髁突矢状骨折治疗中侧向拉力螺钉的应用及关节盘处理

Application of lateral lag screw with sagittal condylar fracture and management of articular disk

目的:探讨侧向拉力螺钉在髁突矢状骨折内固定治疗中的应用,以及颞下颌关节盘的复位固定在髁突矢状骨折治疗中的作用及疗效。方法:对16例患者19侧髁突矢状骨折的骨折片复位后,进行侧向拉力螺钉内固定治疗,术中同时对移位的关节盘进行复位固定。术后进行张口训练,随访期进行临床和影像学复查。结果:全部患者术后骨折片复位固定良好,骨折片未见有移位和吸收征象,关节盘位置恢复正常。11例患者13侧术后有额纹不同程度减弱,面神经功能评价95分,术后6个月平均恢复到100分。患者术后牙合关系均恢复至髁突骨折前状态,无面瘫、错牙合和张口受限发生,无患侧关节区疼痛不适。术后3个月张口度最大43mm,最小32mm,平均37mm;术后6个月平均张口度38mm。结论:髁突矢状骨折的侧向拉力螺钉应用及关节盘的复位固定治疗,效果明显,方法可靠,可以达到稳定的复位固定目的,并早期恢复颞下颌关节功能。

Objective： To evaluate the application of lateral lag screw and reduction of articular disk in management of intracapsular sagittle fractures of the condylar process. Methods： The study group consisted of 16 cases （19 joints）,including 10 males （12 joints） and 6 females（7 joints）. Condylar sagittal fracture and displaced articular disk were detected in all patients. The condylar segments were repositioned and fixed by using lateral lag screw and the displaced articular disk were repositioned at the same time. The mean postoperative follow-up was 16 months （range 6～28 months）. During the follow up,facial nerve function was monitored and radiologic re-examinations were performed to evaluate reposition of condylar process fractures and articular disk,while the mouth opening and occlusion were registered. Results： The reduction of the displaced condylar fragments and articular disks in all patients were excellent on 3D CT and MRI. No severe complications were observed （including permanent facial nerve palsies,malocclusion,ankylosis）. Three months after surgery,all patients showed their better mobility with condylar and disk,and mouth opening reached 43 mm on maximum,32 mm on minimum,with a mean of 37 mm. Conclusion： The results by application of lateral lag screw and reduction of articular disk are helpful in anatomical and functional recovery of temporomandibular joint for patients with displaced sagittal condylar process fractures.