应用小切口隧道式入路行髁突颈部骨折复位内固定

›› 2019, Vol. 39 ›› Issue (10): 907-911.

应用小切口隧道式入路行髁突颈部骨折复位内固定

朱亮¹,邢乐君¹,赵睿¹,孟凡皓¹,乔波¹,周正¹,胡随馨¹,田晓光²,贾婷婷¹,郑斌芬¹,张海钟¹,于秋华³

1. 解放军总医院（301医院）
2. 解放军第88医院
3. 青岛市即墨区人民医院消毒供应室

收稿日期:2019-03-01 修回日期:2019-04-26 出版日期:2019-10-28 发布日期:2019-10-28
通讯作者: 张海钟 E-mail:zhang126301@126.com
基金资助:
颅底及面侧深区穿刺诊疗机器人实用系统开发及示范应用;基于单兵综合系统战现场救治关键技术研究级新器材研发

A new treatment for condylar neck fracture with small incision reduction and internal fixation

Received:2019-03-01 Revised:2019-04-26 Online:2019-10-28 Published:2019-10-28

摘要/Abstract

摘要： 目的　研究一种利用耳屏内联合颌下小切口入路制备隧道复位固定髁突颈部及基部骨折的方法，并观察其临床疗效。方法　选择2012年1月至2018年1月30例髁突颈部中低位骨折患者，采用耳屏内联合颌下小切口入路，制造隧道式入路进行手术治疗。结果　①30例患者术中恢复正常咬合关系，术后复查无一例出现咬合紊乱；②张口度分析采用重复测量设计资料的方差分析进行检验（P<0.05），术前及术后1~12个月复查，患者平均张口度分别为（5.43±2.012）mm，（14.83±2.135）mm，（19.67±2.123）mm，（32.20±2.14）mm，（32.23±1.633）mm，（32.4±1.653）mm，患者术后张口度逐渐改善；③术后1、3、6、12个月复查CT显示骨折断端对位愈合，钛钉钛板无松动、变形、移位；④瘢痕位于耳内及颌下，位置隐蔽。⑤1例患者术后出现口角轻度歪斜症状，予以神经营养治疗，术后6个月复查症状消失。结论　耳屏内联合颌下小切口隧道式入路治疗髁突颈部及基部骨折，显露充分，复位精确，实现早期张口功能训练及咬合关系恢复的同时，可做到瘢痕隐蔽，有效保护了面神经、颞浅动静脉、翼外肌等重要解剖结构，为临床髁突颈部及基部骨折手术入路的选择提供新的参考。

关键词: 下颌骨髁突骨折, 坚强内固定, 耳屏内联合颌下小切口

Abstract: Objective　 To study a method of making tunnel reduction and fixation of condylar neck and base fractures by using intraocular lens combined with small incision approach, and to observe its clinical effect. Methods　From January 2012 to January 2018, 30 cases of middle and low condylar neck fracture were selected for surgical treatment by using the ototragus combined with the submandibular small incision approach to create a tunnel. Results　1) Normal occlusal relationship was restored in 30 patients during the operation, and no occlusal disorder was found in postoperative review. 2) The anova of repeated measurement design data was used for the gap-mouth degree analysis, and the difference in gap-mouth degree was statistically significant (P<0.05) The reexamination was carried out before the operation and 1 to 12 months after the operation. The average interincisor distances were respectively (5.43averag) mm，(14.83verage) mm，(19.67verage) mm，(32.20verag) mm，(32.23verage) mm，and (32.4(verag) mm. The gap-mouth degree of the patients recovered gradually after surgery. 3) CT reexamination 1, 3, 6 and 12 months after surgery showed that the fracture healed in contrapuntal position, and there was no loosening, deformation or displacement of the titanium plate. 4) The scar was located in the ear and under the jaw, and the position was concealed. 5) One patient presented mild angulation after surgery, and was treated with neurotropic therapy. The symptoms disappeared 6 months after the surgery. Conclusion　 Intraocular lens combined with submandibular small incision approach for the treatment of condylar neck and base fractures has adequate exposure, accurate reduction, which achieves the goal of scar concealment, early mouth function training and recovery of occlusion, and effective protection for important anatomical structures like facial nerves, superficial temporal vessels and lateral pterygoid muscles. It provides a new reference for the choice of operative route of condylar neck and base fractures.

Key words: condyle fracture, Rigid internal fixation, minimally invasive

中图分类号:

R782.4

朱亮邢乐君赵睿孟凡皓乔波周正胡随馨田晓光贾婷婷郑斌芬张海钟于秋华. 应用小切口隧道式入路行髁突颈部骨折复位内固定[J]. , 2019, 39(10): 907-911.

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