【作者】 陈州莉；

【导师】 王慧明；

【作者基本信息】 浙江大学 ， 临床医学， 2010， 硕士

【摘要】 目的：研究开放复位坚固内固定技术用于髁状突骨折的临床效果及预后,探索髁状突骨折治疗的最优化方法,为髁状突骨折坚固内固定提供理论依据和临床指导,总结手术前后及术中注意点。方法：回顾性调查浙江大学医学院附属第一医院口腔科(2005年9月至2010年2月)58例接受手术切开复位坚固内固定治疗的髁状突骨折病例,通过查阅病历资料、电话随访、门诊复查等手段获取所需的信息。1.查阅病历资料及读片,了解患者年龄、性别、致伤原因、骨折类型、临床表现、有无合并其他部位骨折及手术方案等情况。2.门诊复查或电话随访了解患者术后面形、张口度、咬合关系及术后并发症情况。结果：随访的58例患者均接受了切开复位坚固内固定治疗,术后患者面型、咬合、关节功能等均得到改善,术后有6例患者出现暂时性面神经损伤,5例表现为患侧眼睑闭合不全,1例表现为患侧鼻唇沟变浅,均在随访期内愈合。患者对疗效满意率达93.1%。结论：切开复位坚固内固定治疗髁状突骨折能使骨折断端得到解剖复位,充分保持骨折断端的稳定,下颌骨能进行早期、无痛的功能活动,对患者术后颞下颌关节功能的恢复有良好效果。手术入路的选择应基于保护面神经和暴露骨折断端两个原则,各种方法均有各自的优缺点,可根据实际情况选择不同的切口。术中翼外肌的解剖复位是真正恢复下颌运动的重要一环。使用小钛板、拉力螺钉、可吸收板行坚固内固定各有其适应症。不可忽视开放复位坚固内固定术后出现并发症的可能。内固定材料具有良好的生物相容性及很强的耐腐蚀性,可作为永久性植入体长期滞留体内,但临床上存在术后取板或螺钉的情况,坚固内固定是否会影响儿童下颌骨的发育还有待于长期进一步研究。更多还原

【Abstract】 Objective:To investigate the clinical outcome and prognosis of the open reduction and rigid internal fixation for the condylar fracture patients. To conclude the clinical experience and summarize the pre and post operation management.Method:58 cases receiving the treatment of open reduction and rigid internal fixation for condylar fractures were retrospectively reviewed, in the department of oral and maxillo-facial surgery,1st affiliated hospital, Medical Collage of Zhejiang University from September 2005 to February 2010. Information was collected by looking up medical records, telephone following up, questions answering and clinical rechecking.1. Collecting case history for patients’gender, age, etiology, fracture type, clinical manifestation, complications and treatment schedule.2. By telephone following-up and clinical rechecking, mouth functional et al index were recorded as well as satisfaction with treatment effect.Result:58 cases were followed up. All patients showed great improvement on the facial type, occlusion, temporomandibular joint function, and etc.6 patients underwent the injury of facial nerve but cured during the follow-up period.93.1% of the patients were satisfied with the therapeutic effect.Conclusion:open reduction and rigid internal fixation result in satisfactory therapeutic efficacy for the condylar fracture, but the complications cannot be ignored. The selection of operation approach should base on the conservation of facial nerves and exposure of fractures. The reduction of external pterygoid muscle is impeotant for recovery of mandibular movement.The minor titanium plates,lag screws and biodegradable plates are all favourable materias for rigid internal fixation. Some patients undergo plate removal after the operation. The influence of open reduction and rigid internal fixation to the mandibualr development in children still awaits further long-term study.更多还原