鼻内镜下PRP凝胶在上颌窦前壁粉碎性骨折手术中的应用研究

Study on Application of PRP Gel in the Operation of comminuted Fracture in Anterior wall of maxillary sinus under Nasal Endoscopic

目的探讨PRP凝胶在用可吸收材料固定的上颌窦前壁粉碎性骨折的临床应用价值及鼻内镜临床应用的优越性。方法选56例上颌窦前壁粉碎性骨折采用可吸收材料固定加PRP凝胶贴敷治疗(鼻内镜直视下手术28例;常规无影灯照明下治疗28例);对照组54例单纯采用可吸收材料固定(鼻内镜直视下手术27例;常规无影灯照明下治疗27例)。对于上颌窦前壁粉碎性骨折采用距下睑缘下3.0 mm切口,并于眶骨缘下2 mm处做骨膜横切口,暴露骨折处,同时分离嵌顿的肌肉和其他组织并拉至解剖位置,并分别吸出和刮出(鼻内镜下或无影灯下)上颌窦内的积血及病变坏死组织,取适当大小的可吸收材料固定骨折处(如果骨片太碎也可先用医用耳脑胶粘合之),56例患者采用制备好的PRP凝胶贴敷骨折处,分层缝合骨膜、皮下组织及皮肤。结果随访12个月,治疗组患者术后恢复快、无感染,皮肤瘢痕细小、光泽好,可吸收材料吸收好;骨折愈合好,双侧面部对称,眼睑无肿胀。咬合关系正常。鼻内镜下手术时间明显缩短(平均比无影灯下手术缩短25 min)、出血量减少(平均减少60 ml)、术后组织消肿明显加快(平均缩短3.0天)。结论 PRP凝胶能促进皮肤伤口和骨折的快速愈合、能使皮肤瘢痕变细、皮肤光泽水嫩,PRP凝胶可适用于上颌窦前壁粉碎性骨折的修复和重建;鼻内镜下手术:视野好、清除坏死组织彻底干净,出血少且费时短,值得临床推广应用。

Objective To explore the clinical application value of PRP gel with absorbable fixation materials of anterior wall of maxillary sinus comminuted fracture; To explore the superiority of the clinical application of nasal endoscopy. Methods 56 cases of anterior wall of maxillary sinus comminuted fracture with absorbable fixation with PRP gel sticking therapy （nasal endoscopic surgery, and 28 cases; conventional shadowless lamp illumination under treatment of 28 cases） ; the control group （54 cases） treated with absorbable fixation material （27 cases of nasal endoscopic operation; often gauge shadowless lamp illumination treatment in 27 cases） . For maxillary sinus comminuted fractures were treated from 3.0mm incision under eyelid and orbital margin 2mm do transverse incision was made in the periosteum, exposure of the fracture site, also separated block tons of muscle and other tissue and pulled to the anatomic location, and aspiration and curettage （under nasal endoscope or under shadowless lamp） of maxillary sinus in the product of blood and necrotic tissue and take the appropriate size of the absorption fracture fixation material （if bone too broken can be first with medical ear brain glue） , 56 patients with PRP gel prepared sticking fracture, hierarchical suturing to the periosteum, subcutaneous tissue and skin. Results Follow up in December, the treatment group of patients recovered fast, no infection, skin scar small, shiny, absorbable material absorption good; fracture healing, bilateral facial symmetry, no swelling of the eyelids. Normal occlusal relationship. Under nasal endoscope operation time was significantly shortened （on average than under shadowless lamp operation relationship 25 minutes） , bleeding decreased （average reduction of 60ml） , postoperative tissue swelling significantly accelerate （shorten the average 3.0 days） . Conclusion PRP gel can promote skin wounds and fractures heal quickly, can make the skin scar thinning, skin supple, shiny, PRP gel can be applicable to the anterior wall of maxillary sinus fracture repair and reconstruction of the milling; nasal endoscopic surgery with a nice view, removing necrotic tissue completely clean, less bleeding and shorter time, it is worth of clinical application.