儿童髁突骨折治疗方法选择的临床评价与分析

发布时间：2018-11-07 11:14

【摘要】：儿童及青少年面部骨折多发于下颌骨,以髁突骨折最常见,该年龄段颌骨处于发育状态,髁突为下颌骨发育的中心点之一,具有生长发育及改建功能,该年龄段患者的髁突骨折一直受到较多学者的关注。大多数学者认为,儿童及青少年髁突骨折的首选治疗方法为闭合治疗法,开放性治疗可能破坏髁突结构、损伤关节周围组织,从而引起下颌骨发育障碍,术后瘢痕、面神经损伤以及手术本身也可能对患者身心造成影响。也有学者认为,大多闭合治疗的研究对象为髁突骨折移位不明显、临床症状较轻的患者,对开放性治疗效果的研究较少,也没有证据表明开放性治疗效果不佳,并认为开放复位治疗在恢复髁突解剖形态和下颌升支高度、重建下颌骨连续性方面更具优势,有利于骨折的早期愈合。不同观点的存在主要是由于髁突骨折的分类及治疗方法选择至今尚无统一定论。本研究第一部分对儿童及青少年髁突骨折进行流行病学分析,以了解儿童及青少年髁突骨折的发病特点。在本研究第二部分,在以往学者的观点的基础上提出一种新的针对儿童及青少年髁突骨折的分类方法,ADP分类法,并根据分类采用相应的治疗方法,在患者治疗,后进行2年进行复诊及随访,并评价该分类法对儿童及青少年髁突骨折的治疗效果。本研究第三部分,主要对12岁以下儿童髁突骨折患者进行ADP分类后,进行保守与于术治疗的术后疗效的比较,以对该分类方法及治疗方法的有效性进行分析。第一部分儿童及青少年髁突骨折流行病学研究目的：对儿童及青少年髁突骨折进行流行病学分析,以了解儿童及青少年髁突骨折的发病特点。方法：回顾分析195例18岁以下髁突骨折患者共268侧髁突骨折的临床资料,对患者发病年龄、性别、受伤原因、髁突骨折为单侧或双侧、髁突骨折部位、骨折块移位情况等进行统计分析。结果：195例患者中,男性132例,女性64例；0-6岁患者42例,7-12岁患者58例,13-18岁患者95例；受伤原因依次为自行摔伤、高处坠落伤、交通事故伤、白行车事故伤、摩托车事故伤等；单侧髁突骨折患者123例,双侧73例；骨折部位：P1髁突骨折侧数130侧,P2髁突骨折侧数86侧,P3髁突骨折侧数31侧,P4髁突骨折侧数21侧；骨折移位程度D1髁突骨折侧数21侧,D2髁突骨折侧数101侧,D3髁突骨折侧数110侧,D4髁突骨折侧数36侧；92侧髁突骨折采用保守治疗法,172侧采用手术治疗法。结论：儿童及青少年髁突骨折患者以男性最为常见,13-18岁年龄段为最高发年龄,受伤原因以白行摔伤最为常见,单侧较双侧多发,骨折部位以P1最为常见,移位程度以D3最为常见,多数骨折采用手术治疗法。第二部分儿童及青少年髁突骨折的分类及治疗方法选择目的：探讨儿童及青少年髁突骨折分类与治疗方法的选择,为临床治疗作参考。方法：回顾分析195例18岁以下髁突骨折患者共268侧髁突骨折的临床资料,并在2年后复诊检查患者的面型、开口度,开口型,咬合情况,摄X线片检查骨折愈合情况。结果：根据患者年龄、骨折移位程度和骨折部位分型后,I型171侧,II型97侧,与实际开放治疗及闭合治疗的侧数吻合率达到97.8%。两年后的随访发现,开放治疗与闭合治疗均能取得较满意的临床效果。结论：儿童及青少年髁突骨折患者通过ADP分类法对可获得较为理想的治疗效果；ADP分类法对儿童及青少年髁突骨折的治疗方法的选择有明确的指导作用。第三部分保守及手术疗法对儿童髁突骨折治疗效果的临床评价目的：比较开放与闭合治疗法对儿童髁突骨折治疗后的远期临床效果及影像学表现,为临床治疗方法选择提供参考。方法：78例儿童髁突骨折患者,共发生105侧髁突骨折,根据分类分别选择开放或闭合治疗法,并在治疗后进行至少三年的随访,检查患者的面型、开口度、开口型、咬合及髁突重建情况,比较开放治疗法与闭合治疗法的临床疗效及影像表现差别。结果：依据分类,I型患者14侧均采用开放治疗法。II型患者48侧均采用闭合治疗法。Ⅲ型中,37侧采用开放治疗法,6侧采用闭合治疗法。患者经开放治疗与闭合治疗后均取得较满意的临床效果,经开放治疗患者影像表现方面优于经闭合治疗患者。结论：依据综合分类法,对于I型儿童髁突骨折建议采用开放治疗法,II型建议采用闭合治疗法,III型应根据具体情况慎重选择。经分类建议的方法治疗后均取得较满意的临床效果；但在髁突影像表现中,经开放治疗患者髁突重建效果优于经闭合治疗患者。
[Abstract]:The fracture of children and adolescents is most common in the mandible and the condylar fracture is the most common. The maxilla of the age group is in the development state. The condylar process is one of the central points of the development of the mandible, and has the function of development and reconstruction. The fracture of the condyle of this age group has been paid more and more attention by the scholars. Most scholars believe that the preferred method of treatment for condylar fractures of children and adolescents is a closed treatment, which may destroy the condylar structure and damage the surrounding tissues of the joint, thus causing the development of the mandible and the post-operation scar. Facial nerve injury and the procedure itself may also have an impact on the patient's body and mind. It is also believed that most of the study subjects of closed treatment are the patients with dylar fracture, less clinical symptoms, less research on the effect of open-label treatment, and no evidence that the effect of open-label treatment is not good, It is believed that the open reduction therapy is more advantageous in the restoration of the anatomic morphology of the condyle and the height of the lower jaw and the continuity of the mandible, and is beneficial to the early healing of the fracture. The existence of different views is mainly due to the classification of the condylar fracture and the choice of the treatment method. The first part of this study conducted an epidemiological study of the condylar fractures of children and adolescents to understand the incidence of condylar fractures in children and adolescents. Characteristics: In the second part of this study, a new classification method for condylar fracture of children and adolescents was put forward based on the point of view of the past scholars. Follow-up and evaluate the treatment of condylar fractures in children and adolescents Effect. The third part of this study is to compare the curative effect of conservative and operative treatment after the classification of ADP in the children under 12 years of age, in order to evaluate the effectiveness of the method and the treatment method. Analysis. The first part of the children and the adolescent condylar fracture epidemic Objective: To study the epidemiology of condylar fractures of children and adolescents in order to understand the condylar fractures of children and adolescents. Methods: The clinical data of a total of 268 lateral