联合面部小切口穿皮内固定微创治疗颌面部骨折

Minimally Invasive Treatment of Maxillofacial Fractures with Percutaneous Internal Fixation through Small Facial Incision

目的：观察联合面部小切口穿皮内固定微创治疗颌面部骨折的效果，总结经验。方法：对2011-03—2014．04期间收治的87例颌面部骨折病例，采用口内切口或颞部发际内切口显露骨折，并联合面部皮肤小切口，应用穿皮技术进行内固定治疗。观察穿皮操作技术的可行性。观察术后有无面神经损伤、腮腺导管损伤和涎瘘，并评价手术治疗效果。结果：87例病例中．81例采用口内切口，6例采用颞部发际内切口显露骨折，经面部小切口穿皮内固定手术均顺利完成。穿皮操作未发现有面神经分支损伤、腮腺导管损伤和涎瘘等症状。采用口内切口中有5例术后伤口有渗出，伤口延期愈合，其中3例术后反复感染。术后1～3个月复查，x线检查发现1例髁颈下部骨折错位固定，87例患者面部外形对称．面部小切口瘢痕不明显．张口和咬合功能恢复正常。结论：联合面部小切口穿皮内固定技术为颌面部某些骨折内固定提供了可行的垂直手术通道．该方法手术创伤小，骨折固定可靠，术后并发症少，不影响面部皮肤美观．

Objective： To observe the effects of minimally invasive approaches with percutaneous internal fixation in the treatment of maxillofacial fractures. Methods： From 2011-01--2014-04, 87 cases of maxillofacial fracture patients were undergone intraoral or temporal intra-hairline incision to expose the fracture sites and combined with percutaneous inter- nal fixation through small facial incisions. After reduction, the feasibility and postoperative effects, the incidence of facial nerve injury, parotid duct injury, and salivary fistula complications were observed.and recorded. Results： In order to ex- pose fracture site, intraoral incision approach was used in 81 patients, and temporal intra-hairline incision approach was used in 6 patients. At the same time, through small facial incision and by using percutaneous internal fixation technique, the operations of all 87 cases were successfully completed. Percutaneous internal fixation technique did not cause facial nerve branch injury and parotid duct injury, did not cause salivary fistula. In patients of intraoral incision, 5 cases under- gone infection, and the wound healing was delayed. Postoperative examination by X-ray, a misplaced fixation of fracture was found in 1 patient. After 1-3 months follow-up, the facial appearance of 87 patients was symmetrical, the scar of small facial incision was not obvious. The mouth opening and occlusion function returned to normal. Conclusion： The method of percutaneous internal fixation through small facial incision provides a feasible vertical fixation channel for operative treat- ment of some maxillofacial fractures.