改良带针负压引流管联合口内入路在下颌骨骨折中的应用

Application of improved tramsbical trochar combined with intraoral incision in mandibular fractures

目的探讨改良带针负压引流管联合口内入路在下颌角及升支区域线性闭合性骨折中的临床治疗效果。方法选取南充市中心医院2014年10月至2017年10月期间就诊的下颌角和(或)下颌升支线性闭合性骨折患者42例,采用带针负压引流管经面部皮肤穿刺、联合口内入路坚固内固定22例(观察组);采用传统方法经口外颌下或颌后入路治疗20例(对照组)。术后观察随访3~6个月,对比两组患者的手术时间及术后并发症。结果两组患者术后咬合关系恢复及骨折复位固定均获得良好效果,观察组患者平均手术时间为(109.4±35.2)min,明显小于对照组的(129.5±20.8)min,差异有统计学意义(P<0.05);观察组患者术后出现1例皮肤瘢痕,明显低于对照组的20例,差异有统计学意义(P<0.05);观察组患者无涎瘘、面瘫、耳廓麻木等并发症出现,对照组发生3例涎瘘、7例面瘫、8例耳廓麻木,差异均有统计学意义(P<0.05)。结论相比传统方法经口外颌下或颌后入路,采用带针负压引流管经面部皮肤直接穿刺、联合口内入路坚固内固定下颌角及升支骨折,具有创伤小、术后并发症少、手术时间短等优点,临床效果显著。

Objective To assess the clinical effect of tramsbical trochar combined with intraoral incision in mandibular fractures. Methods From October 2014 to October 2017, 42 patients who suffered from mandibular fractures were selected divided into two groups. The observation group（22 patients） used tramsbical trochar for puncture and intraoral incision for internal fixation. The control group（20 patients） used traditional methods for treatment. The patients were followed up for 3-6 months, and the operation time and postoperative complications were compared between the two groups. Results Postoperative occlusion and restoration were obtained in both the two groups. The operation time of the observation group was（109.4 ± 35.2） min, significantly shorten than（129.5 ± 20.8） min of the control group（P〈0.05）. One patient in the observation group versus 20 patients in the control group had skin scar（P〈0.05）.There was statistically significant difference in salivary fistula, facioplegia, auricle numb between the observation group and the control group（P〈0.05）： 0 case vs 3 cases, 0 case vs 7 cases, 0 case vs 8 cases, respectively. Conclusion Tramsbical trochar combined with intraoral incision for treating mandibular fractures can reduce the operation time and postoperative complications, with significant effect.