颧骨弓伴发关节结节骨折的临床探讨

TREATMENT OF FRACTURE OF ZYGOMATIC ARCH AND FRACTURE OF TUBECULUM ARTICULARE

目的探讨颧骨弓伴发关节结节骨折的诊断及治疗方法。方法对30例颧骨弓伴发关节结节骨折的患者可疑骨折区行螺旋CT三维重建检查。18例关节结节骨折移位明显,其中10例行颧骨弓骨折或颧上颌骨折手术治疗,同时行关节结节骨折复位固定术,另8例未行关节结节骨折复位固定;12例关节结节骨折移位不明显者仅行颧骨弓骨折复位固定术。术后观察面部形态及张口度。结果螺旋CT扫描三维重建均能清晰显示患者的关节结节骨折部位、骨折的移位程度、与周围结构的空间关系。10例行颧骨弓骨折或颧上颌体骨折手术同时行关节结节骨折复位术者中,9例有效纠正畸形及改善张口度。8例关节结节骨折移位明显但未行关节结节骨折复位固定者,5例畸形及张口受限明显。另12例关节结节骨折未明显移位并未行固位术者,其面部形态可,其中2例张口轻度受限。结论螺旋CT三维重建对颧骨弓伴发关节结节骨折的诊断具有重要的价值;对关节结节骨折移位明显者,行颧骨弓骨折或颧上颌体骨折手术治疗的同时行关节结节骨折复位术,有助于纠正面部畸形及改善张口度。

Objective To investigate the diagnosis and treatment of fracture of zygomatic arch and fracture of tuberculus articulate. Methods Spiral CT were used to detect the fractures in 30 cases. Displacement occurred in 18 cases,of which 10 cases received operations and reposition, and the other 8 cases did not go through reposition. Another 12 cases with less obvious displacement underwent reposition of tuberculum articulate. Facial shape and mouth opening after treatment were observed. Results Spiral CT could clearly reveal the position, the degree of displacement and the space relationship. 10 cases received both operation and reposition, and 9 of them had fa- cial deformity corrected and their mouth opening improved. Of the 8 cases with ovbious displacement but without going through reposition, 5 suffered from facial deformity and the limitation of mouth opening. Another 12 cases without obvious displacement and without receiving reposition showed normal facial shape, but 2 of them had limitation of mouth opening. Conclusion Spiral CT plays an important role in detecting fracture of zygomatic arch and fracture of tuberculum articulave. Operation and reposition should be porformed to correct facial deformity and to improrc mouth opening.