骨性下颌偏突患者BSSRO术后骨折相关因素分析

Analysis of Related Factors for Fractures After BSSRO in Patients with Osseous Mandibular Deviation

目的:探讨骨性下颌偏突患者正颌术后颌骨骨折发生的相关因素。方法:选取行双侧下颌升支矢状劈开截骨后退术(BSSRO)的23例骨性下颌偏突患者,回顾患者术后愈合情况,分析下颌偏斜方向、伤口感染及升支内侧骨裂开方式与BSSRO术后颌骨骨折发生之间的关系。结果:所有患者术后有3侧下颌骨发生骨折,7侧伤口发生感染,Ⅰ类骨裂开方式32侧,Ⅱ类骨裂开方式14侧,左偏10例,右偏13例,经统计分析发现伤口感染及升支内侧骨裂开方式与BSSRO术后骨折发生之间有明显统计学差异,伤口感染与术后骨折发生之间存在一定的相关性,Ⅱ类骨裂开方式较Ⅰ类骨裂开方式更容易发生骨折,而下颌偏斜方向与BSSRO术后颌骨骨折之间无统计学意义。结论:下颌偏突患者BSSRO术后颌骨骨折与升支内侧骨裂开方式及伤口感染有关,术前应充分剖析颌骨结构,对下颌升支骨裂开方式进行综合分析及预防术后伤口感染对术后骨折的防治有重要意义。

Objective: To investigate the related factors of jaw fractures in patients with osseous mandibular deviation after orthognathic surgery. Methods: Twenty-three patients with bony mandibular deviation who underwent bilateral sagittal split osteotomy and retraction(BSSRO) were selected. The postoperative healing status of the patients was reviewed, and the relationship between the direction of mandibular deviation, wound infection, the way of medial ramus dehiscence, and the occurrence of jaw fractures after BSSRO was analyzed. Results: There had 3 mandibular fractures, 7 infections, 32 types of bone dehiscence in type Ⅰ and 14 in type Ⅱ, and 10 cases of left deviation and 13 cases of right deviation. There were significant differences between wound infection and medial dehiscence of the ascending ramus and fractures after BSSRO. There was a certain correlation between wound infection and postoperative fractures. Type Ⅱ bone dehiscence was more prone to fracture than type Ⅰ bone dehiscence, while there was no statistical significance between the direction of mandibular deviation and jaw fracture after BSSRO. Conclusion: The mandibular fracture after BSSRO in patients with mandibular deviation is related to the dehiscence pattern of the medial ascending ramus and wound infection. The jaw structure should be fully analyzed before the operation. The comprehensive analysis of the dehiscence pattern of the mandibular ascending ramus and the prevention of postoperative wound infection are of great significance to the prevention and treatment of postoperative fractures.