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目的观察不同类型下颌骨髁突高位骨折采用不同治疗方法结合功能性训练后的临床效果。方法不同类型髁突高位骨折36例(51侧),单侧21例,双侧15例。按Neff分类分为A型11侧、B型17侧、C型21侧、粉碎型2侧。选择牙弓夹板或牵引钉颌间牵引固定保守治疗6例(7侧);镙钉内固定治疗28例(42侧);摘除髁突治疗2例(2侧)。术后2周开始下颌功能训练,包括张口、前伸和侧向运动训练。6个月后进行张口度、张口型、咬合关系及面神经功能的评估。结果手术治疗共30例(44侧),创口延期愈合2例(2侧),其余均一期愈合;出现面神经颞支损伤19例,18例术后1年内完全恢复,1例未恢复。6个月后下颌运动评估,保守治疗的张口度正常6例,张口型正常5例,1例轻度偏斜,咬合关系正常6例;镙钉内固定治疗的28例张口度及咬合关系均正常,张口型2例轻度偏斜。摘除髁状突的张口度及咬合关系正常,但张口型均出现向患侧偏斜。结论不同类型髁突高位骨折可根据实际情况采用不同的治疗方法,镙钉内固定能较好恢复下颌的运动功能和咬合关系。
Objective To observe the clinical effect of different types of high condylar fractures of the mandible with different treatment methods combined with functional training. Methods Different types of condylar fractures in 36 cases (51 sides), unilateral in 21 cases, bilateral in 15 cases. By Neff classification is divided into A type 11 side, B type 17 side, C type 21 side, crushing type 2 side. Six cases (7 sides) were treated conservatively by intermaxillary traction and fixation. 28 cases (42 sides) were treated with internal fixation with screws and 2 cases (2 sides) with condyle removal. Mandibular function training began 2 weeks after the operation, including mouth opening, extension and lateral exercise training. After 6 months, mouth opening, mouth opening, occlusion and facial nerve function assessment. Results A total of 30 cases (44 sides) underwent surgical treatment. The wounds were healed in 2 cases (2 sides) and the rest were all healed in the same period. Nineteen cases were found with facial nerve branch injury. 18 cases recovered completely within 1 year and 1 case did not recover. 6 months after mandibular movement assessment, conservative treatment of normal mouth in 6 cases, 5 cases of normal mouth type, 1 case of mild skewness, occlusion in 6 cases of normal; screw fixation of 28 cases of mouth opening and occlusal relationship Normal, mouth type 2 cases of mild skewness. Excision of the condylar mouth opening and occlusion of the normal relationship, but the mouth-type appear to the affected side of the skewed. Conclusion Different types of high condylar fractures can be treated differently according to the actual situation. Internal fixation with screw fixation can restore the motor function and occlusion relationship of the mandible.