condylar fractures of the patients under 18 years of age were retrospectively analyzed, and the age, sex and the cause of the injury were analyzed. The fracture of the condyle was one or two sides, and the fracture site of the condyle and the displacement of the fracture were observed. Results: Among the 195 patients, there were 132 males and 64 females, 42 patients with 0-6 years of age, 58 patients with 7-12 years of age, and 95 cases of 13-18 years of age. The cause of the injury was the self-injury, the falling injury, the traffic accident injury, the white driving accident, the accident injury of the motorcycle, etc. There were 123 cases of lateral condyle fracture and 73 cases of double side; the fracture site: the side number 130 on the side of the P1 condyle fracture, the side number of the P2 condyle fracture side, the side number of the P3 condyle fracture side, the side number of the P4 condyle fracture side, the fracture degree of the D1 condyle fracture side number 21, the D2 condyle fracture side number 101 side, the D The side number of the 3-condyle fracture side was 110, the side of the D4 condylar fracture was 36 sides, and the 92-side condylar fracture was treated with a conservative treatment. The results were as follows: The most common in male and 13-18 years of age for children and adolescents with condylar fractures were the most common in the age group of 13-18 years. The most common cause of the injury was that the one-sided and double-sided fracture was the most common, and the fracture site was the most common in P1. It is common that the degree of displacement is the most important in D3 The majority of the fractures are common, and most of the fractures are treated surgically. The second part of the child Objective: To study the classification and treatment methods of condylar fractures in children and adolescents: to study the condylar bone of children and adolescents. Methods: The clinical data of a total of 268 lateral condylar fractures of the patients under 18 years of age were retrospectively analyzed, and the surface type and opening of the patients were examined after 2 years. Results: On the basis of the age of the patient, the degree of fracture and the fracture site, the type I 171, the type II, and the fracture were on the side of type I and type II. and the rate of side-to-side anastomosis with the actual open and closed treatment reached 97.8%. Two years later, Conclusion: The results of follow-up show that both open and closed treatment can achieve satisfactory clinical results. The selection of treatment methods for condylar fractures of children and adolescents has clear guidance. The effect of the third part of conservative and surgical therapy on the treatment of children's condylar fractures: a comparative study of open and closed treatment The long-term clinical effect and the imaging performance after the treatment of the children's dylar fracture were provided. Methods: 78 cases of condylar fractures of the children were treated with 105 lateral condylar fractures, and the open or closed treatment was selected according to the classification. Follow-up for at least three years after treatment, check the patient's surface, open, open, Oral, occlusal and condylar reconstruction, and comparison of open and closed treatment The clinical effect and image performance of the therapy were different. Results: On the basis of the classification, open treatment was used on both sides of type I patients. On the 48 side of type II, closed therapy was used. In type III, open therapy was used at 37 sides, and closed treatment was used at 6 sides. The patient was treated with open treatment Conclusion: According to the comprehensive classification method, I can find a better clinical effect after the treatment and close treatment, and it is superior to the patients with closed treatment. Conclusion: According to the comprehensive classification method, I type The fracture of the children's condyle is recommended to be open therapy. The type II is recommended to be closed, and the type III should be carefully selected according to the specific conditions. After treatment with the method recommended by the classification,
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R782.4

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