颌面创伤致神经损伤的临床研究

发布时间：2018-06-09 15:39

  本文选题：口腔颌面部 + 面神经损伤　； 参考：《郑州大学》2014年硕士论文

【摘要】：背景和目的 创伤是指机械力能量传给人体后所造成机体结构完整性破坏的损伤，它伴随着人类的诞生、劳动、和一切社会活动，纵观古今中外，，人们对创伤的认知与处理水平是一个不断提升的过程。随着社会经济的发展和人们生活模式的改变，和平年代创伤又有了全新的定义，创伤作为“发达社会疾病”不仅威胁着人类的身体健康更重要的是对患者心理造成很大的影响，对人们的生存质量及人口素质都有很严重的影响。河南地处中国中东部交通发达，是我国的人口大省，截止2013年末全省总人口达到9417万。近年来我省经济的高速发展，随着高速交通工具的普及以及道路基础建设的改善，因交通事故导致创伤的患者数量与日俱增。但截至目前，河南地区颌面部创伤的流行病学特点分析的报道却极为少见。本次研究通过对郑州大学第一附属医院口腔医学中心颌面外科收治的颌面部创伤住院患者进行回顾性分析，主要通过数据库对口腔颌面部创伤的致伤原因、合并伤及治疗方法等相关数据进行分析，得出口腔颌面部创伤的流行病学资料，为减少和预防颌面部创伤引起的颌面部骨折提供数据参考。同时通过对相关神经损伤患者的病历资料的分析，探讨颌面神经损伤后功能恢复规律及相关影响因素。 材料与方法 总结分析郑州大学第一附属医院口腔医学中心颌面外科病房2011.7～2014.1期间收治的颌面部创伤住院患者，共搜集到病历资料完整的颌面部损伤患者住院病历479例。用条图、线图和圆图等直观图表以及具体数据来说明统计结果。回顾性分析颌面创伤致颌面神经损伤患者的病历资料，包括损伤部位、损伤方式对颌面部神经功能恢复结果的影响，结果以统计图表的形式进行描述性分析。其中面神经损伤前后功能评定，采用目前国际通用的HB评价(House—Brackmann facial nerve grading)。 结果 479例颌面创伤患者，男女比例3.17：1；交通事故在致伤原因中占据首位（60.33%）；在颌面诸骨中下颌骨是骨折的好发部位（43.62%）；四肢及颅脑（42.08%，30.60%）损伤是颌面部骨折常见合并伤；术中出现神经损伤患者41例，占全部手术患者的10.49%。面神经及颏神经损伤比率最高，各占37.20%；眶下神经损伤患者中10例（38.46%）于术后1周开始恢复。面神经分支损伤患者中12例（57.14%），在术后2周左右恢复正常。颏神经损伤患者中8例（47.06%)。而面神经主干损伤患者1例（33.33%），在术后半年开始恢复。目前手术切开复位坚强内固定术已成为治疗颌面部骨折的首选治疗方式； 结论 颌面部创伤的首要原因为交通事故，颌面骨折以下颌骨最为多见。感觉神经术后恢复较快，运动神经恢复则相对较慢。面神经HB功能Ⅲ级以内的损伤患者预后较好。HB功能≥IV级的患者，预后则较差。
[Abstract]:Background and objective Trauma refers to the damage to the structural integrity of the body caused by the transmission of mechanical force and energy to the human body. It is accompanied by the birth of human beings, labor, and all social activities, throughout history and all over the world. The level of cognition and treatment of trauma is an increasing process. With the development of society and economy and the change of people's life mode, trauma in peacetime has been defined completely. Trauma, as a "disease of developed society", not only threatens the health of human beings, but also has a great influence on patients' psychology. People's quality of life and the quality of the population have a very serious impact. Henan, located in the middle and eastern part of China, is a populous province with a total population of 94.17 million by the end of 2013. In recent years, with the rapid development of economy in our province, with the popularization of high-speed transportation and the improvement of road infrastructure, the number of patients with trauma caused by traffic accidents is increasing day by day. But so far, the epidemiological analysis of maxillofacial trauma in Henan is rare. In this study, we retrospectively analyzed the causes of maxillofacial trauma caused by oral and maxillofacial trauma in the oral and maxillofacial trauma patients in the stomatology Center of the first affiliated Hospital of Zhengzhou University. The epidemiological data of oral and maxillofacial trauma were obtained by analyzing the related data such as combined injury and treatment methods, which provided a data reference for reducing and preventing maxillofacial fracture caused by maxillofacial trauma. At the same time, through the analysis of the medical records of patients with related nerve injuries, To investigate the regularity of functional recovery after maxillofacial nerve injury and the related influencing factors. Materials and methods the patients with maxillofacial trauma admitted from the maxillofacial surgery ward of the Stomatology Center of the first affiliated Hospital of Zhengzhou University were analyzed. A total of 479 inpatients with maxillofacial injuries were collected. Use bar diagram, diagram and circle chart and other visual charts and specific data to explain the results. The medical records of patients with maxillofacial nerve injury caused by maxillofacial trauma were analyzed retrospectively, including the location of injury and the effect of injury mode on the recovery of maxillofacial nerve function. The results were analyzed in the form of statistical chart. The function of facial nerve was evaluated before and after injury, and House-Brackmann facial nerve evaluation was used to evaluate House-Brackmann facial nerve grading.Results there were 479 patients with maxillofacial trauma. The ratio of male to female is 3.17: 1; traffic accident occupies the first place among the causes of injury: 60.33; the mandible is the most common site of fracture in maxillofacial bones; the mandible is the most common site for fracture; and the limbs and brain are 42.08 and 30.60.) injuries are common and complicated injuries in maxillofacial fractures. It accounted for 10.49% of all patients undergoing operation. The ratio of facial nerve injury and mental nerve injury was the highest (37.20%, respectively), and 10 cases of suborbital nerve injury (38.46%) began to recover 1 week after operation. Twelve patients with facial nerve branch injury recovered to normal 2 weeks after operation. Of the 8 patients with mental nerve injury, 47.06 were involved. One patient with facial nerve trunk injury began to recover half a year after operation. At present, open reduction and rigid internal fixation has become the first choice for the treatment of maxillofacial fractures. Conclusion the primary cause of maxillofacial injuries is traffic accidents, and mandibular fractures are the most common. The recovery of sensory nerve was faster than that of motor nerve. The prognosis of the patients with HB grade 鈪

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