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目的:总结分析颌间牵引钉在颌骨骨折手术治疗中的使用方法、效果及注意事项。方法:在168例颌骨骨折内固定手术中,应用颌间牵引钉牵引骨折端复位,恢复并维持咬合关系稳定。记录颌间牵引钉使用数目、位置、牵引效果及术后并发症。结果:168例手术中共使用颌间牵引钉705枚,其中:使用4枚者147例(88%),6枚者12例(7%),5枚者9例(5%)。使用位置:5-4 4-55-4 4-5牙根间336枚(47.7%),4-3 3-44-3 3-4牙根间292枚(41.4%),6-5 5-66-5 5-6牙根间50枚(7.1%);其余部位27枚(3.8%)。术后92例咬合关系正常,无需牵引;76例咬合关系不协调或有偏差,经术后4~14 d牵引,71例咬合关系恢复正常,总有效率97%。主要并发症是牵引钉周围黏膜疼痛23例(13.7%),牙根损伤13例(1.8%)、牵引钉松动11例(1.6%)、牙脱位2例(0.3%)。结论:颌间牵引钉最常见和安全的植入位置在尖牙到第一磨牙的牙根之间,植入位点距牙龈缘5~8 mm;植入数目4~6枚可满足手术需要;颌间牵引钉弹性牵引有一定并发症,应注意防范。
Objective: To summarize and analyze the methods, effects and precautions of intermaxillary traction nail in surgical treatment of jaw fracture. Methods: 168 cases of mandibular fracture internal fixation operation, the application of intermaxillary traction nail traction fracture reduction, recovery and maintain a stable occlusion. Record the number of intermaxillary traction nail, position, traction effect and postoperative complications. Results: A total of 705 intermaxillary traction screws were used in 168 cases, of which 147 were used in 4 cases (88%), 6 were in 12 cases (7%) and 5 were in 9 cases (5%). Location: 5-4 4-55-4 4-5 336 teeth (47.7%), 4-3 3-44-3 3-4 292 teeth (41.4%), 6-5 5-66- 5 5-6 50 (7.1%) of the roots and 27 of the remaining (3.8%). The occlusion was normal in 92 cases without traction. The occlusion was uncoordinated or biased in 76 cases. After 4 to 14 days of traction, the occlusion of 71 cases returned to normal with a total effective rate of 97%. The main complication was mucosal pain around traction nail in 23 cases (13.7%), root injury in 13 cases (1.8%), traction nail loosening in 11 cases (1.6%) and tooth dislocation in 2 cases (0.3%). Conclusion: The most common and safe placement of intermaxillary traction nail is between the canine teeth and the root of the first molars. The implantation site is 5 ~ 8 mm away from the gingival margin. The number of implants is 4 ~ 6 to meet the surgical needs. Intermaxillary traction nail flexible traction has certain complications, should pay attention to prevention.