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目的比较小型钛板内固定手术与保守方法在成人髁突骨折治疗中的临床效果,评价这两种治疗方法选择的可靠性及愈后结果。方法通过对安徽省淮北市矿工总医院口腔颌面外科2010—2011年间收治的21例成人髁状突骨折病例进行回顾性分析,将21例不同类型的髁突骨折病例采取随机分类的方法分为对照组、实验组2组。对照组中10例患者采用上下颌牙弓夹板结扎固位,骨折侧后牙区放置颌垫的方法。术后1周内调节颌间弹力牵引,以最大程度地恢复伤前咬合关系,并使骨断端最大面积达到复位,术后制动牵引的时间3~5周不等;实验组中11例患者采用小型钛板内固定及髁突摘除的手术治疗,治疗程序遵循术中及术后1周保持制动,恢复并保持伤前咬合关系,然后去除弹力牵引,开放口腔,尽可能使口腔功能得以发挥。结果对照组与实验组的病例分别于术后的3个月,半年复查。通过临床及X光摄片检查,结合开口度、开口型、咬合关系、咀嚼力、面型等5个方面的指标综合评估,愈后结果提示对照组和实验组病例的有效率均在90%以上。结论治疗前,首先依据外伤力作用的大小和方向对成人髁突骨折的严重程度进行评估,然后结合影像学检查进一步明确诊断,并对骨折类型进行临床分类。术前再针对骨折分类结果采取相应的治疗方法,就能获得较为满意的临床效果。
Objective To compare the clinical effects of internal fixation with small titanium plates in the treatment of adult condylar fractures and to evaluate the reliability and prognosis of these two treatment options. Methods A retrospective analysis of 21 cases of adult condylar fractures admitted to the Department of Oral and Maxillofacial Surgery, Huaibei Mining General Hospital of Anhui Province from 2010 to 2011, 21 cases of different types of condylar fractures were randomly divided into Control group, experimental group 2 groups. Ten patients in the control group were treated with maxillary and maxillary arch splint ligation and maxillary pad in the posterior teeth of the fracture. Within 1 week after operation, the intermaxillary elastic traction was adjusted to maximize the preoperative occlusal occlusion, and the maximum area of the broken ends of the bone was reset. The time of postoperative traction traction ranged from 3 to 5 weeks. In the experimental group, 11 cases Patients with small titanium plate fixation and removal of condyles surgery, the treatment process to follow the intraoperative and postoperative 1 week to maintain the brake, restore and maintain pre-occlusion relationship, and then remove the elastic traction, open the mouth, as far as possible so that oral function To play. Results The cases of the control group and the experimental group were respectively reviewed at 3 months and 6 months after operation. Through the clinical and X-ray examination combined with the comprehensive evaluation of five aspects of the opening degree, open type, occlusal relationship, chewing force, surface type, the results of the more advanced results showed that the effective rate of the control group and the experimental group were all above 90% the above. Conclusion Before treatment, the severity of condylar fractures in adults was evaluated according to the size and direction of traumatic force. Then the imaging diagnosis was further clarified and the fracture types were classified. Preoperative and then for the classification of fracture results to take the appropriate treatment, you can get more satisfactory clinical results.