74例腭部骨折内固定策略评价

Internal fixation strategies of palatal fracture： a review of 74 cases

目的 评价腭部骨折不同内固定治疗策略的疗效. 方法 回顾性分析2007年10月—2013年10月腭部骨折患者74例,通过门诊随访,观察其咬合及腭部情况,并行CT检查观测骨折复位及愈合情况. 结果 腭部Ⅰ～Ⅵ型骨折分别为8例（11％）、14例（19％）、26例（35％）、12例（16％）、6例（8％）、8例（11％）.术后共随访43例（随访率58％）,其中31例（72％）咬合评估为良好或中等.所有骨折愈合良好,均无腭部相关感染、钛板外露、口鼻瘘等并发症.43例中27例腭部矢状骨折（Ⅱ、Ⅲ、Ⅳ型）,颧上颌支柱及鼻上颌支柱均固定（17例）较单纯颧上颌支柱固定（10例）术后咬合评价成功率高（82％：80％）,但差异无统计学意义（P＞0.05）;上颌骨垂直支柱及牙槽部均固定（12例）较单纯上颌骨垂直支柱固定（15例）成功率高（100％：67％,P＜0.05）.结论 腭部骨折早期完整的钛板内固定,上颌骨垂直支柱尤其是颧上颌支柱处的固定以及水平方向的牙槽部固定,可获得满意的疗效.

Objective To assess the efficacy of different internal fixations of palatal fracture.Methods Seventy-four patients with palatal fracture admitted between October 2007 and October 2013 were reviewed retrospectively.Through out-patient follow-up,postoperative occlusion and palatal complications were examined and fracture healing was evaluated using CT scan.Results Palatal type Ⅰ-Vfractures involved in 8 patients （11％）,14 patients （19％）,26 （35％）,12 patients （16％）,6 patients （8％）,and 8 patients （11％） respectively.Forty-three patients were available to follow-up,including 31 patients with good or acceptable occlusion.All wounds healed without palate associated infections,plate exposure or oronasal fistula.Of the 27 patients classified as type Ⅱ,Ⅲ and V sagittal palatal fractures,both nasomaxillary and zygomatico-maxillary struts fixation （n =17） and isolated zygomatico-maxillary struts fixation （n =10） had insignificant differences in success rate as to occlusion assessment （82％ vs 80％,P ＞0.05）.Whereas compared with isolated vertical buttress fixation （n =15）,additional immobilization of horizontal alveolar buttresses （n =12） had significantly higher success rate （100％ vs 67％,P ＜ 0.05）.Conclusion Complete rigid fixation at early stage,including vertical buttress fixation,in particular the zygomatico-maxillary struts,and horizontal alveolar buttress fixation can achieve satisfactory outcome.