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目的探讨颧骨复合体骨折的顺序复位固定技术及疗效。方法 2004年3月-2012年2月,收治颧骨复合体骨折32例。男28例,女4例;年龄17~55岁,中位年龄29岁。致伤原因:交通事故伤29例,跌伤3例。新鲜骨折28例,受伤至入院时间1~12 d,平均3 d;陈旧性骨折4例,受伤至入院时间22~60 d,平均40 d。均经临床和CT检查确诊。采用头皮冠状切口、下睑缘切口和口内前庭沟切口入路,显露颧面部骨折,以先横向后纵向顺序进行骨折复位固定。横向由后向前(即颧弓根部→颧弓→颧骨体部→眶下缘)顺序,纵向先行颧额缝和眶外壁骨折复位,后转向口内使颧牙槽嵴骨折复位并固定。结果术后切口均Ⅰ期愈合,无上颌窦瘘、钛钉及钛板感染等并发症发生。18例获随访,随访时间6个月~6年,中位时间32个月。患者面形恢复满意,两侧基本对称,开、闭口功能正常。无眼球损伤、视力损害发生。术后2例出现额纹消失、眉下垂,6个月有一定程度自行恢复。头皮冠状切口遗留2~3 mm脱发痕迹,无瘢痕增生;下眼睑无明显瘢痕。6个月复查时,CT及X线片示骨折均愈合。结论顺序复位固定技术符合颧骨复杂骨折的力学特点,容易达到精确解剖复位。
Objective To study the sequential reduction and fixation of cuneiform complex fractures and its curative effect. Methods From March 2004 to February 2012, 32 cases of zygomatic complex fractures were treated. 28 males and 4 females; aged 17 to 55 years, mean age 29 years. Cause of injury: 29 cases of traffic accidents, fell injury in 3 cases. Fresh fractures in 28 cases, 1 to 12 days after injury to hospital admission, an average of 3 days; 4 cases of old fractures, hospital stay from 22 to 60 days, an average of 40 d. All confirmed by clinical and CT examination. The scalp coronal incision, the lower eyelid incision and vestibular canal incision approach, revealed zygomatic facial fractures, to the first horizontal and vertical longitudinal fracture reduction and fixation. Lateral to posterior (ie, zygomatic arch → zygomatic arch → zygomatic body → infraorbital margin) order, vertical zygomatic frontal orbital wall fracture reduction, and then to the mouth of the zygomatic alveolar ridge fractures reset and fixed. Results Postoperative incision healed by first intention without complication such as maxillary fistula, titanium nail and titanium plate infection. Eighteen patients were followed up for 6 months to 6 years with a median time of 32 months. Patients satisfied with the restoration of shape, both sides of the basic symmetry, open, closed mouth function is normal. No eye damage, visual impairment occurred. Postoperative 2 cases of forehead pattern disappeared, eyebrow ptosis, 6 months have a certain degree of self-recovery. Scalp coronal incision left 2 ~ 3 mm hair loss marks, no scar hyperplasia; no significant scar lower eyelid. 6 months after the review, CT and X-ray showed fracture healing. Conclusion Sequential reduction and fixation technique is in line with the mechanical characteristics of complicated zygomatic fractures and can easily achieve accurate anatomic reduction.