天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (10): 1283-1286.doi: 10.11958/20160606

• 新技术交流 • 上一篇    下一篇

成人下颌骨髁突骨折手术治疗32例临床分析

严颖彬，穆洁，张兰成，刘浩，王志兴，张军，沈军，张萍   

  1. 1 天津市口腔医院口腔颌面外科（邮编 300041）；2 天津市第五中心医院口腔科
  • 收稿日期:2016-07-05 修回日期:2016-08-20 出版日期:2016-10-15 发布日期:2016-10-21
  • 作者简介:严颖彬（1980）， 男， 副主任医师， 博士， 主要从事口腔颌面部肿瘤和创伤研究
  • 基金资助:
    国家自然科学基金青年项目（81300901）；天津市自然科学基金青年项目（14JQNJC12500）；天津市卫生局面上项目（2012KY18）

Surgical treatment of adult mandibular condylar fractures: a clinical analysis of 32 cases

YAN Yingbin, MU Jie, ZHANG Lancheng, LIU Hao, WANG Zhixing, ZHANG Jun, SHEN Jun, ZHANG Ping   

  1. 1 Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, Tianjin 300041, China; 2 Department of Stomatology, Tianjin Fifth Central Hospital
  • Received:2016-07-05 Revised:2016-08-20 Published:2016-10-15 Online:2016-10-21

PDF (PC)

4035

摘要： 目的 探讨包括囊内骨折在内的成人下颌骨髁突骨折的手术疗效。 方法 32 例 33 侧髁突骨折中， 囊内骨折 6 例， 采用耳前入路和 2 枚 18 mm 的长螺钉固定； 髁颈骨折 6 例 7 侧， 采用颌后穿腮腺入路及 1 块小型板固定；髁颈下骨折 20 例， 采用环下颌角入路和 2 块接骨板固定。 结果 术后平均随访 13.5 个月 ， 随访期末平均最大张口度 37.5 mm。 32 例患者均获得良好的咬合关系和面部对称性。 7 例（21.9%）出现暂时性面神经瘫痪， 术后 3 个月均完全恢复， 1 例出现涎漏， 加压包扎后痊愈。 无永久性面瘫、髁头吸收等严重并发症。 结论 对不同类型的髁突骨折采用适宜的手术入路和内固定方法是取得良好手术效果的关键。

关键词: 下颌骨折, 髁突骨折, 成年人, 开放复位及内固定, 手术入路, 并发症

Abstract: Objective To investigate the effect of surgical treatment of adult mandibular condylar fractures (including intracapsular fracture). Methods Thirty-two patients (33 sides) with condylar fractures underwent open reduction and rigid fixation. Six patients with intracapsular condylar fractures were treated with two 18- mm positional screws through a preauricular approach. Six patients (7 sides) with condylar neck fractures were rigidly fixed by 1 mini- plate via a retromandibular transparotid approach. Twenty patients with subcondylar fractures were operated and fixed by two titanium plates using an angular approach. Results The mean follow-up period was 13.5 months, and the mean maximum mouth opening was 37.5 mm by the last visit. All patients acquired good occlusal relationship and mandibular symmetry. Seven patients (21.9%) experienced transient palsy of the branches of the facial nerve, and recovered completely after three months. One patient developed a salivary fistula, and healed after two weeks of gauze compression. No permanent deficit of any facial nerve branch was observed. No patient showed condylar head resorption. Conclusion Appropriate surgical approaches and fixation methods for different types of condylar fractures are the key factors to achieve reliable clinical results.

Key words: mandibular fractures, condylar fractures, adult, open reduction and internal fixation, surgical approach, complications