可吸收钉板在上颌骨及全面部骨折中的应用

The application of resorbable plate system in treatment of maxillary and panfacial fractures

目的评价可吸收钉板在上颌骨与全面部骨折中的应用。方法选择2011年6月至2018年7月在武汉大学口腔医院口腔颌面创伤与颞下颌关节外科接受治疗的涉及上颌骨骨折的患者244例。全面部骨折的纳入标准是同时包含上颌骨骨折、颧骨颧弓眶骨骨折和下颌骨骨折。所有患者均主动要求使用可吸收钉板系统进行内固定。对其人口统计学信息、治疗情况和随访结果进行回顾性分析。结果 244例患者的上颌骨骨折部位全部使用可吸收钉板进行内固定,其中男145例,女99例;年龄6~73岁,平均35岁;上颌骨Le FortⅠ型骨折36例,Le FortⅡ型骨折111例,Le FortⅢ骨折型97例。涉及额骨骨折3例,鼻骨-眶-筛骨(NOE)复合体骨折42例,上颌骨矢状骨折37例,全面部骨折36例。全面部骨折患者中,颧骨颧弓眶骨、上颌骨、下颌骨同时使用可吸收钉板固定的有14例;仅颧骨颧弓眶骨、上颌骨同时使用可吸收钉板固定的有6例;仅颧骨颧弓眶骨使用可吸收钉板固定的有14例;另外2例患者的情况与上述三种分类均不符合。所有患者术前均有面部畸形,且出现咬合紊乱。复位和修复全面部骨折的方法按照"由简单到复杂"进行序列复位固定的原则。术后并发症情况:3例轻度错[牙合]畸形,1例颧骨部分缺损,1例眼球内陷,4例创伤瘢痕,2例眼睑下睑萎缩,2例颞肌萎缩。结论灵活应用可吸收钉板进行上颌骨及全面部骨折复位固定具有可行性。软组织问题引起的手术后并发症,包括撕裂和不对称,难以避免。

Objective To evaluate the use of resorbable plate system in maxillary and panfacial fractures. Methods All patients with maxillary fractures treated in our department were evaluated from June 2011 to July 2018. The inclusion criteria for patients with maxillary fracture is that the application of the resorbable plate system. The inclusion criteria for panfacial fractures included both zygomaticomaxillary complex fracture and mandibular fractures. Results All244 cases of maxillary fractures were included with 145 males and 99 females. The age ranges from 6 to 73 years old,with an average age of 35 years. Among them,36 were Le Fort type Ⅰfractures,111 were Le Fort Ⅱ fractures,and 97 were Le Fort Ⅲ fractures. There were 3 cases of frontal bone fracture,42 cases of NOE complex fracture and 37 cases of maxillary sagital fracture. There were 36 cases of panfacial fractures. All patients had facial deformities and occlusal disorders before surgery. Postoperative complications:there were 3 cases with mild malocclusion,1 case with partial zygomatic bone defect,1 case with eyeball invagination,4 cases with traumatic scar,2 cases with Lower eyelid atrophy,and 2 cases with temporalis atrophy. Conclusion It is feasible to use the resorbable plate system for the fixation of maxillary and panfacial fractures.