下颌骨髁突骨折45例回顾性分析

Treatment of fracture of mandibular condyle:A retrospective analysis of 45 cases

目的:总结基于新分类的下颌骨髁突骨折手术治疗及保守治疗的临床效果。方法:回顾性分析2012年1月—2021年12月期间,南京大学医学院附属苏州医院及苏州九龙医院口腔科收治的45例(57侧)下颌骨髁突骨折患者的临床资料,分析患者受伤原因、骨折分类、治疗方法、并发症及随访结果。结果:45例患者中男性34例、女性11例,平均年龄34.67岁(16~76岁)。交通事故(56%)为主要致伤原因。髁头骨折(囊内骨折) 26例(35侧),其中A型13例(13侧)、B型7例(11侧)、C型1例(1侧)、M型3例(6侧)、无移位2例(4侧);髁颈骨折12例(13侧);髁突基底部骨折7例(9侧)。10例髁头骨折(B型4例、C型1例、M型3例、无移位2例)及3例髁颈骨折共13例行保守治疗;16例髁头骨折(A型13例、B型3例)、9例髁颈骨折及7例髁突基底部骨折共32例行手术治疗。所有患者中,5例失访,40例随访6个月以上。保守治疗者中,3例关节区长期酸痛、1例关节弹响、1例张口受限;手术治疗者1例髁突吸收、2例面神经颞支麻痹。结论:下颌骨髁突骨折应结合骨折分类及患者全身情况综合考虑,选择合理的个性化治疗方案。

Objective:To evaluate the treatment outcomes of mandibular condyle fractures managed by surgical and conservative procedures based on new classification.Methods:A total of 45 patients with 57 condyle fractures who were referred to Department of Stomatology in Suzhou Hospital,Affiliated Hospital of Medical School Nanjing University and Suzhou Kowloon Hospital from January 2012 to December 2021 were retrospected.The data were related to causes of injury,fracture classification,treatment methods,complications,and follow-up results.These data were then analyzed.Results:There were 11females and 34 males,with an average age of 34.67 years(16-76 years).Traffic accidents were the main cause of injury(56%).There were 26 cases(35 sides) of intracapsular condyle head fractures.Among them,there were 13 cases(13 sides) of type A,7cases(11 sides) of type B,1 case(1 side) of type C,3 cases(6 sides) of type M and 2 cases(4 sides) of no displacement.There were also 12 cases(13 sides) of condylar neck fractures,and 7 cases(9 sides) of condyle base fractures.Ten cases of condylar head fractures including 4 cases of type B,1 case of type C,3 cases of type M and 2 cases of no displacement,and 3 cases of condylar neck fractures.Thirteen cases were treated conservatively.Sixteen cases of condylar head fractures including 13 cases of type A and 3 cases of type B,9 cases of condylar neck fractures and 7 cases of condyle base fractures(a total of 32 cases)were treated surgically.Five patients were lost to follow-up,forty patients had follow-ups over 6 months.There were 3 cases of pain,1 case of TMJ clicking,and 1 case of limited mouth opening in conservative treatments group.Postoperative complications showed 1 case of condyle resorption and 2 cases of facial nerve injury.Conclusion:Mandibular condyle fractuers should be considered in combinantion with new fracture classification and patient′s general condition,and a reasonable individualized treatment plan should be selected.