颌面部骨折治疗失败原因分析及二期治疗探讨

发布时间：2018-03-30 17:42

本文选题：颌骨骨折　切入点：治疗失败　出处：《新疆医科大学》2016年硕士论文

【摘要】：目的:分析颌骨骨折治疗失败的原因,探讨术后并发症的特点及二期治疗原则和方法。方法:收集2010年1月?2015年6月我院收治的在外院一期治疗失败的颌骨骨折51例,分析一期治疗失败原因。39例拆除原固定钛板,其中21例重新行钛板坚固内固定,12例陈旧性错位愈合骨折以正颌外科的原理和方法行矫正治疗。术后颌间牵引2周,配合正畸、调合治疗,嘱患者行张口锻炼。结果:本组一期治疗后发生术后感染20例,咬合关系紊乱14例,开口受限11例,颜面畸形6例,伴神经损伤7例。分析治疗失败的主要原因:(1)首诊医师非颌面外科医师,术前评估不足,手术操作不当,复位不准确。(2)固定材料、方法及位置选择不当,不适当的应力集中。(3)忽视术后颌间牵引。(4)患者依从性差。(5)术后感染,护理不当。全组51例患者术后骨断端愈合良好,无严重并发症。47例患者术后咬合关系恢复满意、面形对称、满意。4例咬合关系欠佳,需辅以术后正畸或调合治疗。4例咬合基本满意,但颜面畸形有待进一步整形矫治。术后随访49例,5例患者术后3个月中度张口度。结论:临床应掌握颌面部骨折的治疗原则及正确方法,选择内固定材料、方法及部位要得当,不可过分依赖内固定而忽视必要的颌间牵引。拆除原固定钛板或重新行坚固内固定可解决颌骨骨折术后相关并发症,正颌外科手术在陈旧性错位愈合骨折矫治中效果肯定,复杂的上下颌多发骨折所致并发症,需多次手术方可达到满意效果。
[Abstract]:Objective: to analyze the causes of failure in the treatment of jaw fracture and to explore the characteristics of postoperative complications and the principles and methods of secondary treatment.Methods: a total of 51 cases of maxillary fracture treated in our hospital from January 2010 to June 2015 were collected, and the causes of failure in one stage treatment were analyzed. 39 cases were removed from the original fixed titanium plate.Among them, 21 cases were retreated with titanium plate rigid internal fixation and 12 cases of old malposition union fracture were treated with orthognathic surgery principle and method.Postoperative intermaxillary traction 2 weeks, combined with orthodontics, combined with treatment, told patients to open mouth exercise.Results: there were 20 cases of postoperative infection, 14 cases of occlusal disorder, 11 cases of limited opening, 6 cases of facial malformation and 7 cases of nerve injury.Analysis of the main causes of failure in treatment: (1) Non-maxillofacial surgeon, the first physician, the preoperative evaluation was insufficient, the operation was improper, the reduction was not accurate, and the fixation materials, methods and location were not properly selected.Improper stress concentration. 3) neglect of postoperative intermaxillary traction. 4) poor compliance. 5) postoperative infection, improper nursing.51 patients in the whole group healed well after operation. There were no serious complications. The occlusal relationship was satisfactory in 47 patients, the facial shape was symmetrical, and the occlusal relationship was unsatisfactory in .4 patients. The occlusal relationship was basically satisfactory in 4 patients who needed to be treated with orthodontic or adjuvant treatment after operation.But facial deformity needs further plastic treatment.49 patients were followed up for 3 months.Conclusion: we should master the treatment principle and correct method of maxillofacial fracture, select the internal fixation material, the method and position should be appropriate, and we should not rely too much on internal fixation and ignore the necessary intermaxillary traction.Removal of the original titanium plate or re-rigid internal fixation can solve the postoperative complications of maxillary fractures. Orthognathic surgery is effective in the correction of old dislocation healing fractures, and complications caused by complex multiple fractures of the upper and lower jaw.Multiple operations are needed to achieve satisfactory results.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R782.4

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