不同固定方法对下颌骨骨折治疗效果的比较

Comparision of the treatment effect on the different fixation for the mandibular fractures

目的 评价下颌骨骨折不同固定方法的治疗效果及术后并发症,探讨各种骨折固定方法的优缺点。方法 118例下颌骨骨折患者分别采用单纯颌间结扎、颌间结扎加钢丝骨内固定、小型钛板坚固内固定,对其术后功能恢复时间、并发症、骨折严重程度与固定方法及并发症的关系进行统计学分析比较。结果 三种不同的骨折治疗方法并发症的发生率不同,其中骨折的严重程度和并发症的发生率高度相关。单纯颌间结扎治疗下颌骨骨折方法简单,但限制开口时间长,功能恢复慢,产生的并发症多;颌间结扎加钢丝骨内固定在一定程度上增加了固定的稳定性,但口外切口增加了面神经下颌缘支误伤的可能性,限制开口时间长;小型钛板坚固内固定方法对牙周及颞下颌关节影响小,不限制开口或早期就开始下颌骨运动,功能恢复快;但如钛板放置不当,会导致牙根或下牙槽神经的损伤及术后咬合紊乱的发生。结论 小型钛板坚固内固定方法治疗下颌骨骨折并发症少,功能恢复快;且口内切口隐蔽无损伤面神经的风险,疗效明显好于单纯颌间结扎或颌间结扎加钢丝骨内固定方法。

Objective To evaluate the effect and complication of different treatments for mandibular fractures. Then to discuss the excellence and insufficiency of different fixation style. Methods One hundred and eighteen cases of mandibular fractures were treated by three methods respectively: intermaxillary fixation, miniplate fixation and wire fixation with intermaxillary fixation. Function recovering time, treatment complications and the relationship between the fracture degree and fixation method as well as their complications were analysed statisticly. Results The complication rate of each treatment was different. There were high correlation between the severity of fracture and the complication. Intermaxillary fixation was a simple method for the treatment of mandibular fractures. But the limitation of mouth open was too long, so functional recovery was slower, and then more complications. Wire internal fixation with intermaxillary fixation increased stability, but extra - oral incision may cause facial nerve injury. The time of open mouth limition was also long. Miniplate internal fixation rarely affected periodontium and temporomandibular joint. It did not limit mouth open,so time of functional recovery was very quick. However, it will injury dental root and the inferior alveolar nerve when put on wrong place. And furthermore may induce bad bite relationships. Conclusion Miniplate internal fixation for the treatment of mandibular fractures was much better than that of intermaxillary fixation and wire internal fixation with intermaxillary fixation for the less complications, quicker functional recovery and no injury of facial nerve selected the intraoral incision.