不同手术入路切开复位内固定下颌骨角部和升支骨疗效分析

Clinical curative effect analysis of different approach for fractured mandible angle and mandible ramus

目的探讨从口内和穿颊的手术入路复位内固定下颌骨升支及下颌角骨折的手术方法及疗效。方法选择2005年10月-2011年12月28例下颌骨升支及下颌角骨折患者,采用穿颊器经过颊部小切口联合口内切口复位内固定(口内组)。随机选取同期34例同类型骨折患者,按照传统口外入路行手术切开复位内固定(口外组),对两组患者的临床疗效及并发症进行对比分析。结果口内组患者无面神经损伤,面、颈皮肤无手术瘢痕,口内组18例患者术中咬合关系恢复理想。口外组20例患者内固定术后咬合关系欠佳,需行术后颌间结扎固定。口外组14例患者内固定术后出现暂时性面瘫,28例患者出现面部瘢痕,2例出现涎瘘。两组术后面部瘢痕及暂时性面瘫发生率比较差异有统计学意义(P<0.05)。结论口内和穿颊手术入路具有无外部瘢痕形成、不会损伤面神经等优势,是下颌骨升支及下颌角骨折的一种理想的治疗方法。

Objective To discuss the different application and effects of self-made transbuccal pipe for fractured mandible angle and mandible ramus. Methods Twe mandibular ramus fractures were treated by screwed miniplates nt P y eight cases with mandibular angle and laced through a transbuccal incision with self-made transbuccal pipe from October 2005 to December 2011 （intraoral approach group）. 34 cases trea ted through extraoral approach were treated as the controls （extraoral approach group）. The clinical efficacy and complications were analyzed between two groups. Results Eighteen patients treated by intraoral approach and 20 cases by extraoral approach required a period of maxillamandibular fixation because of fracture fragments mobile. Anatomic reduction was achieved in all cases, without damage to facial nerve and major auricular nerve. 14 patients in extraoral approach group had facial nerve damages and 28 patients happened large facial scars, 2 patient had salivary fistula. All cases regained their natural occlusion. The postoperative facial scar and temporary paralysis occurring rate had significant differences between two groups （P d0.05）. Conclusion The intraoral approach is a reliable surgical selection for fractures of the ramus and angle of mandible, without leaving extensive visible scars or damaging facial nerve.