口内切口与牵引钉暂时颌间刚性牵引固定治疗下颌骨骨折45例分析

目的:评价术中利用颌间牵引螺丝暂时牵引,经口内切口进行整复并坚强内固定治疗45例下颌骨骨折的效果。方法:对45例54处下颌体及下颌角区线性骨折,先分别在上、下颌中切牙之间、尖牙与第一前磨牙之间、第一与第二磨牙之间的根向植入颌间牵引螺丝,骨折复位后,进行颌间结扎固定,恢复咬合关系及下颌骨的弓型。自下颌前庭沟、翼下颌皱襞切开黏骨膜,显露骨折处并复位后,在张力线上用小型钛板进行坚强内固定术。术毕拆除颌间结扎,7d后将颌间牵引螺丝拆除。分别于术后第1天和第90天进行临床和X线检查,评价其咬合关系、骨折复位及愈合情况。结果:45例54处下颌骨骨折均获得良好的复位和骨性愈合,咬合关系良好,无明显并发症。结论:经口内途径行小型钛板坚强内固定术,结合颌间牵引螺丝暂时刚性牵引结扎,对下颌体及下颌角骨折的整复固定和功能恢复效果良好。

Transoral miniplate fixation of mandibular body fracture without maxillomandibular fixation: Report of 45 cases

PURPOSE: To assess the efficacy of intraoral open reduction of mandibular body fracture using titanium miniplate rigid fixation and intermaxillary traction titanium screw to rigidly tract the jaw during the operation. METHODS: 54 mandibular fractures in 45 patients were included in this study. After general anaesthesia, the intermaxillary traction titanium screw was inserted in the alveolar bone, between the two incisors, between the canine and the first premolar, between the first molar and the second molar, and the intermaxillary traction was finished with 0.5 mm stainless steel wire. After the mandibular arch and occlusion relationship were returned to preoperative condition, transoral mucoperiosteal incision was made to expose the fracture lines and fragments. Two 2.0 mm titanium miniplates were adapted along the Champy's line of ideal osteosynthesis and secured. After operation the stainless steel wire was released. Panoramic radiograph and clinical examination were applied at the first day and three months after operation to exhibit bone union and occlusion. RESULTS: Most patients displayed satisfied occlusion and bone union without major complications. Seventeen patients had numbness of the lower lips after operation, and the symptom was disappeared three months later. Two patients had improvement of numbness of the lower lips. CONCLUSION: Intraoral open reduction of mandibular body fracture using titanium miniplate rigid fixation and intermaxillary traction titanium screw showed high efficiency in fixation of the mandibular arch fractures , which occurred in the body and the angle of the mandible.