【作者】 汤炜； 龙洁； 王杭； 林云峰； 刘磊； 田卫东；

【Author】 TANG Wei,DUAN Shijun,LONG Jie,WANG Hang,LING Yun-feng,TIAN Wei-dong(Department of Traumatic & Plastic Surgery,West China hospital of Stamatology,Sichuan University,Chengdu Sichuan 610041,China

【机构】 四川大学华西口腔医院创伤整形外科；

【摘要】 目的:建立髁突骨折患者病例收集系统,临床回顾性研究髁突骨折保守治疗及手术治疗的疗效转归,探讨不同髁突骨折类型及不同程度骨折段端移位的愈后,为临床治疗提供参考。方法:运用Access建立数据库病例系统,对21例髁突骨折后保守治疗及10例髁突骨折后手术治疗的患者的基本情况、治疗过程及愈合进行临床回顾性分析,对患者CBCT及颌骨片资料采用OneVolumeViewer、颌骨片测量系统进行定点定量的测量,通过计算机软件数字化定量分析结合统计学分析方法,评价不同治疗方法的疗效。同时,对38例单侧髁突骨折不同高度及不同骨折段端移位的CBCT资料进行定点定量分析,通过患侧、健侧及治疗前后的比较,评估不同骨折类型的疗效及转归。结果:通过患者治疗前后关节区疼痛、张开度、张口型、面型及咬合等方面的对比,结合CBCT比较治疗前后关节脱位情况及下颌升支高度改善状况,结果显示:在较高位、骨折段端与关节窝无接触且髁突骨折对咬合及张开恢复无影响的状况下,保守治疗与手术治疗分析结果非常接近,经统计学分析无差异,经保守治疗后发生关节强直的案例尚未见到。对38例单侧髁突骨折的患者分为A型囊内骨折,B型髁突颈骨折,C型矢状骨折,通过术前、术后及健侧CBCT数据分析,结果显示:三类骨折通过保守或手术治疗后,患者张口及咬合均得到改善,囊内骨折移位不明显,术后髁突与关节窝位置及髁突高度等恢复较其它两组好。对于髁突转角大于100度较小于100度的骨折术后髁突与关节窝位置及髁突高度恢复较差。结论:课题研究表明髁突骨折治疗方案的选择需综合考虑骨折的部位、类型、移位的方向和程度、临床特征及可能出现的并发症等多方面因素。根据不同的情况,在允许的范围内选择减少创伤和经济负担的治疗方法,是一种值得推广和深入研究的途径。对于不同的骨折分型,可通过其影响愈合的结果综合考虑选择治疗方案,如囊内骨折多可采用保守治疗,髁突转角较小移位不明显者可考虑保守治疗。更多还原

【Abstract】 Objective:Establish database including cases of condyle fracture.Discuss the prognosis in reference to different fracture position.displacement and treatment.Provided reference for the clinic. Method:Establish database including cases of condyle fracture by Access.Retrospective study on the basic situations.treatment and prognosis of 21 patients who receive conservative treatment and 10 patients who receive surgical treatment.Quantitative measurements of CBCT and panoramic film through OneVolumeViewer and mandibular film measure.Comparison the prognosis of 38 unilateral condyle fracture between high position and neck fracture and different displacement angle.Result: According to the pain,mouth open,appearance and occlusion combines with the relationship between condyle and the joint and height of the mandibular ramus through CBCT,the result is that there is no different between conservative treatment and surgical treatment when high position,fracture and the joint have no contact and the mouth open have no influence.The patient with 38 unilateral condylar fracture can be divided into three types:A intracapsular fracture,B condylar neck fractures, C sagittal fracture.Analysis of datas before/after the operation and the health datas shows:After expectant treatment of these three types of fracture,mouse opening and occlusion are improved ,translocation of intracapsular fracture is not obvious.After the operation the recovery of processus condylaris and acetabulum position,processus condylaris height etc.are better than the other two groups.For processus condylaris with angles greater than 100 the recovery are worse than that with a angle smaller than 100 The investigation shows the treatment of condylar fracture depends on the fracture posion,type,direction and level of translocation,clinical feature and possible complications etc.According to different situations,treatment methods with only little wound is a benificial way that should be in detial researched and popularized.更多还原