成人髁状突颈部骨折52例手术与保守治疗的临床研究.docVIP

成人髁状突颈部骨折52例手术与保守治疗的临床研究 　　[摘要]目的：探讨成人髁状突颈部骨折的有效治疗手段。方法：随机抽取我院52例（67侧）成人髁状突颈部骨折的病例，根据手术和保守治疗的适应证，分手术治疗组（切开复位钛板内固定）和保守治疗组（手法复位+牙弓夹板固定+颌间弹性牵引），根据治疗后咬合关系、面型、最大开口度和其他并发症的情况，对比两种方法的治疗效果。结果：经过6～36个月随访，手术治疗后平均最大开口度38mm，95%咬合关系良好，无明显的面型改变。保守治疗后平均最大开口度为33mm，83.3%咬合关系良好，口腔卫生相对较差。通过t检验，P0.05，两组治疗效果在最大开口度、面型、平均牵引时间等方面有显著性差异。结论：对于成人髁状突颈部骨折，在无严格手术禁忌症的情况下，应尽可能行切开复位内固定手术治疗。 　　[关键词]成人；髁状突骨折；颈部；临床研究 　　[中图分类号]R782 [文献标识码]A [文章编号]1008-6455（2014）06-0450-04 　　 　　Two surgical methods for 52 adult patients with condylar neck fracture 　　LI Xiao-jun1,2,LI Jin-feng1,CHEN Zhu-lin2,MAO Duo-xi2,GAO Yuan2 　　(1.Department of Oral Maxillofacial Surgery,Hospital of Stomatology of Xian Jiaotong University,Xian 710004,Shaanxi,China;2.Department of Oral Maxillofacial Surgery,Hanzhong 3201 Hospital) 　　 　　Abstract: ObjectiveTo investigate the efficient treatment of the condylar neck fracture in adult patients. MethodsThe clinical records of 52 cases with the fracture of mandibular condylar neck from 2008 to 2013 were divided into conservative group (12 cases) and surgical group (40 cases). The average clinical informations and treatment data were analyzed. ResultsThe cases were followed up for 6～36 months after surgery. In the surgical treatment group, the average maximal mouth opening was about 38mm and 95% of them got satisfactory occlusion contact,no severe facial asymmetry.In the conservative treatment group, the average maximal mouth opening was about 33mm and 83.3% of them got satisfactory occlusion contact, with bad oral hygiene.There were significant differences between surgical and conservative groups. ConclusionThe open-reduction and internal fixation surgical treatment is better in condylar neck fracture in adult patients. 　　Key words:adult;condylar fracture;neck;clinical study 　　下颌骨是颌面部骨折中发生率最高的骨骼，髁状突骨折占下颌骨骨折的比例非常高（16%～52%）[1-2]，髁状突颈部为下颌骨中结构较薄弱处,约59%髁状突骨折发生在髁状突颈部,髁状突骨折多发生于青壮年,占60%,儿童发病率较低,其主要临床症状表现为张口受限（84.7%）和咬合关系紊乱（72.2%）[3]，在治疗方式上也存在颇多争议,处理不当，会发生咬合关系紊乱、面部畸形、关节强直等后遗症[4-5]，其