下颌骨骨折的临床回顾性研究

Retrospective clinical study on mandibular fracture treatment

目的:探讨下颌骨骨折后治疗方法的适应证和治疗效果。方法:对从2005年1月～2010年1月来我院就诊的143例下颌骨骨折患者的治疗效果及随访结果进行总结。结果:牙槽突骨折采用颌间拴丝或牙弓夹板,髁突颈骨折多采用颌间牵引固定;大部分患者采用切开复位,断端选用钛合金小型钛板或钢丝结扎固定,少部分患者采用颌间结扎、颌间拴丝弹性牵引辅以颅颌绷带保守治疗,均取得较好效果,总成功率为95.4%。通过术后1～6年的随访,按3个等级进行分类:Ⅰ级:伤口愈合好,骨折端无错位愈合,钛板无感染或暴露需二次手术取出,无开口困难等功能障碍;Ⅱ级:伤口愈合良好,骨折端无错位愈合或轻微错位不影响功能,钛板无感染或暴露需二次手术取出,无或者轻中度功能障碍;Ⅲ级:伤口感染,骨折断端感染或长期不愈合,钛板感染或暴露需要二次手术取出,有重度开口困难等功能障碍;随访结果3个等级分别为Ⅰ级40例,占27.9%,Ⅱ级92例,占64.8%,Ⅲ级11例,占7.3%。结论:下颌骨骨折正确地选择适应症是各种治疗下颌骨骨折方法取得满意疗效的关键。准确诊断,及时复位、固定,选择正确固定方式,防止感染,待别是应用坚强内固定技术能有效提高颌骨骨折治愈率。

Objective To investigate the indications and management effects of fracture of mandible.Methods 143 mandibular fracture patients were presented and treated with different methods from Jan 2005 to Jan 2010 in our hospital.The relationship between methods and treatment efficiency were appraised objectively.Results Different ways had different advantages,and the total successful rate was 95.4%.The treatment outcomes were evaluated according to three classifications,there were 40 cases belonging to Ⅰ type（27.9%）;92 cases belonging to Ⅱ type（64.8%）;11 cases belonging to Ⅲ type（7.3%）.Conclusion Titanium mimi-plate was a promising reliable method for mandibular fracture treatment,which can surely increase the success rate of treatment.It＇s crucial to select a right method in the mandibular fracture treatment.