颌间牵引联合颌垫治疗儿童髁突骨折的疗效评估

SCREW-BASED INTERMAXILLARY TRACTION COMBINED WITH OCCLUSAL SPLINT FOR TREATMENT OF PEDIATRIC MANDIBULAR CONDYLAR FRACTURE

目的探讨牵引钉颌间牵引联合颌垫治疗儿童髁突骨折的疗效。方法 2005年6月-2013年12月,收治35例（49侧）髁突骨折患儿。男25例,女10例;年龄3～13岁,平均7.3岁。致伤原因：跌伤18例,交通事故伤14例,暴力伤3例。受伤至就诊时间2～30 d,平均6.8 d。除3例不配合患儿外,其余患儿均出现不同程度张口受限,最大开口度为（22.74±7.22）mm。按部位分左侧髁突骨折12例,右侧9例;双侧14例;按骨折线分为囊内骨折35侧,髁突颈部骨折10侧,髁突颈下骨折4侧。采取口内上、下颌前牙区颌骨内植入4枚牵引钉并悬挂橡皮圈以达到颌间弹性牵引,配合使用患侧磨牙区加厚的颌垫;治疗后1个月拆除牵引钉及颌垫,并定期复诊。结果治疗期间除1例出现牵引钉松脱外,余均无牵引钉相关并发症发生。35例患儿均获随访,随访时间6个月～8年10个月,中位时间71个月。末次随访时,患儿最大开口度为（38.82±2.02）mm。4例出现轻度关节弹响,6例出现开口时下颌偏斜。影像学检查示,24例（32侧）髁突骨折完全改建,余11例（17侧）至末次随访时髁突骨折中度改建。结论利用颌间牵引钉的前牙区弹性牵引,配合磨牙区颌垫是治疗儿童髁突骨折的理想方法之一。

Objective To evaluate the effectiveness of the screw-based intermaxillary traction combined with occlusal splint in the treatment of pediatric mandibular condylar fracture. Methods Between June 2005 and December 2013, 35 pediatric patients with 49 mandibular condylar fractures were treated, and the clinical data were retrospectively reviewed. There were 25 boys and 10 girls, aged 3-13 years（mean, 7.3 years）. The injury causes included falling（18 cases）, traffic accident（14 cases）, and violence（3 cases）. The time between injury and treatment was 2-30 days（mean, 6.8 days）. Restricted mouth opening was observed, and the maximal mouth opening was（22.74±7.22） mm except 3 patients who were too young to measure. Condylar fractures were located at the left（12 cases）, at the right（9 cases）, at bilateral（14 cases） based on the sites; and fractures were classified as intra-capsular（35 fractures）, neck（10 fractures）, and subcondylar（4 fractures） based on the fracture line. Four self-drilling titanium screws were inserted into the alveolar bone of both maxilla and mandible. After screw inserting, an occlusal splint with a fulcrum was used on the affected side and elastic band was put to perform anterior intermaxillary traction. After 1 month, the screws and splint were removed. Follow-up examinations were carried out on schedule. Results All the patients were followed up from 6 months to 8 years and 10 months（median, 71 months）. No screw-related complication occurred in the others except one case of screw loosening. The postoperative maximal mouth opening was（38.82±2.02）mm. Mild joint noise was found in 4 cases and opening deviation occurred in 6 cases. Radiographic results demonstrated complete condyle remodeling was achieved in 24 cases（32 fractures）, and moderate remodeling in 11 cases（17 fractures） at last follow-up. Conclusion The screw-basedintermaxillary traction combined with occlusal splint might be an effective method for pediatric mandibular condylar fracture. The screw-related complications may be avoided by careful preoperative investigations.