下颌骨髁突骨折的临床回顾研究

发布时间：2018-09-02 09:00

【摘要】：目的:研究下颌骨髁突骨折不同的分类及治疗方法选择,为髁突骨折的临床治疗提供理论依据及临床指导。方法:对浙江大学医学院附属第一医院口腔颌面外科2014年1月至2016年8月期间资料完整的93例(122侧)下颌骨髁突骨折病人治疗资料的分析,进行髁突骨折流行病学、骨折类型、治疗方法、手术入路、术后并发症、临床随访等方面研究,统计结果并进行统计学分析。结果:93例(122侧)下颌骨髁突骨折病例中男性为好发人群,交通事故是髁突骨折的主要致伤原因。下颌骨CT平扫+三维重建是目前诊断下颌骨髁突各类型骨折的最佳影像学检查方法。髁突骨折合并其他部位骨折最多的是下颌骨颏部骨折。髁突骨折按骨折部位分类囊内骨折最多见,占66.4%。本研究122侧髁突骨折病例中,手术治疗100侧,达82.0%。81侧囊内骨折中,19侧行保守治疗,其余主要行拉力螺钉固定;41侧囊外骨折病例中,3例骨折块未明显移位的髁突下骨折患者选择保守治疗,其余均行小型钛板固定。在手术入路上,耳前入路主要用于囊内骨折,颌后穿腮腺入路及颌下入路主要用于髁突颈部及髁突下骨折,耳轮缘入路应用于囊内骨折及髁突颈部骨折。开口度方面,各类骨折类型病例术后张口度均有所增加。术后5例髁突骨折合并其他部位骨折病例出现咬合紊乱,与单纯髁突骨折病例对比无统计学差异。术后9例患者出现开口型偏斜,但各类型骨折之间无统计学差异。耳前入路的面神经损伤率最高,为21.9%,颌后穿腮腺入路次之,耳轮缘入路最小,口内入路及颌下入路因病例数只有1例和2例,与其他入路方式对比无意义,因此不计入比较。21例长期随访病例中,4例患者患侧关节区疼痛;2例患者张闭口颞下颌关节弹响;3例患者4侧下颌骨髁突骨折术后发生吸收。结论:下颌骨髁突骨折的分类方法和治疗方式选择众多,目前并无统一的共识,但是随着切开内固定方法的改进和固定材料及手术器械的发展,手术适应证正逐渐放宽。目前对于囊内骨折的治疗,应根据骨折块的移位程度、下颌升支高度降低情况、是否伴有其他部位的骨折以及患者年龄、全身状况来系统性的评估,而对于髁突颈部及髁突下骨折都主张行开放性治疗(切开复位内固定术)。不管何种治疗方式,通过最合适的方法、最小的损伤恢复关节的解剖与功能是外科医生应当遵循的基本原则。
[Abstract]:Objective: to study the different classification and treatment methods of mandibular condylar fracture, and to provide theoretical basis and clinical guidance for the clinical treatment of condylar fracture. Methods: from January 2014 to August 2016, 93 patients (122 sides) with mandibular condylar fracture were treated by oral and maxillofacial surgery in the first affiliated Hospital of Zhejiang University Medical College. Methods of treatment, surgical approach, postoperative complications, clinical follow-up, statistical results and statistical analysis. Results among 93 cases (122 sides) of mandibular condylar fracture, male was a predilection group, and traffic accident was the main cause of condylar fracture. Three-dimensional reconstruction of mandible with CT is the best imaging method for the diagnosis of mandibular condylar fracture. Mandibular chin fracture is the most common condylar fracture associated with other fractures. Condylar fracture was the most common fracture classified by fracture site, accounting for 66.4%. In the 122 condylar fracture cases, 100 sides were treated surgically, 19 of the 82.0.81 sides were treated with conservative treatment. Among the other 41 cases of extracapsular fracture, 3 patients with subcondylar fracture without obvious displacement of fracture block were treated conservatively, and the rest were treated with small titanium plate. The anterior ear approach is mainly used for intra capsular fracture, posterior maxillary parotid approach and submandibular approach for condylar neck and subcondylar fracture, and ear ring approach for intracapsular fracture and condylar neck fracture. The opening degree of all kinds of fracture cases increased after operation. The occlusal disorder was found in 5 cases of condylar fracture complicated with other fracture after operation, and there was no statistical difference between the cases of condylar fracture and simple condylar fracture. There were 9 cases of open-type deviation after operation, but there was no statistical difference between each type of fracture. The rate of facial nerve injury in the anterior ear approach was the highest (21.9%), followed by the posterior maxillary parotid approach, the marginal approach was the smallest, the intraoral approach and submaxillary approach were only 1 case and 2 cases, and there was no significance compared with other approaches. Therefore, 4 patients with pain in the affected side of articular area and 2 patients with tension-closed temporomandibular joint elastic sound occurred absorption after operation of mandibular condylar fracture in 4 sides of mandibular condylar fracture. Conclusion: there are many classification methods and treatment methods for mandibular condylar fracture, but with the improvement of incision and internal fixation method and the development of fixation materials and surgical instruments, the indication of operation is gradually being relaxed. At present, the treatment of intra capsular fractures should be systematically evaluated according to the degree of displacement of the fractures, the reduction of the height of the mandibular ramus, whether there are fractures in other parts, the age of the patients, and the condition of the whole body. For condylar neck and subcondylar fractures, open treatment (open reduction and internal fixation) is recommended. No matter what treatment, minimal injury to restore joint anatomy and function is the basic principle that surgeons should follow through the most appropriate method.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.4

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