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目的:探讨髁状突骨折手术方式和疗效。方法:45例髁状突骨折患者,年龄16～65岁,全部采用下颌后切口,切口长约4cm,在腮腺筋膜鞘表面潜行剥离皮瓣,在耳屏至耳垂之间前方,上下方向切开腮腺筋膜,以开窗的方式向深层钝性剥离腮腺,牵开面神经,从咬肌后方切开骨膜,髁状突断端和翼外肌解剖复位,以钛板固定;冲洗关节腔,严密缝合骨膜及切开的关节囊,囊内注射透明质酸钠2.0mL;术后进行早期功能锻炼。结果:45例患者经过6个月～4年的随访观察,骨折全部愈合,面型对称,开口度达到3.0～3.7cm,张口型均正常;咬合关系完全满意42例,基本满意3例;咀嚼功能完全满意41例,基本满意4例;术后出现感染1例,经过切开引流、抗炎后治愈;出现面神经功能异常患者2例,2个月后完全恢复;出现关节弹响不适症状患者1例,治疗后好转。结论:成人髁突骨折,应首选开放手术治疗;下颌后入路手术方式是治疗髁状突骨折较好的方法。
Objective: To investigate the surgical method and effect of condylar fracture. Methods: Forty-five patients with condyle fracture, aged from 16 to 65 years old, all underwent mandibular incision. The incision was about 4 cm in length. The flap was stripped on the surface of the parotidectum fasciculus sheath. The anterior, Open the parotidectum fascia to the window to the blunt dissection of the parotid intimacy, retraction of the facial nerve, masseter muscle rear incision from the periosteum, condylar and pterygoidectomy off the end of the anatomy reduction, titanium plate fixed; flush joint cavity, Closely sutured the periosteum and the incision of the joint capsule, intravitreal injection of sodium hyaluronate 2.0mL; postoperative early functional exercise. Results: 45 patients were followed up for 6 months to 4 years. All the fractures healed, the facial symmetry was achieved, the opening degree reached 3.0 ~ 3.7cm, the mouth opening type were all normal. The occlusion relationship was completely satisfied in 42 cases, basically satisfied in 3 cases; chewing Function completely satisfied in 41 cases, basically satisfied in 4 cases; postoperative infection in 1 case, after incision and drainage, anti-inflammatory cure; facial nerve function abnormalities in 2 patients, 2 months after the full recovery of patients with joint sore discomfort symptoms 1 case, improved after treatment. Conclusion: Adult condylar fractures should be the first choice for open surgery. Mandible posterior approach is a better way to treat condylar fractures.