口内入路治疗髁突低位骨折

Treatment of Subcondylar Fractures through Intraoral Approach

目的:探讨口内入路治疗髁突低位的安全性及有效性。方法:回顾性研究本院2014年1月~2016年4月所收治8例髁突低位骨折的患者,选择口内入路对髁突低位骨折进行切开复位内固定术。结果:8例患者,10侧髁突低位骨折,其中5例患者合并下颌骨体部骨折。髁突低位骨折患者行内窥镜辅助下穿颊器或侧壁螺丝刀口内入路进行手术治疗。术后患者创口均Ⅰ期愈合,未发现面瘫及涎瘘等并发症,术后复查全口曲面断层片和三维CT示骨折断端对位良好。3个月后复查,面部无明显疤痕,张口度正常,咬合关系良好。结论:利用穿颊器或侧壁螺丝刀口内入路治疗髁突低位骨折,相对于传统的耳前、颌下及颌后入路,手术创伤小,面部无明显瘢痕,外形良好,配合内窥镜的使用,更加便于直视下完成骨折复位固定,是治疗髁突低位骨折安全有效的手术入路。

Objective：To investigate the safety and efficiency of surgical treatment for subcondylar fractures though intraoral approach.Methods：This is a retrospective study of patients with subcondylar fractures who underwent surgical open reduction and internal fixation through intraoral approach in our department from January 2014 to April 2016.Results：Eight patients with 10 subcondylar fractures were treated,5 of which were associated with mandibular body fractures.All of them underwent treatment of surgical open reduction and internal fixation by transbucal instrument or angular screwdriver though intraoral approach.All patients healed by first intention,and no patients were observed facial paralysis and salivary fistula.Orthopantomography and 3DCT showed that apposition of fractures were good.After 3months,no obvious scars were observed on facial incision,and X-ray showed subcondylar fractures anatomical reduction.Conclusion：There is advantageous in an intraoral and transoral or angular screwdriver approach than preauricular,retromandibular or submandibular approaches,such as small incision,satisfactory appearance and quick recovery.Fracture reduction and fixation can be performed by using the endoscope.It is a safe and efficient approach for open reduction and internal fixation of subcondylar fracture.