改良耳屏切口应用于髁突骨折切开复位内固定术的临床观察

Application of improved tragus incision in reduction rigid internal fixation of mandibular condylar fracture

目的探讨改良耳屏切口在髁突骨折切开复位内固定术应用的效果。方法 16例髁突骨折患者经改良耳屏切口行髁突骨折切开复位内固定术。方法为沿耳屏切开,在外耳道和腮腺后缘间钝性分离,注意保护耳屏处软骨,把腮腺组织向前牵开,这样能把面神经完整地推向前方,不必专门解剖面神经。直视下觅得两骨折段,按原位置和方向复位,以小型钛板坚固内固定。术后半年复诊。结果 16例病例术后伤口均Ⅰ期愈合,咬合关系恢复良好,面部形态满意。术后半个月张口度大于3.0 cm,半个月及半年后X线片检查,髁突复位良好,无骨折部位不愈或延迟愈合表现,无内固定物松脱,愈合后瘢痕隐蔽,美观效果好,均无面神经损伤症状,临床疗效满意。结论改良耳屏切口在髁突骨折切开复位内固定术的应用中,由于其切口隐蔽安全,利于保护面神经及重要血管,减少并发症,是一种恢复解剖形态和关节功能的有效方法。

Objective To explore the operation method and curative effect of improved tragus incision in open reduction and rigid internal fixation of mandibular condylar fracture.Methods Sixteen cases of condylar fractures treated with improved tragus incision of condylar fracture open reduction and internal fixation were included.Tragus incision was applied along the trailing edge,blunt separation was induced between the external auditory canal and parotid gland with careful attention to protect the Tragus Cartilage,and then put forward the parotid gland tissue and facial nerve flap,with no need of special anatomy of the facial nerve.Under direct vision to find the fractured section,according to the original position and orientation of the reset,and to rigidly fixed with mini titanium plate,and finally followed-up for half year.Results After half a year,healed scar was very subtle,without any symptoms of injury to the facial nerve and condylar restoration effect was good.Conclusion Improved tragus incision in the condylar fracture open reduction and internal fixation of the application provides the hidden incision,safety and conducive to the protection of the facial nerve and blood vessel,reduces complications.