微型钛板治疗下颌骨髁突囊内骨折的疗效评价

MINI TITANIUM PLATE FOR TREATMENT OF INTRACAPSULAR CONDYLAR FRACTURES

目的探讨使用微型钛板治疗A型下颌骨髁突囊内骨折的疗效。方法 2013年3月-2015年7月,采用经耳前切口入路复位、微型钛板内固定治疗A型髁突囊内骨折22例（26侧）。其中男13例,女9例;年龄16-32岁,平均22.7岁。致伤原因：交通事故伤17例,坠跌伤4例,重物撞击伤1例。单纯髁突囊内骨折5例,余均伴上、下颌骨等其他部位骨折。患者均伴不同程度开口受限、咬合关系紊乱及关节区疼痛,最大开口度为5-16 mm,平均8.6 mm。伤后至手术时间2-9 d,平均4 d。术后采用Helkimo指数中的临床检查功能障碍指数（clinical dysfunction index,DI）评价下颌运动功能,根据1999年下颌骨髁突骨折国际共识性会议提出的4项最基本髁突骨折治愈标准及何冬梅等提出的最大开口度范围综合评价效果。结果术后切口均Ⅰ期愈合,无感染等并发症发生。22例均获随访,随访时间5-8个月,平均6个月。术后1周螺旋CT冠状位扫描及三维重建显示骨折均对位良好,髁突位于关节窝内。术后6个月复查最大开口度为33-42 mm,平均35.7 mm。术后3例出现开口型偏患侧,侧向运动受限。末次随访时,根据Helkimo指数中的DI评价方法,DI 0级7侧,DIⅠ级18侧,DIⅡ级1侧。根据髁突骨折治愈标准评价：恢复外伤前咬合关系19例（86.36%）,最大开口度≥35 mm 20例（90.91%）,关节无症状或与创伤前相仿19例（86.36%）,无严重术后并发症22例（100%）;以上4项均符合者17例（77.27%）。结论微型钛板治疗A型下颌骨髁突囊内骨折切实可行。

Objective To investigate the effectiveness of mini titanium plate for the treatment of intracapsular condylar fractures-type A. Methods Between March 2013 and July 2015, 22 cases（26 sides） of intracapsular condylar fractures-type A were treated with mini titanium plate through anterior auricular approach. There were 13 males and 9 females, aged from 16 to 32 years（mean, 22.7 years）. The disease causes were traffic accident injury in 17 cases, falling injury in 4 cases, and heavy impact injury in 1 case. Five cases had intracapsular condylar fractures-type A only, and the other cases were accompanied with fractures of mandible, maxillary, or other part of jaw. All patients had different degrees of limitation of opening mouth, occlusal disorder, and joint pain, and the maximum opening was 5-16 mm（mean, 8.6 mm）. All patients received surgical treatment within 2 to 9 days after injury（mean, 4 days）. The clinical dysfunction index（DI） of Helkimo index was used to evaluate the mandibular motor function postoperatively. According to the 4 basic criterion of cure about mandibular condylar fractures by the international consensus conference in 1999, and maximal mouth opening by HE Dongmei et al., the surgical treatment effectiveness was evaluated. Results All wounds healed at stage I, with no infection or other complications. All 22 cases were followed up 5-8 months（mean, 6 months）. At 1 week after operation, the coronal spiral CT and three-dimensional reconstruction showed that contraposition of fractures was good, and the condyles located in the articular fossa. At 6 months after operation, the maximum opening was 33-42 mm（mean, 35.7 mm）. After operation, 3 cases showed the mandible deflected to the affected side when opening, and limited lateral motion. According to the DI evaluation method in Helkimo index, there were 7 sides of DI grade 0, 18 sides of DI grade I, and 1 side of DI grade II. Based on surgical treatment effect of intracapsular condylar fractures-type A, occlusion recovery was obtained in 19 cases（86.36%）, maximum opening degree of ≥ 35 mm in 20 cases（90.91%）, no symptoms of joint injury in 19 cases（86.36%）, and no serious postoperative complications in 22 cases（100%）; 17 cases（77.27%） were in accordance with the above 4 items. Conclusion Mini titanium plate is one of the most effective approaches to treat intracapsular condylar fractures-type A.