成人髁突骨折三种切口术式在切口选择、止血、面神经损伤的观察研究

Adult Condylar Fractures Three Incision in the Choice of Incision,Stop Bleeding,Observation of Facial Nerve Injury

目的 :讨论归纳比较成人髁突骨折三种切口术式:耳屏前切口、腮腺入路切口、下颌下切口及其在切口、止血、面神经损伤中的不同,达到最大程度管控手术风险及获得后期包括功能恢复等满意疗效。方法:对于耳屏前切口术式,采用本科室手术患者手术全程观察,作为实验组对象;对于腮腺入路切口术式及下颌下切口术式,在其他条件与耳屏前切口术式基本相同的条件下(髁突骨折部位均为单侧高位)采用相关文献资料查阅,作为观察组对象。进而通过观察演绎,以比较三种切口术式在切口、止血、面神经损伤中的不同。结果:1)实验组在术中损伤面横动脉导致大出血,紧急采取纱布块填塞、结扎止血后顺利完成手术;2)实验组、对照组显示不同切口术式由于切口选择位置、开放式手术入路的不同,对于术中止血难度、面神经保护,以及术后功能恢复、瘢痕愈合存在不同影响,文中将展开具体论述。结论:1)三种切口术式对于不同的病例选择各有优缺点,耳屏前切口术式(本科室按照四类手术进行)由于该区域存在上颌动脉等重要知名动脉对手术者要求较高,存在较高的手术风险。而其由于切口术野暴露充分,术者可以通过患者口内配合口外暴露的开放式术野利用手感将断开的髁突固定,对于辅助切口的要求不高甚至不需要辅助切口,该入路切口比较隐蔽故患者术后伤口遗留瘢痕较少适合于亚洲等瘢痕体质者。腮腺入路切口术式切口面积较小,可以避开知名动脉减少术中大出血(注意保护面横动脉),同时手术视野暴露充分,大大降低了手术风险,但术中易损伤面神经(在进入面神经颊支和下颌缘支之间较宽的间隙之前)以及术后可遗留较明显瘢痕,故适合欧美非瘢痕体质者。下颌下切口术式由于切口位置可以事先寻找面神经下颌缘支,将其分离出来并牵开保护,同时结扎面动脉和面静脉,但术中视野对术者提出了较高的要求,有时需要将切口向下颌支后延伸或辅助切口的添加对于术后美观要求也较高。2)三种切口术式只要术中髁突固定完成,对于术后的功能恢复没有明显差异,其差异主要体现在术中不同切口手术入路对于止血、面神经的保护,以及术后出现瘢痕的不同。

Objective：Discuss three incision inductive compare aduh condylar fracture surgery：before tragus incision,parotid gland into the way of incision and incision under the jaw and its different in incisiou,hemostatic,facial nerve injury,to achieve maximum control operation risk,including late for functional recovery satisfied curative effect,etc.Methods：For before the tragus incision,take undergraduate course room surgery patients as observation,as the experimental object;For pamtid gland in the incision and incision under the jaw,in front of the other conditions and tragus incision under the condition of the same basic （condylar fracture of unilateral high）USES the related literature review,as observation group object,in turn, by observing the deduction,to compare three incision in different incision,hemostatic,facial nerve injury.Results：l ）the experimental group in intraoperative injury surface transverse artery hemorrhage, urgent gauze tamponade,ligation hemostasis after successfully completed surgery;2）the experimental group and control group according to different incision operation because the incision location,open the different surgical approach,the difficulty,facial nerve protection,intraoperative bleeding and postoperative function recovery,scar healing exist different influence,this paper will unfold.Conclusion：l）three types of incision for different cases choose each have advantages and disadvantages,before tragus incision（undergraduate course room shall be carried out in accordance with the four types of surgery）becanse the area of maxillary artery and other important well-known artery rival performer the demand is higher,there is a higher risk of surgery.And because the incision operative field exposure,fully performer can cooperate esrtuary exposed patients mouths open operative field using the touch will disconnect the condylar fixed, not tall to the requirement of auxiliary incision don＇t even need to auxiliary incision,the approach of incision hidden reason were compared postoperative wound left scar less suitable for Asia scar constltution.Parotid gland into the way of incision surgical incision area is lesser,can avoid the well-known arteries reduce intraoperative hemorrhage （pay attention to protect surface transverse artery）,at the same time exposed to full field,greatly reduce the risk of surgery,but the operation is easy injury of facial nerve （into the facial nerve buccal branch and the mandibular margin before a wide gap between） and postoperative legacy is obvious scar,so it is suitable for Europe and the United States without scar constitution.Jaw incision under the incision can looking for facial nerve mandible margin in advance,it is isolated and open protection,artery and vein ligation surface at the same time,but in view of performer puts forward higher requirements,sometimes need to be cut or auxiliary incision after mandibular branch to extension to add for postoperative beautiful request also is higher.2）three incision intraoperative condylar fixed to complete,as long as there was no difference for postoperative functional recovery,the difference is mainly manifested in different intraoperative incision surgical approach to the protection of hemostatic,facial nerve, and postoperative scarring.