320例颌面创伤救治临床分析.doc

320例颌面创伤救治临床分析 　【摘要】 目的 探讨严重颌面部创伤的临床特点及治疗方法。方法 回顾分析1996年5月至2006年5月我院收治的320例颌面创伤患者的急救方法及治疗效果。结果 经过清创缝合、坚强内固定、颌间结扎等治疗并结合计算机三维影像重建、模拟手术技术，317例患者咬合关系恢复正常，面容有所改善，功能得到恢复。结论 诊疗中首先要明确主次问题，对软组织损伤尽量一期缝合，对骨折病例注意兼顾功能与外形。 【关键词】 颌面创伤；颌骨骨折；坚强内固定；三维影像重建 　　Abstract: Objective To investigate the clinical characteristic and effective treatment method of severe maxillofacial trauma. Methods Retrospective analysis of methods and effects of treatment were carried in 320 patients with maxillofacial trauma from May 1996 to May 2006. Results The cases with soft tissue laceration were debrided and sutured. The bone fracture cases were treated reduction by intermaxillary elastic traction, open reduction and rigid internal fixation or rigid internal fixation in combination with intermaxillary ligation. Then, increase the effectiveness and reduced period of treatment. Application of the computer software to reconstruct threedimensional image of fracture could got more detailed information to make surgical planning. Occluding relation and function were recovered and feature got well in 317 cases. Conclusion The principal problem must be identified first and soft tissue injury is sutured primary as soon as possible，and most of all bone fracture is considered in terms of function and appearance. 　　Keywords: maxillofacial trauma; jaw fracture; rigid internal fixation(RIF); threedimensional images reconstruction 　　交通事故及工伤导致的颌面创伤发生率逐年增高。由于颌面损伤常常伴有其他重要器官的损伤，病情比较复杂，病人的抢救涉及多个学科，因此，重视多学科的协同治疗，对提高抢救的成功率极其重要。我院自1996年5月至2006年5月共收治中、重度颌面创伤患者320例，经过系统治疗，均取得满意疗效。现报告如下。 　　1 资料与方法 　　1.1 临床资料本组病例共320例，男242例，女78例；年龄6～73岁，其中21～40岁共214例，约占66.88%。车祸伤234例（73.12%），工伤37例（11.56%），打击伤41例（12.81%），其它8例（2.50%）。单纯软组织损伤23例，占7.18%；颌面部多发骨折188例，占58.75%，其中42例伴有颅脑或其它脏器损伤；颌面部单发骨折109例，占34.06%。合并颅脑损伤22例，颅底骨折5例，锁骨骨折6例，四肢骨折24例，肋骨骨折9例，胸部外伤11例，腹部脏器损伤8例，颈部外伤6例，耳外伤6例，眼外伤14例。为迅速且比较准确地对患者的伤情作出判断，制订适当的手术方案，我们依据“创伤严重评价法”（injury severity scale，ISS）和“简化伤情分法”（abbreviated injury scale，AIS）对损伤情况进行分级，见表1。本组病例均在AIS 2级以上。 　　表1 口腔颌面创伤简明分级法AIS分级