内镜辅助开放手术治疗髁突下颌支联合体骨折

Endoscopy-assisted open treatment for fractures of the mandibular ramus-condyle unit

目的探讨内镜技术在手术切开复位内固定治疗髁突．下颌支联合体骨折中的应用。方法16例（18侧）髁突．下颌支联合体骨折患者中，2侧髁颈部骨折，11侧髁颈下骨折，5侧下颌支骨折；6侧髁突骨折段无明显移位，10侧髁突骨折段有明显移位，2侧髁突骨折段脱位。术中经口外入路或经口内入路，在内镜监视下复位移位的骨折段，并利用穿刺套管完成内固定。结果所有患者手术顺利，患者恢复原有的咬合关系，骨折段复位；术后随访12～36个月，关节功能良好、骨折固定稳固、无严重并发症。结论经口内入路或经口外入路内镜辅助手术复位内固定治疗髁突-下颌支联合体骨折具备可行性；该手术方式具有微创和美观等优点。

Objective To describe the use of endoscopic technique for exposure of the mandibular ramus-condyle unit （RCU） to facilitate reduction and rigid fLxation of the fractures. Methods Sixteen patients （ 18 sides） with diagnosis of subcondylar fracture （ 11 sides）, condylar neck fracture （ 2 sides ）, and mandibular ramus fracture （5 sides ）, who underwent endoscopic exposure of the RCU and fixation with miniplates by an extraoral or transoral approach. Six sides were no displacement, 10 sides were obvious displacement, and 2 sides were dislocation. Results All patients had successful treatment of fractures of the mandibular RCU,all patients showed quick recovery to preinjury occlusion. Followed up 12-36 months, normal temporomandibular joint function was noted in all patients. No patient had marginal mandibular nerve weakness or other complications. Conclusions It demonstrates the feasibility of endoscopic access to the RCU for treatment of the fractures. The procedures can be performed with minimal morbidity and functional impairment.