较,开口度及前伸运动度均无显著性差异(P>0.05);侧方运动度手术组优于非手术组,有显著性差异(P<0.01)。非手术治疗的患者,下颌骨平面不对称,X线片显示髁突的解剖位置欠佳。手术患者,下颌下区存在线形疤痕,但下颌骨平面对称,X线片显示患侧髁突与健侧形态相似。19例中无1例出现明显的颞下颌关节紊乱综合征。结论:采用下颌升支垂直截骨内固定术+颌间牵引术治疗下颌骨髁突高位复杂骨折,兼顾美观和功能,手术简便,不失为一种理想的治疗方法。

Vertical Mandible Ramus Osteotomy for the Treatment of Subcondylar Fractures

Objective： To observe and compare the clinical effect of surgical and non-surgical method of treatment for unilateral mandibular subcondylar fractures. Methods： Ten of 19 cases of subcondylar fractures were performed by mandibular ramus osteotomy with internal fixation and iutermaxillary traction, other 9 cases were treated by intermaxillary traction only. All cases were followed-up for 0.5-1 year. Results： No significant difference was observed between surgical and non-surgical group compared with opening movement and the protrusion movements （P〉0.05）, while the lateral movements of the surgical group was better than non-surgical group （P〈0.01）. In the non-surgical treatment group with the mandibular asymmetry, X-ray photographs showed that the anatomical location of mandibular condyle was not in proper position. While in the surgical treatment group with the mandibular symmetry, the ipsilateral and eontralateral condylar and temporomandibular joint morphological were similar in X-ray, despite of the existence of sears in submandibular area. No temporomandibular joint disorder syndrome occured. Conclusion： The vertical ramus osteotomy with internal fixation provides excellent functional and cosmetic results in cases of the mandibular high condylar fracture, with more advantages than the single intermaxillary traction alone.