运用新分类法指导髁突囊内骨折的治疗

A new classification for intracapsular condyle fractures

目的本研究基于"髁突-关节盘"复合体观点提出一种新分类法,并尝试通过一项前瞻性研究初步论证新分类法的可行性及临床价值。方法从2010年至2014年,选择单侧髁突囊内骨折成年患者纳入研究并分为三类:A类(存在升支高度降低伴随或不伴随关节盘移位);B类(升支高度不变但存在关节盘移位);C类(升支高度不变且关节盘无移位)。A、B两类骨折采取手术治疗,C类骨折采取保守治疗。通过CT、MRI以及各项功能检查评估患者疗效及新分类法的临床价值。结果共有55例患者纳入研究(A类:31,B类:17,C类:7),除一位A类骨折患者术后反映关节区疼痛,所有患者患侧关节在解剖形态以及功能恢复上均达到健侧水平。结论本研究初步证明了新分类法能够有效地指导髁突囊内骨折的临床治疗,强调了关节盘位置对于囊内骨折诊疗及预后的重要性。

Objective In this study we proposed a new classification based on the concept of＂disc-condyle＂unit and aimed to validate the feasibility and clinical values of this classification. Methods From 2010 to 2014,adult patients with unilateral intracapsular fractures were included and classified into three types. Type A was defined by reduction of the mandibular height with or without disc displacement. Type B had disc displacement without mandibular height reduction. Type C had no mandibular height reduction nor disc displacement. Open reduction and fixation treatment was performed for both type A and B fractures,while type C fractures were managed nonsurgically. CT,MRI,and function examination were conducted to evaluate patients＇ prognosis and the clinical values of the new classification. Results There were 55 patients included in this study,31 with type A,17 with type B,7 with type C. In the 6-month follow-up,no differences in vertical ramus height,mandibular deviation,protrusion and lateral protrusion were observed between the fractured and healthy sides. All patients had normal occlusion and functional recovery post-operatively and only one patient in type A was reported to have pain in the joint area. MRI and CT examination showed good osseous healing and disc-condylar relationship in all cases. Conclusion This study shows the effectiveness of the new classification,and the importance and the necessity to recover the position of the articular disc in the treatment and prognosis of ICFs.