颧骨复合体骨折59例临床分析

Clinical investigation of 59 patients with zygomatic complex fracture

目的:对59例颧骨复合体骨折病例进行临床回顾性分析。方法:59例颧骨复合体骨折病例中,A型骨折15例(25.42%),B型骨折25例(42.37%),C型骨折19例(32.20%)。所有患者均行外科手术治疗。采用颞部切口3例(5.08%),前庭沟切口1例(1.69%),单纯冠状切口22例(37.29),冠状切口+下睑缘切口14例(23.73%),冠状切口+结膜囊切口6例(10.17%),冠状切口+前庭沟切口4例(6.78%),冠状切口+下睑缘切口+前庭沟切口9例(15.25%)。结果:术后随访3～6个月,59例患者均取得良好疗效:开口度及咬合关系均得到明显改善;颜面部外形恢复满意,两侧基本对称;复视消失;神经症状中的感觉异常恢复好。结论:颧骨复合体骨折的复位和固定应根据受伤时间、骨折类型、功能障碍和面部畸形等情况选择适当的手术方法。手术入路应该有利于充分暴露术区、骨折的复位及固定。恢复颧弓前后向距离及外侧凸度是纠正颧突点位置、重建面部高度和面容突度的关键。

Objective：To analyze retrospectively 59 patients with zygomatic complex fracture,and to investigate etiology,clinical feature,treatment and complication.Method：All the 59 patients,who were treated by surgery,were grouped as follow：type A 15 cases（25.42 %）,type B 25 cases（42.37 %）,type C 19 cases（32.20 %）.All the surgical approaches were listed as follow：temporal incision 3 cases（5.08 %）,incision of vestibular groove 1 case（1.69 %）,simple coronary incision 22 cases（37.29 %）,coronary incision with incision of inferior palpebral margin 14 cases（23.73 %）,coronary incision with incision of conjunctival sac 6 cases（10.17 %）,coronary incision with incision of vestibular groove 4 cases（6.78 %）,coronary incision with incision of inferior palpebral margin and vestibular groove 9 cases（15.25 %）.Result：Follow-ups have been conducted for 3 to 6 months.The surgeries have produced good curative effects in 59 patients.The mouth opening and occlusal relation have been improved,satisfactory symmetrical facial profile has been gained,diplopia has been cured and paraesthesia has disappeared.Conclusion：Proper surgery should be selected according to the length of time after fracture,fracture type,dysfunction and facial deformity.Surgical approach should be conducive to exposure,reposition and fixation.Rectifying convexity of zygomatic arch was the key point in the surgery.