可吸收钉板在下颌骨髁突骨折中的应用

Application of resorbable plates and screws in mandibular condylar fractures

目的回顾性分析可吸收钉板在下颌骨髁突骨折中的应用,探讨其在髁突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应用可吸收钉板固定下颌骨髁突骨折患者82例(共106侧),其中髁突高位矢状骨折46侧,中位髁颈骨折26侧,低位髁颈下骨折34侧。髁头及髁颈骨折复位术均经耳屏前径路;髁颈下骨折复位术中,多数经耳屏前径路及颌下径路。髁突高位矢状骨折复位后以1~2枚可吸收长螺钉固定,髁颈及髁颈下骨折以2块可吸收板固定。术后随访6个月至3年。结果所有患者术后未诉明显不适,面型基本对称,面部肌肉运动正常,咬合对位良好,开口度恢复,未见明显排斥反应及严重并发症。结论可吸收钉板可应用于髁突高位矢状骨折、中位髁颈骨折、低位髁颈下骨折的开放复位内固定。应用可吸收钉板固定髁突骨较钛板钛钉复杂,需熟练掌握合适的操作技巧及注意事项。

Objective To retrospectively analyze clinical application of resorbable screws and plates in mandibular condylar fractures,and to explore indications,operation techniques,and consideration of resorbable screws and plates during the treatment of condylar fractures. Methods Totally 82 cases(106 laterals)of condylar fractures were fixed by resorbable screws and plates in Department of Oral Maxillofacial Trauma and Temporomandibular Joint Surgery,Hospital of Stomatology,Wuhan University from July 2012 and June 2018. Of the 106 laterals,there were 46 condylar head fractures,26 condylar neck fractures,34 subcondylar fractures. Condylar head and neck fractures were treated through incisions before tragus,and most subcondylar fractures through incisions before tragus or submandibular approaches. Condylar sagittal fractures were fixed by 1-2 resorbable screws,and condylar neck fractures and subcondylar fractures were fixed by 2 resorbable plates. Postoperatively,the duration of follow-up ranged from six months to three years. Results In all the fractures,there were no complaints of obvious discomfort;the face forms were symmetrical and facial muscle activities and occlusion were normal,mouth opening restored. All the fractures healed without foreign body reactions or serious complications. Conclusion Resorbable screws and plates can be used in the internal fixation for condylar head,neck,and subcondylar fractures. The application of resorbable screws and plates is more complex than titanium plates and screws. It is necessary for doctors to master operation techniques and considerations of resorbable screws and plates.