颧骨复合体骨折不同手术切口的对比观察

Comparative study of incisions in the treatment of zygomaticomaxillary complex fractures

目的比较经头皮(半)冠状切口和面部小切口应用于颧骨复合体骨折治疗的临床效果与并发症。方法对2002~2017年收治的50例颧骨复合体骨折按照手术入路分为冠状切口组(28例)和面部小切口组(122例)。冠状切口组采取耳前颞顶部发际线后切口,小切口组以眉外侧切口、面部小切口或经伤口入路。2组必要时可以结合口内前庭切口或经瘢痕切口。全麻下行骨折内固定术,骨折固定部位以眶下缘、颧额缝及颧上颌支柱三维固定为主。对临床资料、骨折类型及术后并发症进行分析总结。纳入病例者术前术后摄华特位(Waters View)或CT片,术后的X线或CT片可提供骨折块复位和钛板放置部位的详细情况,以及固定稳定性的资料,对患者的面部形态和咬合功能进行评价。结果2组病例全部患者均一期愈合,2种切口皆能够达到复位固定的要求,各自选择的适应证有所不同。冠状切口组骨折固定部位以颧颞缝、颧额缝及颧上颌支柱三维固定为主,小切口组以眶下缘固定代替颧颞缝固定,同样可以达到稳定固位的目的。冠状切口的并发症为:切口周围麻木(2例),额纹变浅(1例),颞部凹陷及局部脱发。小切口组除不明显的切口瘢痕外未见明显并发症。结论面部小切口能够满足复位固定的要求,美观上也能为患者接受。冠状切口对于陈旧性骨折、移位明显骨折或复杂粉碎性骨折有独特优势。

Objective To compare the clinical effects and complications of scalp (half)coronal incision and lateral eyebrow plus small facial incision in the treatment of zygomaticomaxillary complex (ZMC)fractures.Methods A total of 50 cases of ZMC fractures admitted from 2002 to 2017 were divided into two groups according to the surgical approach, namely the coronary ineision group (28 cases)and the facial small incision group (122 cases).In the coronal incision group,anterior temporal-parietal hairline and posterior incision were used as incision approaches.In the sm.all incision group,lateral eyebrow incision,facial incision or transineisonal approach were used as incision approaches.Both groups can be combined with intraoral vestibular incision or scarring incision when necessary.The internal fixation of fractures was performed under general anesthesia,and the main fracture fixation sites were the infraorbital margin,zygomaticofrontal suture and zygomaticomaxillary pillar.The clinical data,fracture types and postoperative complications were analyzed and summarized.Preoperative and postoperative Waters View or CT images,and postoperative X-ray or CT examination were performed to observe the detailed situation of fracture block reduction and titanium plate placement,as well as the data of fixation stability,and to evaluate the facial morphology and occlusal function of the patients.Results All the patients in the two groups were healed in the first stage,and both types of incision could meet the requirement of restoration and fixation,and their indications were different.The fixation site of the fracture in the coronal incision group was dominated by three -dimensional fixation of the zygomatic temporal suture,zygomatic frontal suture and zygomatic upper mandibular column.The complications of coronal incision were:periincision numbness (2 cases),superficial forehead striae (1 case),temporal depression and local hair loss.There were no obvious complications in the small incision group except inconspicuous incision scar.Conclusions The smaU facial incision can meet the requirements of reduction and fixation and is aesthetically acceptable to patients.Coronal incision has unique advantages for old fractures,displaced fractures or complex comminuted fractures.