摘要
目的研究一种利用耳屏内联合颌下小切口入路制备隧道复位固定髁突颈部及基部骨折的方法,并观察其临床疗效。方法选择2012年1月至2018年1月30例髁突颈部中低位骨折患者,采用耳屏内联合颌下小切口入路,制造隧道式入路进行手术治疗。术后随访测量张口度、CT检查骨折断端对位情况及钛板有无变形、移位。结果①30例患者术中恢复正常咬合关系,术后复查无一例出现咬合紊乱;②张口度分析采用重复测量设计资料的方差分析进行检验(P<0.05),术前及术后1~12个月复查,患者平均张口度分别为(5.43±2.012)mm,(14.83±2.135)mm,(19.67±2.123)mm,(32.20±2.140)mm,(32.23±1.633)mm,(32.40±1.653)mm,患者术后张口度逐渐改善;③术后1、3、6、12个月复查CT显示骨折断端对位愈合,钛钉钛板无松动、变形、移位;④瘢痕位于耳内及颌下,位置隐蔽。⑤1例患者术后出现口角轻度歪斜症状,予以神经营养治疗,术后6个月复查症状消失。结论耳屏内联合颌下小切口隧道式入路治疗髁突颈部及基部骨折,显露充分,复位精确,实现早期张口功能训练及咬合关系恢复的同时,可做到瘢痕隐蔽,有效保护了面神经、颞浅动静脉、翼外肌等重要解剖结构,为临床髁突颈部及基部骨折手术入路的选择提供新的参考。
Objective To study a method of making tunnel reduction and fixation of condylar neck and base fractures by using intraocular lens combined with small incision approach, and to observe its clinical effect. Methods From January 2012 to January 2018, 30 cases of middle and low condylar neck fracture were selected for surgical treatment by using the ototragus combined with the submandibular small incision approach to create a tunnel. The opening capacity was measured in postoperative follow-up and CT was taken to dectect weather the fracture healed in the contrapuntal position and the titanin plates were distorted or shifted. Results ①Normal occlusal relationship was restored in 30 patients during the operation, and no occlusal disorder was found in postoperative review.②The anova of repeated measurement design data was used for the opening capacity analysis, and the difference in the opening capacity was statistically significant(P<0.05) The reexamination was carried out before the operation and 1 to 12 months after the operation. The average interincisor distances were respectively(5.43±2.012) mm,(14.83±2.135) mm,(19.67±2.123) mm,(32.20±2.140) mm,(32.23±1.633) mm,and(32.40±1.653) mm. The opening capacity of the patients recovered gradually after surgery.③CT reexamination 1, 3, 6 and 12 months after surgery showed that the fracture healed in contrapuntal position, and there was no loosening, deformation or displacement of the titanium plate.④The scar was located in the ear and under the jaw, and the position was concealed.⑤One patient presented mild angulation after surgery, and was treated with neurotropic therapy. The symptoms disappeared 6 months after the surgery. Conclusion Intraocular lens combined with submandibular small incision approach for the treatment of condylar neck and base fractures has adequate exposure, accurate reduction, which achieves the goal of scar concealment, early mouth function training and recovery of occlusion, and effective protection for important anatomical structure
作者
朱亮
邢乐君
赵睿
孟凡皓
乔波
胡随馨
周正
田晓光
贾婷婷
郑斌芬
于秋华
张海钟
ZHU Liang;XING Lejun;ZHAO Rui;MENG Fanhao;QIAO Bo;HU Suixin;ZHOU Zheng;TIAN Xiaoguang;JIA Tingting;ZHENG Binfen;YU Qiuhua;ZHANG Haizhong(Oral and Maxillofacial Surgery Department,The Chinese PLA General Hospital,Beijing100853,China)
出处
《口腔医学》
CAS
2019年第10期907-911,共5页
Stomatology
基金
国家重点研发计划(2017YFB1304300)
北京市科技计划(Z161100000516191)
关键词
下颌骨髁突骨折
髁突颈部骨折
髁突基部骨折
小切口
耳屏内切口
mandibular condyle fracture
condylar neck fracture
condyle base fracture
small incision
tragus incision
