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目的 :总结髁突骨折(mandibular condylar fractures,MCF)的临床特点、分类及治疗原则,为MCF的治疗提供理论依据。方法:选取我院口腔科2006年4月—2014年4月68例(91侧)MCF患者作为研究对象;从流行病学、骨折临床特点、分类、治疗方法及并发症角度对MCF进行分析。采用SPSS12.0软件包对结果进行统计学分析。结果:68例MCF患者中,男49例(72.06%)、女19例(27.94%),男性患者显著多于女性患者(P<0.05);7~40岁MCF患者56例,显著大于41~70岁MCF患者(12例,P<0.05)。MCF的主要诱发因素是暴力创伤及交通事故。从髁突骨折部位、骨折移位方式及骨折移位块与关节窝的位置3个层面进行MCF分类,囊内骨折32例(47.06%)、髁颈骨折16例(23.53%)、髁突下骨折20例(29.41%);囊内骨折中,A型骨折13例,B型骨折8例,C型骨折6例,M型骨折5例。68例MCF患者接受闭合性治疗11例(16.18%),开放性治疗57例(83.82%)。57例接受开放性治疗的患者术后2周开口度、咬合关系及开口型均显著改善(P<0.05),改善程度显著大于闭合性治疗(P<0.05)。囊内骨折、髁颈骨折及髁突下骨折的疗效存在显著差异(P<0.05)。颌后穿腮腺入路可显著提高开口度,降低咬合关系紊乱及开口型偏斜(P<0.05);耳前入路组术后面神经损伤发生率为40.0%,与传统下颌下入路组及下颌后穿腮腺入路组相比,具有显著差异(P<0.05),耳前入路组、颌后穿腮腺入路组及传统下颌下入路的感染及流涎发生率无显著差异(P>0.05)。结论:MCF的临床分类及治疗方法具有多样性,其中囊内骨折是MCF最常见的类型;MCF的治疗应根据临床特点及分类,选取适合的治疗方法:闭合性治疗或开放性治疗包括合适的手术入路、手术摘除骨折块术、螺钉或钛板固定术等。
Objective: To summarize the clinical features, classification and treatment principles of mandibular condylar fractures (MCF), so as to provide a theoretical basis for the treatment of MCF. Methods: A total of 68 patients (91 sides) with MCF from April 2006 to April 2014 in our hospital were enrolled in this study. MCF was analyzed from the aspects of epidemiology, clinical features, classification, treatment and complications. SPSS12.0 software package for statistical analysis of the results. Results: Among 68 MCF patients, 49 (72.06%) were males and 19 (27.94%) females, there were significantly more males than females (P <0.05) 70-year-old MCF patients (12 cases, P <0.05). The main triggers of MCF are violent trauma and traffic accidents. From the condylar fracture site, the fracture displacement and the position of the displaced fracture block and the joint socket, 32 cases (47.06%) were intracranial fracture, 16 cases (23.53%) were under the condyle Fractures in 20 cases (29.41%); intracapsular fracture in 13 cases of type A fracture, B type fracture in 8 cases, C type fracture in 6 cases, M type fracture in 5 cases. Sixty-eight MCF patients received closed therapy in 11 patients (16.18%) and open treatment in 57 patients (83.82%). The opening degree, occlusal relationship and open type of 57 patients undergoing open treatment were significantly improved (P <0.05), and the improvement was significantly greater than that of closed therapy (P <0.05). There were significant differences in the efficacy of intracapsular fractures, condylar neck fractures and subcondylar fractures (P <0.05). After the parotid approach, the parotid approach could significantly improve the degree of opening, reduce the occlusion relationship and open skew (P <0.05). The incidence of facial nerve injury in the anterior approach group was 40.0%. Compared with the traditional submandibular approach (P <0.05). There was no significant difference in the incidence of infection and salivation between the anterior approach group, parotid gland approach group and the traditional submandibular approach (P> 0.05). Conclusion: The clinical classification and treatment of MCF are diverse. Among them, intracapsular fracture is the most common type of MCF. The treatment of MCF should be based on the clinical features and classification, select the appropriate treatment: closed treatment or open treatment, including appropriate Surgical approach, surgical removal of the fracture block, screw or titanium plate fixation and so on.