应用穿颊器口内入路微创治疗下颌骨角和升支骨折

Treatment of mandibular angle and ramus fractures by an intraoral and transoral approach

目的：观察口内和穿颊的手术入路处理下颌骨角部和升支骨折,并用小钛板坚强内固定的疗效.方法：对2004-01～2005-07间18 例连续的下颌骨角部和升支骨折患者,用穿颊器经过颊部小切口联合口内切口复位内固定.随机选取同时期的另外20 例同类型骨折患者,仍按照传统口外入路行手术切开复位内固定,2 组间进行对比.结果：用口内和穿颊入路患者中有1 例内固定术后骨折处仍有小幅动度,还需辅以颌间固定;口外入路行内固定手术的患者中有2 例需行术后颌间固定.没有术后感染发生,没有出现需要行切开引流或需取出固定物的病例.结论：通过口内和穿颊入路行坚强内固定适用于不伴有严重错位或粉碎性骨折的下颌骨角部和升支部骨折的病例.

Objective ：To evaluate the treatment with screwed miniplates through an intraoral and transoral approach for patients with angle and ramus fractures. Methods：18 cases of mandibular angle and ramus fractures were treated by screwed miniplates placed through a transbuccal incision with transbuccal troear instrumentation from January 2004 to July 2005. 20 cases treated through extraoral approach were served as the controls. An intraoral and transoral approach for open reduction and internal fixation of mandible with limited incisions was used to reduce the risk of facial nerve damage and extensive visible scars. Patients were followed-up for 3 months. Results：3 months after operation only one patient treated by intraoral approach and two by extraoral approach required a period of maxillomandibular fixation because of fracture fragments mobile. No postoperative infection occurred in all the eases. Conclusion： The use of rigid internal fixation through an intraoral and transoral approach can be applied in the patients with angle and ramus fractures without severely dislocated fracture fragment.