颌面部多发骨折临床特点的探讨

Complex Fractures of the Facial Skeleton

目的:分析下颌骨不同骨折类型的骨折特点和并发症防治。方法 :312例下颌骨骨折经螺旋CT三维重建检查,将下颌骨骨折分型,分析其伴发骨折部位和特点。对下颌骨骨折行复位内固定术,伴髁突后上移位者配合磨牙区置垫的颌间弹性牵引治疗。结果:下颌骨单发线状骨折164例,多发线状骨折102例,粉碎性骨折46例。合并上颌骨骨折38例,颧骨骨折12例,鼻骨骨折13例,伴发外耳道前壁骨折48例,髁突后移位10例。髁突矢状骨折伴发外耳道前壁骨折比例,与其他类型比较差异有统计学意义(P<0.01);颏部合并髁突矢状骨折伴发外耳道前壁骨折比例,与单独颏部或髁突骨折比较,差异有统计学意义(P<0.01)。3例发生外耳道闭锁,2例术后发生颞颌关节强直,3例髁突后移位复位不良。结论:下颌骨骨折可为单发、多发及粉碎性,可合并上颌骨、颧骨、鼻骨、外耳道前壁骨折及髁突后移位。颏部、髁突矢状骨折易伴发外耳道前壁骨折,颏部合并髁突矢状骨折者伴发外耳道前壁骨折、髁突后移位的比例显著增高。诊治中应注意预防外耳道腔狭窄、颞下颌关节强直、关节后脱位等并发症发生。

Objective：To summarize characteristics and prevention of complications of different types of fractures of the facial skeleton.Methods： 312 patients with mandibular fractures were examined by CT and Spiral 3D-CT reconstruction and classified into different types of fractures.Mandibular fractures associated with fracture of the tympanic plate,condylar process retrodisplacement,and fractures of maxilla,zygoma and nasal bones were analyzed.Reduction of fractures and internal rigid fixation（IRF） were used for the treatment of mandibular fractures.Besides,patients who have condylar backward-upward displacement were treated with intermaxillary elastic traction combined with occlusal pad after surgery.Results： 164 cases of mandibular fractures were single linear fracture,102 cases were multiple linear,46 cases were comminuted fractures.Among them,38 cases were associated with maxillary fracture,12 cases with zygoma fracture,13 cases with fracture of the nasal bone,48 cases with fractures of tympanic plate,10 cases with condylar fracture and retrodisplacement.There was significant difference between incidence of sagittal fracture of the condyle accompanying with anterior wall fracture of external auditory canal and that of other types（P0.01）,there was significant difference between incidence of mentum and condyle sagittal fracture accompanying with anterior wall fracture of external auditory canal and that of fracture of mentum or condylar process（P0.01）.3 cases complicated with obstruction of external auditory canal.2 cases resulted in ankylosis of the temporomandibular joint,3 cases occurred dislocation of temporomandibular joint.Conclusion： The mandibular fractures manifested as single linear fracture,multiple fracture and comminuted fracture,in association with fractures of other facial skeletons.The proportion of mandibular mentum and condyle sagittal fracture accompanying with fractures of anterior wall of external auditory canal was significantly increased.Attention should be paid on the prevention of complications as stenosis of external auditory canal,ankylosis and posterior dislocation of the temporomandibular joint.