不同类型下颌骨髁状突骨折的外科手术治疗探讨

›› 2015, Vol. 35 ›› Issue (3): 187-191.

不同类型下颌骨髁状突骨折的外科手术治疗探讨

郭松松¹,杜一飞²,戈杰¹,程杰³,杨蓉²,李明³,叶金海⁴,江宏兵³

1. 南京医科大学
2. 江苏省口腔医院
3. 南京医科大学附属口腔医院
4. 南京医科大学附属口腔医院口腔颌面外科

收稿日期:2014-10-17 修回日期:2014-11-27 出版日期:2015-03-28 发布日期:2015-03-30
通讯作者: 江宏兵 E-mail:jhbcd@sina.com
基金资助:
江苏省高校优势学科

Evaluation of surgical treatment for different types of mandibular condyle fracture

Received:2014-10-17 Revised:2014-11-27 Online:2015-03-28 Published:2015-03-30

摘要/Abstract

摘要： 目的　分析不同类型下颌骨髁状突骨折的手术入路、复位固定方法、疗效及并发症，为外科手术治疗髁状突骨折提供参考。方法　收集近3年完成的下颌骨髁状突骨折切开复位内固定患者的临床资料及随访资料，根据不同骨折类型分别选择耳屏前/内、耳下颌后或口内切口入路，高位骨折采用长螺钉固定，中位和低位骨折选择小型钛板固定，对骨折类型，手术入路，复位固定方式，术后愈合、开口功能恢复及相关并发症进行相关分析。结果　①46例共57侧髁状突骨折手术后均未出现钛板/螺钉松动及frey’s综合征；面神经受损征7例，均为高位和中位骨折治疗组的面神经颞支暂时性损伤，低位骨折组面神经损伤概率低于高位及中位骨折组（P<0.05）。②各治疗组术前术后的张口度均得到显著改善（P<0.05），平均张口度3.5cm以上。③高位骨折术后张口偏斜有11例，占23.91%；中位骨折术后张口偏斜4例，占8.70%，低位骨折5例，占10.87%，患者张口偏斜均在0.5cm以内。结论　髁状突骨折应根据不同类型选择手术入路、复位固定方式；外科解剖学复位可实现早期张口功能训练及良好的咬合关系，患者总体满意度高；髁状突高位骨折复位时应尽量避免剥离翼外肌附着，注意关节结构保存；耳前切口入路过度牵拉暴露易致面神经颞支损伤。

关键词: 下颌骨髁状突骨折, 坚强内固定, 面神经损伤, 张口度, 咬合关系

Abstract: Objective　To analyze the method of ORIF for different types of mandibular condyle fracture. Methods　From January 2011 to March 2014, 46 adult patients with condyle fractures of the mandible were studied. ALL the patients undergone the ORIF of mandibular condyle fractures and were followed up weekly for 3 weeks and then at 2, 3 and 6 months after surgery. The patients accepted CBCT examination 1 week and 3months after operation. Clinical examinations including mouth opening, deviation on mouth opening, occlusion, function of facial nerves, frey syndrome, screw loosing and salivary fistula were conducted. And the satisfaction degree of the patients was checked. Result　No screw loosing salivary fistula and frey syndrome were found in the follow-up patients; facial nerve dysfunction was found in 7 patients (23.91%) all in condyle head and subcondyle fracture group. Facial nerve dysfunction in condyle neck group was significantly lower than the other two groups（p<0.05）.Mmouth opening outcome in all groups significantly improved over time after surgery（p<0.05）.Of the 46 condyle fractures that were associated with deviation on mouth opening were those of condyle head fracture 11 (23.91%), followed by subcondyle fracture 5 (10.87%) and condyle neck fracture 4 (8.70%). 37 of 46 patients expressed high satisfaction degree for the treatment. Conclusion　Appropriate incisions, fixation methods and operations should be chosen for different types of mandibular condyle fractures. For condyle head fracture, it will be better to be fixed with titanium screws and the lateral pterygiod muscle should be remain attached to the fractured medial segment. The patients got good mouth opening and occlusion and gave high satisfy degree for the treatment..

Key words: Mandibular condyle fracture, Facial nerve injury, Deviation on mouth opening

中图分类号:

R782.4

郭松松杜一飞戈杰程杰杨蓉李明叶金海江宏兵. 不同类型下颌骨髁状突骨折的外科手术治疗探讨[J]. 口腔医学, 2015, 35(3): 187-191.

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