长螺钉在下颌骨髁突斜形骨折内固定中的应用研究

Internal Fixation with Long Screw in Treatment of High Oblique Condylar Fracture of the Mandible

目的:探讨长螺钉在下颌骨髁突骨折内固定中的应用,对其疗效进行初步评价。方法:对29例髁突高位斜形骨折患者经耳前途径行髁突解剖复位长螺钉内固定。测量术前、术后高度正常侧与降低侧下颌升支长度差值的变化(双侧髁突骨折时至少一侧为矢状骨折,该侧升支高度正常者才纳入研究),骨折段前后向及内外侧向的夹角,对结果进行统计分析及随访观察。结果:患者术后愈合良好,X线测量显示:术前患侧升支缩短高度平均6.6mm,术后为2.3mm,升支高度有显著性恢复;术前前后向平均夹角为47.7°,术后为9.8°,术前内外向平均夹角为60°,术后为16.9°,两组均有显著性改善。13例随访患者主观满意(随访时间为3～23个月,平均9个月),平均开口度为39mm,开口型正常,前伸、侧向运动幅度均大于5mm,无功能障碍。除2例双侧髁突骨折患者的髁突中度吸收外,其余均恢复良好。结论:长螺钉可用于髁突斜形骨折开放复位的内固定,特别是累及囊内的高位骨折,但其长期效果有待进一步随访观察。

Objective： The aim of this study was to evaluate the effectiveness of long screws fixation in treatment of high oblique condylar fractures. Methods： 29 patients were consisted in this assessment. The repositioned fragments were fixed with long screws. Clinical and radiologieal examinations were recorded. Ramus height and angulation between the mandibular ramus and the fragment were measured and then followed up. Results： The postoperative healing of wounds were uneventful in most patients. The average shortening of ramus height was 6.6 mm before treatment, and decreased to 2.3 mm after treatment with a significant difference. The average degree of angulation in the anteroposterior direction was 47.7° before treatment and decreased to 9.8° after treatment （significant difference）. The average angulation in the mediolateral direction was 60° preoperation, and decreased to 16.9° postoperation （significant difference）. 13 patients were followed up 3-23 months （average 9 months） and were all satisfied with their operation outcomes. The average maximal mouth opening （MMO） was 39 mm. There were no symptom of temporomandibular disorders （TMD） and other complications. All ramus heights restored to normal except two bilateral condylar fractures with moderate resorption. Conclusion： Long screw fixation is ideal for treatment of mandibular oblique condylar fracture, especial fracture related to intracapusule. Long term follow-up is essential.