穿颊器联合口内切口治疗下颌角及升支骨折临床探析.docVIP

穿颊器联合口内切口治疗下颌角及升支骨折临床探析【摘要】目的:探讨穿颊器联合口内入路复位内固定下颌骨升支及下颌角骨折的方法,评价该手术方法的的疗效。方法:对2006年12月~2009年5月间50例下颌骨升支及下颌角骨折患者,使用穿颊器经过颊部小切口联合口内切口复位内固定。采用口腔内切口达骨面,在骨折线对应皮肤处作约0.3cm切口,将穿颊器经皮肤切口穿通至骨面,经穿颊器行坚强内固定术。同时期的另外21例同类型骨折患者,仍按照传统下颌下入路行手术切开复位内固定,两组患者进行组间对比。结果:用穿颊器口内入路全部患者的开口度正常,咬合关系良好,无主诉关节疼痛与弹响症状。全部患者无面神经损伤、无涎瘘、面颈皮肤无明显手术瘢痕。传统口外入路6例患者内固定术后出现暂时性面瘫,下颌下区均可见明显术后瘢痕。结论:口内入路微创治疗下颌骨角部及升支骨折优于传统的下颌下切口法,是下颌骨升支及下颌角骨折的一种理想的治疗方法。? 【关键词】穿颊器;下颌角骨折; 骨折内固定术; 口内入路? 【中图分类号】R782.4 【文献标识码】B 【文章编号】1008-6455(2010)07-0068-02 Throughintraoral approach for patients with mandibular angle and mandibular ramus fractures 50 cases? Jiang Lian Zou Sihai Huang Guilin et al.? 【Abstract】Objective: To evaluate the effect with screwed mini-plates rigid internal fixation through an intraoral and extraoral approach for patients with mandibular angle and ramus fractures.Methods: 50 cases of mandibular angle and ramus fractures were treated by screwed mini-plates placed through a transbuccal incision with transbuccal trocar instrumentation from December 2006 to May 2009. From the same period 21 cases of patients with the type of fracture, is still the traditional surgical approach extraoral open reduction and rigid internal fixation. Patients were followed-up for 3 months. Results:The 6 patient treated by extraoral approach happened temporal facial palsy. The 2 patient treated by extraoral approach happened limitation of mouth opening. All cases were no bony resorption but also regained their natual occluding relation and temporomandibular joint nction after surgery. Conclusions:The intraoral approach is better than extraoral approach to therapy the mandibular angle and ramus fractures.The intraoral approach is a reliable surgical selection. ? 【Key words】Transbuccal trochar instrumentation; mandibular angle fractures; Internal fixation Intraoral approach 下颌骨骨折在颌面诸骨中发生率较高,临床治疗方法有多种[1],下颌角区是下颌骨骨折好发部位之一,约占下颌骨骨折的20%。自上世纪80年代以来颌骨坚固内固定术治疗颌骨骨折得到国内外学者的广泛认可[2]。对于下颌角部、升支部等位置的骨折而言,若要在口内操作完成坚强内固定则较为困难。传统的下颌角区部、升支