应用小型钛板治疗下颌骨髁状突创伤性骨折对患者咬合功能的影响及预后分析

Effect of Surgical Treatment with Small Titanium Plate on the Occlusal Function of the Patients with the Traumatic Fracture of Mandibular Condyle and the Analysis of the Prognosis

目的:研究应用小型钛板治疗下颌骨髁状突创伤性骨折对患者咬合功能的影响并分析其预后。方法:选取2014年1月-2017年1月于笔者科室行手术治疗的髁状突创伤性骨折患者37例为手术组,同时选取健康志愿者37例为健康组。回顾性分析患者伤情等临床资料,收集患者术前、术后4周及健康组研究对象咬合功能数据,并随访6个月观察远期并发症,绘制Kaplan-Meier生存曲线。结果:手术组与健康组比较显示,患者术后最大咬合接触面积(P=0.000)、最大咬合力(P=0.000)小于健康组,患者最大咬合接触面积(P=0.000)、最大咬合力(P=0.000)术后大于术前;患者咬合力不对称指数术前大于术后(P=0.000),但患者术后咬合力不对称指数与健康组相比,差异无统计学意义(P=0.090);患者术后咬合接触时间大于健康组(t=9.51,P=0.000)。随访中,37例患者中5例出现远期并发症,包括开口型偏斜伴健侧关节弹响疼痛2例,髁突再移位2例,面神经损伤未恢复1例。结论:应用小型钛板治疗下颌骨髁状突创伤性骨折可以明显改善患者咬合功能,且患者预后较好。

Objective To study the effect of surgical treatment with small titanium plate on the occlusal function of the patients with the traumatic fracture of mandibular condyle and to analyze the prognosis. Methods 37 patients with condylar fractures who were treated with surgery from January 2014 to January 2017 in our hospital, and 37 healthy volunteers were selected as the healthy group. The clinical data of patients were analyzed retrospectively,and the occlusal function data of the patients before and 4 weeks after surgery and of the healthy group were collected. All the patients were followed-up for 6 months, and the Kaplan-Meier survival curve was drawn by observing the long-term complications of the patients. Results Compared with the healthy group, the maximal occlusal contact area （P = 0.000） and the maximal occlusal force （P = 0.000） were lower than those in the healthy group, and the maximal occlusal contact area （P= 0.000）, and the maximal bite force （P = 0.000） was greater than that before surgery. The bite force asymmetry index of the patients before the surgery was higher than postoperative （P = 0.000）, however, the difference of the bite force asymmetry index between healthy group and the patients after the surgery was not statistically signifcant （P = 0.090）. The postoperative occlusal contact time was higher than that of the healthy group （P = 0.000）. 5 cases of long-term complications were observed in the followed-up period, including open skew with contralateral joint sounding pain in 2 cases, condylar displacement in 1 case, facial nerve injury that did not resume in 1 case. Conclusion The application of small titanium plate in the treatment of mandibular condylar traumatic fracture can signifcantly improve the patient occlusal function, and the prognosis of patients is good.