髁突高位骨折的手术治疗

A Surgical Technique Using Vertical Ramus Osteotomy for High Condylar Fractures

目的观察颌下切口下颌升支垂直截骨术治疗髁突高位骨折的效果。方法对16例(19侧)下颌骨髁突高位骨折患者采用颌下切口下颌骨升支后缘垂直截骨,取出升支后缘骨块,将骨折的髁突游离后取出,体外直视下将骨折片与升支后缘骨块复位固定后再回植,行颞下颌关节重建。结果 6个月、12个月、24个月随访,检查开口度为30～48 mm,平均为34.9 mm。16例患者术后咬合关系良好,无关节疼痛症状。部分病人有轻度的开口偏斜,均<3 mm,有关节弹响1例。结论颌下切口下颌升支垂直截骨术治疗髁突高位骨折有操作简便、复位准确、近期疗效。

Objective To evaluate the effects of fixing and reduction of high condylar fractures by using vertical ramus osteotomy（VRO）.Methods Sixteen patients（19 condyles）were underwent open reduction and internal fixation through the submandibular approach,vertical osteotomy of mandibular ramus was performed.The fractured condylar head was reducted with titanium miniplate in vitro and reimplanted to the glenoid fossa.Results All the patients were followed up at th 6th,12th,24th month.The ranges of mouth opening were 30～48 mm（34.92 mm average）.No temporomandibular joint（TMJ）pain or dysfunctions were found during follow-up.All patients gained ideal occlusions,some cases showed the slight mandibular deviation,usually in the sixth postoperative month.A TMJ click was observed in 1 patient.Conclusion The surgical technique using VRO for high condylar fractures is easy and reliable to operate,relocate accurately and has a good therapeutic effect.