髁状突骨折治疗的临床分析

Clinical Analysis of Treatment for Fracture of Condylar Process

目的评价髁状突骨折治疗效果,总结治疗经验。方法方便选取该院2010—2015年接诊120例下颌骨髁状突骨折,其中82例采用切开、复位坚固内固定治疗,其余采用保守治疗。术式采用耳屏前垂直向下做切口,4例超过耳垂,显露困难14例做辅助切口,适当延长切口;1例儿童患者,悬颅颌弹力固定,固定2周,早期进行开口训练,1周后,评价愈合情况,咬合不佳者,适当延长牵引时间,部分患者进行修整。结果手术均获得成功,术后随访时间6~10个月、平均(7.4±1.4)个月;术前张口度低于术后(3.3±0.3)mm,术前张口偏斜发生率、颏点偏斜低于术后5.0%、(0.5±0.2)mm,差异有统计学意义(P<0.05);术后住院期间并发症发生42例次,对症处理后好转,末次随访未见咬合不良等并发症。结论髁状突骨折治疗方法基本成熟,内固定治疗是首选,术后早期并发症发生率高,需做好对症处理。

Objective To evaluate the treatment effect for fracture of condylar process and summarize the treatment experience. Methods 120 cases of patients with fracuture of mandibular condyloid process admitted and treated in our hospital from 2010 to 2015 were convenient selected, and 82 cases were treated with incision and reduction and rigid internal fixation, and the other adopted the conservative treatment, the operative way was making temporo-preauricular incision vertically downward, 4 cases exceeded the earlobes, 14 cases were extremely difficult to be exposed and the auxiliary incision was made and the incision was properly extended, 1 case of child was fixed by the Xuanlu elasticity for 2 weeks, and the mouth open training was conducted in the early period, and the healing situation was evaluated after 1 week, and for the persons with malocclusion, the pull-in time was properly prolonged, and some patients need to be adjusted. Results The operation was successful, the postoperative follow-up time was from 6 month to 10 month, and the average time was（7.4 ±1.4）months, and the preoperative mouth opening degree was lower than that after operation, the incidence rate of mouth opening deviation and genion deviation before operation was lower than those after operation, and the preoperative mouth opening degree, incidence rate of mouth opening deviation and genion deviation after operation were respectively（3.3±0.3）mm, 5.0% and（0.5±0.2）mm, and the differences had statistical significance（P0.05）, 42 cases were with complications during the hospitalization period after operation, and improved after the symptomatic treatment, and the last follow-up showed that there was no complications such as malocclusion. Conclusion The fracture of condylar process treatment method is basically mature, and the internal fixation is the first choice, and the incidence rate of early complications after operation is high, and we need to do a good job in the symptomatic treatment.