上颌骨骨折的非手术牵引治疗

Non-operative treatment of maxillary fracture by elastic traction

目的研究一种新的上颌骨骨折非手术治疗方法,以提高上颌骨骨折早期和现场救治能力。方法12例上颌骨骨折患者均行上下颌牙弓夹板结扎,然后戴入并固定颌面骨折牵引复位固定器,根据上颌骨骨折移位情况和患者的耐受程度,决定牵引力的方向、时间和大小。牵引复位时采用自制的两端有钢丝小钩的输液用乳胶管,对上颌骨进行向前、向上下和向左右的牵引。如果上颌骨骨折发生向下移位,则需在固定器的上颌牙弓上安置口内托盘,利用两侧的上颌弓移动调节器进行弹性牵引。结果本组12例患者的最短牵引时间为2d,最长7d,平均4d,均完全恢复咬合关系和正常面容。结论上颌骨骨折非手术牵引治疗是一种新的、有效的临床治疗方法。

Objective To explore and estimate a new non-operative treatment of maxillary fracture with elastic traction for the purpose of early treatment and on-spot first aid. Methods 12 patients, who were suffer from maxillary fracture including Lefort Ⅰ, Ⅱ, Ⅲ frac- ture, zygomatieo-maxillary complex fracture and nasomaxillary complex fracture within the past 2 or 3 weeks, were treated by closed trae tire reduction with a patent craniomaxillary tractive device, a non-operative manner instead of surgical open reduction and rigid internal fixation. The devices were placed after dental splints had been ligated, and the traction force was adjusted depending on the extent of maxillary displacement and patient＇s endurance. In general, the displaced maxilla could be pulled upwards, downwards, forward, leftward and rightward. For fallen maxilla, a special plate was placed on upper teeth and palate in order to push up the whole maxillary fragments. By adjusting the position of maxillary bar, the displacement could he reduction and correction. The elastic rubber loops were placed between dental splint and headframe, then the reduction of maxilla was accomplished. After reduction, external fixation such as intermaxillary fixation and craniomnetal bandage were used for maintenance. Results Tractive times of those 12 patients lasted from 2 days to 7 days, with an average of 4 days. After the non-operative trative reduction, satisfactory functional and cosmetic results were achieved with normal oc clusion and facial contour in all patients. No obvious complications were found. Conclusion For fresh maxillary fracture except comminuted and impacted fracture, this new non-operative tractive treatment could be an ideal treatment rather than surgical open reduction.