髁突颈下部骨折口内入路与颌后入路的临床效果比较

目的:总结髁突颈下部骨折口内入路的治疗体会。方法:回顾2017年10月—2019年6月经手术治疗的髁突颈下部骨折患者17例,其中实验组7例行口内切口内固定,对照组10例行颌后切口内固定,比较2组的手术时间、骨折内固定情况、术后伤口感染率。术后随访3个月,观察开口及咬合功能恢复、术后面部瘢痕、术后面神经损伤情况。结果:实验组平均手术时间2 h,对照组2.5 h。实验组7例均采取单钛板固定,对照组10例均采用双钛板固定。实验组术后2例发生伤口感染,感染率28%;对照组伤口未出现感染。实验组术后常伴开口受限及咬合关系不协调,均需配合颌间牵引1~2周左右,随访3个月开口及咬合功能基本恢复正常。对照组术后开口受限较实验组轻,术后咬合关系基本恢复正常;随访3个月,开口及咬合功能恢复正常。实验组术后面部仅遗留1~2个3 mm左右穿颊小切口,瘢痕不明显;对照组术后于颌后区遗留3 cm左右手术切口,瘢痕较明显。2组均未发现面神经损伤。结论:口内入路髁突颈下部骨折的治疗可以达到与颌后入路相近的疗效,面部遗留瘢痕较轻。但伤口感染风险高,视野及操作空间受限,手术创伤较口外入路大,术后需要配合较长时间颌间牵引,开口及咬合功能恢复时间较长。

Clinical investigation of transoral internal fixation for subcondylar fracture:a comparative study

PURPOSE:To investigate the clinical outcomes of transoral internal fixation for subcondylar fracture.METHODS:From October 2017 to June 2019,seven patients with subcondyle fracture were treated with transoral internal fixation,ten patients with subcondyle fracture were treated with retromandibular internal fixation.Operation time,effect of internal fixation,oral function,facial scar and incidence of facial nerve injury were recorded and compared.RESULTS:The operation time was 2 hours in transoral group and 2.5 hours in retromandibular group.Internal fixation of transoral group almost used single miniplate and double miniplates were used in retromandibular group.Infection rate was 28%in transoral group and none in retromandibular group.Limitation of mouth opening and poor occlusal relationship often occured in transoral group,which needed intermaxillary traction for 1-2 weeks,and oral function returned to normal after 3 months.Oral function returned faster after operation in retromandibular group.Almost no scar left on the face in transoral group and the scar was more obvious in retromandibular group.No facial nerve injury occurred in both groups.CONCLUSIONS:Transoral interal fixation is a better approach for subcondylar fracture,which almost has no scar left on the face,but has high risk of infection,poor operation field,poor fixation stability,more operation trauma,needs intermaxillary traction and oral function recovery needs longer time.