髁突骨折解剖复位及小型接骨板坚强内固定

目的 探讨髁突骨折解剖复位和小型接骨板坚强内固定的技术要点和并发症的发生因素。方法 髁突骨折72例97侧（单侧47例，双侧25例）。陈旧性骨折12例，髁颈和髁颈下骨折81例，移位和脱位骨折90例。8侧未手术，7侧髁突摘除，6侧升支垂直截骨间接复位，76侧直接复位。59侧单板固定，21侧双板固定，2侧螺钉穿接固定，有22侧髁突呈游离再植，68例经颌后入路，21侧经耳屏前入路。术后1～3个月复查9例，3～6个月36例，6个月以上27例，复查内容包括骨折复位准确性、固定稳定性、骨折愈合改建，伤口愈合、面型、he关系、下颌运动、关节症状、神经损伤。结果 感染2侧，错he2例，假关节2侧，接骨板断裂3侧，接骨板变形2侧，骨折块再移位7侧，髁突吸收6侧，张口受限7例，关节疼痛5侧，关节杂音5侧，面神经损伤9例。并发症发生率33%（24/72例），排除医源性因素后的并发症率14%（10/72例）。结论 切开复位及小型接骨板坚强内固定是治疗髁颈和髁颈下移位及脱位骨折的效方法，升支垂直截骨髁突游离再植是治疗髁突陈旧性骨折的可选择方法。低位髁颈和髁颈下骨折应采用颌后入路，接骨板应沿后外缘作张力带固定，髁颈下严重移位和陈旧性骨折需在髁颈前或乙状切迹处增加补偿固定。

Treatment of condylar fractures by anatomic reduction and rigid fixation with mini-plates

Objective To evaluate open reduction and miniplate rigid fixation for condylar fractures Methods Ninty seven condylar fractures (unilateral 47, bilateral 25) in 72 consecutive patients were studied In them, 12 were old fractures, 81 were condylar neck and subcondylar fractures, 90 displaced or dislocated Eighty nine fractures were treated by operation, including removal of 7 broken condyles, reduction for 6 condyles with the aid of ramus osteotomy and directe anatomical reduction for 76 condyles Fifty nine fractures were fixed with a single miniplate, 21 with a double miniplates and 2 only with screws Sixty eight fractures were approached by retromandibular incision and 21 by periarticular incision Postoperative follow up period was 1 to 3 months in 9 cases, 3 to 6 months in 36 cases and 27 cases over 6 months, all cases were radiologically and clinically examinated to confirm the post operative position of reduced fragment and complications secondary to operation Results There were 2 wound infection, 2 malocclusion, 2 nonunion, 3 plate fracture, 2 plate deformity, 7 inaccurate reduction, 6 fractured bone absorption, 7 mouth open, 5 TMJ chronic pain, 9 facial nerve damages, all above accounted 33% morbidity; however 91% (70/77) severely displaced or dislocated condylar neck and subcondylar fractures got accurate reduction and satisfactory final outcomes Conclusions miniplate rigid fixation based on anatomical reduction is an effective procedure in limitation of treating severely displaced or dislocated condylar neck and subcondylar fractures, biomechanical placement of plate is very important in successful application of this technique