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目的研究不同入路途径微型钛板坚固内固定术在颧骨上颌骨复合体骨折治疗中的临床应用价值。方法颧骨上颌骨复合体骨折病例132例,严格按照随机化原则将所有观察对象分为治疗组和对照组各66例。两组均采用钛板进行坚固内固定,治疗组采用开放性软组织切口入路,对照组行经头皮冠状切口入路。观察两组术后X线下骨折处接合情况及面部外形恢复情况、神经症状、视觉情况、张口开合度等情况,并对其进行疗效评价。结果两组观察患者在年龄、骨折发生原因、受伤距手术时间等方面均无显著差异,具有可比性。仅一处骨断端未接合良好治疗组有1例,对照组有2例;两处及以上未接合良好治疗组有2例,对照组有5例;张口开合度异常治疗组3例,对照组6例;复视治疗组1例,对照组3例;神经症状治疗组2例,对照组6例;面部畸形治疗组2例,对照组6例。治疗组总有效率(97.0%)显著高于对照组总有效率(87.9%),差异具有统计学意义。结论微型钛板坚固内固定术治疗颧骨上颌骨复合体骨折的疗效稳定,采用开放式软组织切口入路具有安全、高效、切口小、部分患者可利用原面部创口手术的优势,费用相对较低,经六个零超细线面部美容缝合,可使术后疤痕最大限度减少。虽经头皮冠状切口入颅具有切口隐蔽、美观等优势,但具有切口相对较大,手术耗时长,需全麻,费用较高,有时暴露不足,操作不便,易损伤面神经等不足之处。
Objective To study the clinical value of mini-titanium plate fixation by different approachs in the treatment of maxillary complex fractures of the cheekbones. Methods 132 cases of maxillary complex fractures of the cheekbones were divided into two groups (66 cases in each group) according to the principle of randomization. Both groups were fixed with titanium plate, the treatment group with open soft tissue incision approach, the control group through the scalp coronal incision approach. The postoperative X-ray fracture joint junction and facial shape recovery, neurological symptoms, visual conditions, mouth open degree and so on were observed, and the curative effect was evaluated. Results There was no significant difference between the two groups in the observation of age, the cause of the fracture, the time of injury and the operation time, which was comparable. There was 1 case in the non-jointed bone fracture group and 2 cases in the control group, 2 cases in the control group and 2 cases in the non-jointed group and 5 cases in the control group, 3 cases in the control group with open mouth abnormalities, 6 cases in the treatment group; 1 case in the treatment group and 3 cases in the control group; 2 cases in the neurological symptoms group and 6 cases in the control group; 2 cases in the facial deformity treatment group and 6 cases in the control group. The total effective rate (97.0%) in the treatment group was significantly higher than that in the control group (87.9%), the difference was statistically significant. Conclusion Micro-titanium plate fixation is effective in treating maxillary complex fractures of the cheekbones. It is safe and efficient to use an open soft tissue incision approach. Some patients can take advantage of the advantages of original facial wound surgery with relatively low cost , The six zero ultra-fine line facial beauty suture, can minimize the postoperative scar. Although scalp coronal incision into the skull with incision hidden, beautiful and other advantages, but with a relatively large incision, the operation takes a long time, requiring general anesthesia, the higher the cost, sometimes exposed, the operation inconvenient, easy to damage the facial nerve and other deficiencies.