可吸收钉板在下颌骨骨折中的应用

Application of resorbable screws and plates in mandibular fractures

目的回顾性分析可吸收钉板在下颌骨骨折中的应用,探讨其在下颌骨骨折治疗中的适应证、操作难点及注意事项。方法 2012年7月至2018年6月,武汉大学口腔医院口腔颌面创伤与颞下颌关节外科收治各类颌面部骨折患者1498例,应用可吸收钉板固定下颌骨骨折271例,其中合并面中份骨折35例、髁突骨折160例、喙突骨折3例;单纯下颌骨骨折94例。94例单纯下颌骨骨折中,涉及联合区53例、体部31例、角部40例、升支6例;单处骨折58例,双处骨折36例;线性简单骨折88例,粉碎性骨折6例;所有病例均为新鲜骨折、不伴有骨缺损。针对每处骨折,成人以2块可吸收板固定,儿童以1块可吸收板固定,均辅以单颌牙弓夹板或钢丝拴结。术后随访6个月至3年。结果所有患者术后咬合关系恢复,骨折愈合良好。2例下颌角、3例联合区骨折术后轻度移位,1例下颌角、1例体部、1例联合区骨折术后创口感染。结论下颌骨骨折选择可吸收钉板需谨慎,需严格把握适应证及加强操作规范。对于简单或轻度粉碎的下颌骨骨折,以可吸收钉板固定,需辅以单颌牙弓夹板或钢丝拴结,术后颌间牵引,避免术后过早承重。

Objective To retrospectively analyze clinical application of resorbable screws and plates in mandibular fractures,and to explore indications,operation techniques,and consideration of resorbable screws and plates during the treatment of mandibular fractures. Methods From July 2012 to June 2018,1498 cases of various types of maxillofacial fractures were treated in our department,and 271 cases of mandibular fractures were treated with resorbable screws and plates. Among them,35 cases had mid-facial fractures,160 cases had condylar fractures,3 cases had coronoid fractures and 94 cases were simple mandibular fracture. Of 94 cases,there were 53 symphysis fractures,31 body fractures,40 angle fractures,and 6 ramus fractures;there were 58 cases of single fracture and 36 cases of double fracture;there were 88 cases of simple linear fracture and 6 cases of comminuted fracture. All cases were fresh fractures without bone defects.For each fracture,adults were fixed with 2 resorbable plates,and children were fixed with one resorbable plate,all of which were supplemented with dental arch splints or wires to fix the loosen teeth. The patients were followed up for 6 months to 3 years. Results All patients had a recovery of postoperative occlusion and a good fracture healing. Slightly displacement was found in 2 cases of angle fractures and 3 cases of symphysis fractures;wound infection was found in 1 case of angle fracture,1 case of body fracture and 1 case of symphysis fracture. Conclusion The selection of resorbable screws and plates for mandibular fractures requires strict indications and enhanced operating specification. Simple or slightly comminuted mandibular fractures can be fixed with resorbable screws and plates,supplemented with arch bars or wires;intermaxillary traction should be done after surgery,and early weight bearing should be avoided after surgery.