颧骨复合体骨折手术前后咬合力的对比研究

Comparative Study of Occlusal Force Rehabilitation in Zygomatic Complex Fractures before and after Operation

目的:应用计算机咬合分析系统,评价颧骨复合体骨折手术前后的咬合力变化情况。方法:临床收集15例颧骨复合体骨折病例。所有患者在全麻下行切开复位坚固内固定治疗。利用T-ScanⅡ(牙合)力测量系统在术前一周内、术后3月和术后6月(牙合)力测定。分析患者的总(牙合)力(TOF)、MIP/MAX指数、(牙合)力不对称指数(AOF)、(牙合)力中心点的位置(COF)及其咀嚼时的最大位移距离(MCOF)进行比较研究。结果:颧骨复合体骨折术后3个月时总(牙合)力有所上升,6个月时与术前相比已有显著差异(P<0.05),此时咀嚼功能已有提高。MIP/MAX指数略有下降。不对称指数术后呈下降趋势,在术后3个月和6个月时均比术前明显减小。(P<0.05,P<0.01)。术后(牙合)力中心点位置逐渐趋向正常,咀嚼时(牙合)力中心点最大位移距离有下降趋势,在术后6个月时较术前有明显改善,表明患者的咀嚼功能有所提高.结论:T-scan-Ⅱ能定量评价切开复位坚固内固定治疗,对颧骨复合体患者的咀嚼功能的变化,术后患者的总(牙合)力及平衡性明显提高。

Objective： An occlusion assessment system was used to evaluate the perioperative changes of occlusal forces in patients suffered from ZMC fractures and treated with ORIF. Methods： 15 cases with ZMC fractures in our ward from 2003 to 2004 were investigated in this study. The T-scan- Ⅱ system was used to record and analyze the patients＇ occlusion in three different periods, before operation, three month after operation and six month after operation. After regular cheek up, all the patient underwent open reduction and rigid fixation under general anaesthesia. We use coronal approach or micro approach as incisions for the patient. The positions for fixation were zygomatic frontal suture, zygomatic -maxillary suture, sub-orbital rim or zygomatic temple suture instead. Asymmetry index of occlusal force （AOF）, total occlusal force （TOF） and centre of occlusal force （COF） were compared in statistical way. Results： All the wounds had a healing in first intention and a better change in function of mouth opening. The decrease of AOF in one and three month after operation was significant and data in six month indicated a difference in statistics which means a better change of the occlusal function, the COF returned to normal after operation and the TOF did not increase three month after operation until six month after operation. The indexes of MIP/MAX was declined. Conclusions： The occlusal force was increased slowly after operation compared with the other two indexes; The AOF, TOF and COF were effective in evaluating the occlusion function of the fractured zygomatic bone perioperatively.