髁突-翼外肌解剖复位与游离复位治疗髁状突骨折的疗效比较

Comparison of Treatment Efficacy of Condylar-wing Muscles Anatomic Reduction with Free Reduction in the Treatment of Condylar Fractures

目的:比较髁突-翼外肌解剖复位与游离复位治疗髁状突骨折的疗效,促进髁突形态恢复。方法:收治的80例单侧髁状突骨折患者随机分为两组,每组40例,A组行髁突-翼外肌解剖复位术,B组行髁状突游离复位术,术后3个月、6个月观察髁突形态及下颌骨运动功能变化。结果:A组治愈率为90%,高于B组的70.00%(P<0.05);术后3个月A组髁状突吸收、张口受限、开口偏斜、咬合关系紊乱、关节弹响发生率分别为12.50%、15.00%、15.00%、7.50%、12.50%,均低于B组的32.50%、35.00%、37.50%、25.00%、35.00%(P<0.05);术后6个月A组张口受限、关节弹响发生率为5.00%、2.50%,均低于B组的20.00%、20.00%(P<0.05);两组术后并发症发生率比较差异无统计学意义(P<0.05)。结论:髁突-翼外肌解剖复位术保留髁状突骨折患者骨折断端血运,髁突形态及下颌骨运动能力恢复良好,疗效优于髁状突游离复位术。

Objective： To compare the treatment efficacy of condylar-wing muscles anatomic reduction with free reduction in the treatment of condylar fractures, so as to improve condylar shape recovery.Methods： In this study, 80 patients with unilateral condylar fracture were randomly divided into two groups, 40 cases in each group. Patients in group A underwent condylar-wing muscle reattachment surgery, while those in group B got condylar free reduction surgery. The mandibular condylar morphology and motor function were observed at three and six months after treatment. Results： The cure rate in group A was 90%, higher than in group B （70.00%）, with statistical difference （P〈0.05）. After three months, occurrence rate of condylar absorption, limited mouth opening, opening skewed, malocclusion and joint clicking was respectively 12.50%, 15.00%, 15.00%, 7.50% and 12.50% in Group A, and respectively 32.50%, 35.00%, 37.50%, 25.00% and 35.00% in group B. All were lower in group A than in group B and the differences were statistically significant （P 〈0.05）. After six months, the incidence rate of limited mouth opening and joint Clicking was respectively 5.00% and 2.50% in group A, significantly lower than the rate of 20.00% and 20.00% in group B （P〈0.05）. No difference was found in the incidence of postoperative complications between the two groups （P〉0.05）. Conetusion： Condylar-wing muscle reattachment surgery could reserve blood supply for fracture site of condylar fractures, and have good recovery in morphology and mandibular condylar athletic ability. It was more effective than condylar free reduction surgery.