34例髁突骨折伴发外耳道骨折临床分析

Clinical study of condylar fracture with external auditory canal fracture in 34 patients

目的:探讨髁突骨折与外耳道骨折的关系及同期手术的必要性。方法:230例320侧髁突骨折根据骨折线位置不同分为矢状(Ⅰ型)、头部(Ⅱ型)、颈部(Ⅲ型)、髁突下(Ⅳ型)4种类型,随访髁突与外耳道骨折同期手术与否的预后差异。采用SPSS 20.0软件包中的χ2检验,比较不同类别髁突骨折伴同侧外耳道骨折之间的差异。结果:230例320侧髁突骨折伴外耳道骨折34例46侧,Ⅰ~Ⅳ型分别为12侧、16侧、7侧、5侧,另有6侧外耳道骨折无髁突骨折。Ⅲ型髁突骨折伴同侧外耳道骨折发生率显著低于另外3型(P<0.05);Ⅰ型髁突骨折伴外耳道骨折的发生率显著高于Ⅳ型(P<0.05),其他各型之间两两比较无显著差异。22例30侧随访至受伤后6个月,5例8侧在排除外耳道脑脊液漏的情况下,同期行髁突及外耳道骨折治疗,术后6个月外耳道无狭窄,听力无下降;另17例22侧均出现不同程度的外耳道狭窄,其中4例5侧出现严重听力障碍(均为外耳道粉碎性骨折)。结论:髁突颈部骨折伴外耳道骨折的概率较低,而髁突矢状骨折较基底部骨折更易导致外耳道骨折。治疗颌面部骨折,应早期发现、治疗外耳道骨折,积极预防外耳道狭窄、听力下降等并发症。

PURPOSE:To investigate the association between condylar fracture and external auditory canal fracture and the necessity of simultaneous operation.METHODS:A total of 230 cases with 320 condylar fractures were divided into 4 clinical types according to the location of fracture line:sagittal fracture of the condyle(typeⅠ),intracapsular condylar fracture(typeⅡ),condylar neck fracture(typeⅢ)and condylar base fracture(typeⅣ).Chi-square test of SPSS 20.0 software package was used to compare the distribution of ipsilateral external auditory canal fracture between different types of condylar fracture.The prognosis of condylar and external auditory canal fractures were also compared.RESULTS:Forty-six sides in 34 patients were found with condylar fracture combined with external auditory canal fracture,including12 sides,16 sides,7 sides and 5 sides in type I to typeⅣof condylar fractures,and 6 sides without condylar fracture.The incidence of typeⅢcondylar fracture combined with ipsilateral external auditory canal fracture was significantly lower than other three types(P<0.05).Type I condylar fracture was found with significantly higher incidence of external auditory canal fracture compared to typeⅣ(P<0.05).No significant difference was observed between any other two types.Thirty sides in 22 patients were followed up for 6 months after injury.Among these followed-up patients,eight sides in 5 patients without cerebrospinal leakage were treated with operations simultaneously.No traumatic stenosis and atresia of the external auditory canal and no decrease of hearing within 6 months was found after operation.In another 17 patients,twenty-two sides of the external auditory canal showed stenosis of varying degrees.Furthermore,among these 17 patients,five sides in 4 patients had severe hearing impairment(all of them were diagnosed as comminuted fractures of the external auditory canal).CONCLUSIONS:The incidence of external auditory canal fracture was observed lower in condylar neck fracture compared to sagittal condylar fracture.Treatment of maxillofacial fractures should be accompanied by early treatment of external auditory canal fractures,and active prevention of external auditory canal stenosis,hearing loss and other complications are necessary.