下颌骨髁状突骨折56例疗效分析

Retrospective study of treatments for 56 condylar fractures

关键词:  髁状突骨折  坚固内固定  颞下颌关节强直  髁状突吸收

Key words:  condylar fracture  rigid fixation  ankylosis of temporo-mandibular joint  absorption of condyle

摘要:

[目的] 探讨不同类型髁状突骨折的治疗方法和临床效果。 [方法] 回顾性分析大连市中心医院56例髁状突骨折病例，分别采用保守治疗及髁状突摘除、关节成形和小型钛板坚固内固定，并评价其临床效果。 [结果] 随访47例，所有病例均一期愈合，无感染，无涎瘘。但部分病例出现面神经损伤（5例）、张口受限（3例）、颞下颌关节强直（1例）、髁状突吸收（2例）等并发症。 [结论] 切开复位及小型钛板坚固内固定是治疗髁颈和髁颈下骨折的有效方法，但应保留翼外肌附着。经颌后区入路可明显降低面神经损伤的几率。囊内粉碎性骨折和髁状突骨折伴关节盘明显移位如处理不当易发生颞下颌关节强直。

Abstract:

[Objective] To investigate the treatments and curative effects for different types of condylar fractures. [Methods] There were 56 condylar fractures presented with expectant treatments, condylar removal, arthroplasty, rigid fixation and evaluated the clinical effects. [Results] The curative effects were satisfactory but some patients suffered with complications such as injury of facial nerve, limitation of mouth opening, ankylosis of temporo-mandibular joint and absorption of condyle. [Conclusion] Miniplate rigid fixation based on anatomical reduction is an effective procedure in treating condylar neck and subcondylar fractures. Post-mandibular approach could significantly reduce the probability of facial nerve injury. Ankylosis of temporo-mandibular joint could happen if the serious dislocation of articular disc and comminuted fractures of condyle head.