儿童及青少年单侧髁突骨折保守治疗的影像及咀嚼生理学疗效评估

Radiographic and masticatory physiologic evaluation after conservative treatment of condylar fractures in children and adolescents

目的 探讨影像及咀嚼生理学检测手段评价儿童及青少年髁突骨折保守治疗疗效的可行性.方法 选取北京大学口腔医学院·口腔医院口腔颌面外科确诊的8例单侧髁突骨折患者,年龄5～13岁.根据患者年龄、牙弓发育状况、骨折部位及移位情况制作不同厚度的全牙列（牙合）垫.患者按照医嘱戴用（牙合）垫1～3个月,配合早期功能训练.检测指标：临床检查、影像学检查（曲面体层X线、颞下颌关节锥形束CT）、咀嚼肌肌电图.复查时间：伤后1、3、6个月,之后为每年复查1次.每次复查均行临床检查,影像学检查为初次就诊以及伤后半年进行,之后每年1次.结果 8例单侧髁突骨折患者临床检查疗效满意;影像学检查显示：双侧髁突骨皮质光滑连续,患侧髁突短粗且升支高度小于对侧,下颌体长度大于对侧.咀嚼肌肌电图检查显示：患侧咀嚼肌肌电活性低或高于对侧,不对称指数（asymmetry index, AI）咬肌：（15.0±16.9）％、颞肌前束：（21.5±15.9）％、二腹肌前腹：（11.9±10.7）％.结论 儿童及青少年髁突骨折保守治疗后临床疗效满意;颌骨发育受到影响,但程度较轻;健侧与患侧咀嚼肌肌电活性差异较大,不对称指数离散.咀嚼肌肌电图可客观反映儿童髁突骨折后的功能恢复情况.

Objective To evaluate the developmental and functional outcome of condylar fractures in children and adolescents after conservative treatment.Methods Eight children and adolescents with unilateral condylar fracture, aged 5-13 were included.A removable occlusal splint, the thickness of which was determined according to the age, the developmental stage of the dentition, the level of the fracture and the degree of dislocation, worn for 1-3 months, and the patients were asked to perform functional exercises.The patients were followed up by clinical observation, panoramic radiograph, temporomandibular joint（TMJ） cone beam computed tomography（CBCT）, and surface electromyography（sEMG） of masticatory muscles （superficial masseter, anterior temporalis, and anterior digastric muscles）.Ramus height and body length of mandible were measured on panoramic radiograph.The patients were asked to return for follow-up visits at 1, 3, and 6 months after treatment, and then once a year.The patients underwent clinical examination at each follow-up visit, and radiological examinations at 6 months and then annually.Results All the patients showed clinically satisfactory results.CBCT showed smooth and continuous cortex.Panoramic X-ray revealed that the ramus height was shorter in the fractured side than in the contralateral side, while body length was longer.The mean asymmetry index（AI, （x） ± s） for ramus height and body length were （3.29±2.68）% and （4.01 ± 2.54）%.sEMG showed either hypertension or hypotension in the masticatory muscles of the fractured side and asymmetries were obvious.The mean AI for sEMG activity of the anterior temporalis, masseter, and anterior digastric muscle were masseter： （15.0 ± 16.9）%;anterior temporalis： （21.5 ± 15.9）%;anterior digastric muscles： （11.9 ± 10.7）%.Conclusions Conservative treatment of condylar fracture in children and adolescents had clinically satisfactory results, while mandibular development was slightly interrupted.Asymmetries of EMG activities of masticatory muscles were obvious.EMG could objectively reveal the functional recovery of condylar fracture in children.