摘要
目的探讨颧骨复合体骨折的顺序复位固定技术及疗效。 方法2004年3月－2012年2月，收治颧骨复合体骨折32例。男28例，女4例；年龄17～55岁，中位年龄29岁。致伤原因：交通事故伤29例，跌伤3例。新鲜骨折28例，受伤至入院时间1～12 d，平均3 d；陈旧性骨折4例，受伤至入院时间22～60 d，平均40 d。均经临床和CT检查确诊。采用头皮冠状切口、下睑缘切口和口内前庭沟切口入路，显露颧面部骨折，以先横向后纵向顺序进行骨折复位固定。横向由后向前（即颧弓根部→颧弓→颧骨体部→眶下缘）顺序，纵向先行颧额缝和眶外壁骨折复位，后转向口内使颧牙槽嵴骨折复位并固定。结果术后切口均Ⅰ期愈合，无上颌窦瘘、钛钉及钛板感染等并发症发生。18例获随访，随访时间6个月～6年，中位时间32个月。患者面形恢复满意，两侧基本对称，开、闭口功能正常。无眼球损伤、视力损害发生。术后2例出现额纹消失、眉下垂，6个月有一定程度自行恢复。头皮冠状切口遗留2～3 mm脱发痕迹，无瘢痕增生；下眼睑无明显瘢痕。6个月复查时，CT及X线片示骨折均愈合。 结论顺序复位固定技术符合颧骨复杂骨折的力学特点，容易达到精确解剖复位。
ObjectiveTo explore the procedure and effectiveness of sequential reduction and fixation for zygomatic complex fractures. MethodsBetween March 2004 and February 2012, 32 patients with zygomatic complex fractures were treated. There were 28 males and 4 females with a median age of 29 years （range, 17-55 years）. Fractures were caused by traffic accident in 29 cases and by tumble in 3 cases. The time between injury and admission was 1-12 days （mean, 3 days） in 28 fresh fractures and 22-60 days （mean, 40 days） in 4 old fractures. All patients were diagnosed by clinical symptom and CT scan. Coronal scalp incision, lower eyelid aesthetic incision, and intraoral incision were used to expose the zygomatic bone segments. The sequence of fractures reduction and fixation was horizontal first, and then longitudinal. In horizontal orientation, reduction and simultaneous fixation started from the root of the zygoma, to zygomatic arch, body of the zygoma, and inferior orbital rim in turn. Longitudinally, fracture reduction of zygomatico-frontal suture and orbital posterolateral walls was done first, followed by fracture reduction of zygomaticomaxillary buttress. ResultsPrimary healing of incision was obtained in all 32 cases, without complications of maxillary sinus fistula and infection. Eighteen patients were followed up 6 months to 6 years with a median time of 32 months. All the patients gained satisfactory results with normal zygomatic contour and symmetric midface. All patients restored normal mouth opening. No eye and vision damage occurred. Frontal disappearance and brow ptosis were observed in 2 cases. Hair loss （2-3 mm） was seen at the site of coronal scalp incision, without scar hyperplasia; there was no obvious scar at lower eyelid. CT and X-ray films showed bony healing at 6 months after operation. ConclusionSequential reduction and fixation is accord with the mechanical characters of complicated zygomatic fractures. It is very easy to achieve anatomic reduction of the bone segments and facial symme
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2013年第10期1181-1184,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
颧骨复合体骨折
顺序复位固定技术
骨折复位
Zygomatic complex fractures
Sequential reduction and fixation
Fracture reduction
