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目的比较手术或非手术治疗儿童下颌骨髁状突骨折临床疗效,为临床选择治疗方法提供依据。方法回顾分析1988年1月-2006年12月手术(手术组,8例11侧)与非手术(非手术组,17例22侧)治疗下颌骨髁状突骨折患儿的临床资料。手术组:男6例9侧,女2例2侧;年龄8～13岁。摔伤7例,车祸伤1例。伤后至入院时间1～6d。单侧髁状突骨折5例,其中伴下颌骨颏部骨折3例;双侧髁状突骨折伴下颌骨颏部骨折3例。非手术组:男12例15侧,女5例7侧;年龄3～12岁。高处坠落伤4例,摔伤10例,车祸伤3例。伤后至入院时间1～25d。单侧髁状突骨折12例,其中伴下颌骨颏部骨折3例;双侧髁状突骨折5例,其中伴下颌骨颏部骨折1例。结果手术组术后切口均Ⅰ期愈合。两组患儿均获随访,随访时间1～6年,平均3.5年。治疗12个月后两组患儿双侧颞下颌关节局部均无疼痛,进普食无障碍,无张口受限,下颌前伸及左、右侧运动无受限。两组6、12个月时张口度、前伸及左、右侧运动程度比较,差异均无统计学意义(P>0.05)。正中咬时颏点位于中线,双侧面部对称。手术组2例、非手术组3例有轻微张口初弹响;手术组及非手术组各3例出现张口时向骨折侧轻度偏斜。X线片示两组骨折于治疗后3～6个月愈合,髁状突有不同程度改建。X线头影测量片示两组面部和双侧下颌升支对称。结论手术和非手术治疗儿童下颌骨髁状突骨折均可获得较好疗效,因儿童髁状突具有较强的愈合和改建能力,对于7岁以下儿童建议首选非手术方法治疗,避免手术干预对颞下颌关节的再次损伤。
Objective To compare the clinical efficacy of surgical or non-surgical treatment of mandibular condyle fracture in children and provide evidence for the clinical choice of treatment. Methods The clinical data of children with mandibular condyle fractures treated with surgery (8 cases in 11 cases) and non-surgical (non-operation in 17 cases) were retrospectively analyzed from January 1988 to December 2006. Surgical group: 6 males and 9 females, 2 females 2 sides; aged 8 to 13 years. 7 cases of falls, 1 case of traffic accident. Injured to admission time 1 ~ 6d. Unilateral condylar fracture in 5 cases, including mandibular chin fracture in 3 cases; bilateral condylar fracture with mandibular chin fracture in 3 cases. Non-operation group: male 12 cases of 15 sides, female 5 cases 7 sides; aged 3 to 12 years old. Fall injury in 4 cases, falls in 10 cases, car accident injury in 3 cases. Injured to admission time 1 ~ 25d. Unilateral condylar fracture in 12 cases, including mandibular chin fracture in 3 cases; bilateral condyle fracture in 5 cases, including mandibular chin fracture in 1 case. Results All the incisions in the operation group were healed by first intention. Two groups of children were followed up for 1 to 6 years, an average of 3.5 years. After 12 months of treatment, the bilateral temporomandibular joint in both groups had no pain locally, no obstruction to the general diet, no mouth restriction, and no limitation of mandibular protraction and left and right movement. There was no significant difference in mouth opening degree, anteversion, left and right degree of exercise between the two groups at 6 and 12 months (P> 0.05). When the middle bite is located in the midline chin, bilateral facial symmetry. There were 2 cases in the operation group and 3 cases in the non-operation group. The operation group and the non-operation group had slight skew to the fracture side in 3 cases. X-ray showed two groups of fractures healed in 3 to 6 months after treatment, condyles have different degrees of reconstruction. X-ray Cephalometric measurement showed symmetry of mandibular ascending face in both groups. Conclusion Both surgical and non-surgical treatment of mandibular condyle fractures in children can achieve a better curative effect. Due to the strong healing and remodeling ability of children’s condyles, it is suggested that non-surgical treatment be preferred to children under 7 years of age to avoid surgical intervention Temporomandibular joint re-injury.