论文部分内容阅读
目的探讨PRP凝胶在用可吸收材料固定的上颌窦前壁粉碎性骨折的临床应用价值及鼻内镜临床应用的优越性。方法选56例上颌窦前壁粉碎性骨折采用可吸收材料固定加PRP凝胶贴敷治疗(鼻内镜直视下手术28例;常规无影灯照明下治疗28例);对照组54例单纯采用可吸收材料固定(鼻内镜直视下手术27例;常规无影灯照明下治疗27例)。对于上颌窦前壁粉碎性骨折采用距下睑缘下3.0 mm切口,并于眶骨缘下2 mm处做骨膜横切口,暴露骨折处,同时分离嵌顿的肌肉和其他组织并拉至解剖位置,并分别吸出和刮出(鼻内镜下或无影灯下)上颌窦内的积血及病变坏死组织,取适当大小的可吸收材料固定骨折处(如果骨片太碎也可先用医用耳脑胶粘合之),56例患者采用制备好的PRP凝胶贴敷骨折处,分层缝合骨膜、皮下组织及皮肤。结果随访12个月,治疗组患者术后恢复快、无感染,皮肤瘢痕细小、光泽好,可吸收材料吸收好;骨折愈合好,双侧面部对称,眼睑无肿胀。咬合关系正常。鼻内镜下手术时间明显缩短(平均比无影灯下手术缩短25 min)、出血量减少(平均减少60 ml)、术后组织消肿明显加快(平均缩短3.0天)。结论 PRP凝胶能促进皮肤伤口和骨折的快速愈合、能使皮肤瘢痕变细、皮肤光泽水嫩,PRP凝胶可适用于上颌窦前壁粉碎性骨折的修复和重建;鼻内镜下手术:视野好、清除坏死组织彻底干净,出血少且费时短,值得临床推广应用。
Objective To investigate the clinical value of PRP gel in the treatment of comminuted fractures of anterior maxillary sinus with absorbable materials and the superiority of clinical application of endoscopic sinus surgery. Methods 56 cases of maxillary anterior comminuted fractures were treated with absorbable material and PRP gel (28 cases under endoscopic sinus surgery; 28 cases under conventional shadowless lighting); 54 cases in control group were treated with Absorption of materials fixed (endoscopic surgery under direct vision in 27 cases; conventional shadowless lamp treatment of 27 cases). For comminuted fracture of the anterior wall of the maxillary sinus, a 3.0 mm incision was made under the lower eyelid and a transverse periosteal incision was made 2 mm below the orbital margin to expose the fracture site. Meanwhile, the incarcerated muscles and other tissues were separated and pulled to the anatomical site , And were aspirated and scraped (endoscopic or shadowless lamp) maxillary sinus hemorrhage and necrosis tissue, take the appropriate size of the absorbable material to fix the fracture (if the bone chips can also be broken with medical ear Adhesive glue), 56 patients with prepared PRP gel applied fractures, layered periosteum, subcutaneous tissue and skin. Results The patients were followed up for 12 months. The patients in the treatment group recovered fast and had no infection after operation. The skin scar was fine and the gloss was good. The absorbable material was well absorbed. The fractures healed well, bilateral facial symmetry and no eyelid swelling. Bite normal. The operation time under endoscopic sinus surgery was significantly shortened (average 25 minutes shorter than that without shadow lamp), the amount of bleeding was reduced (an average reduction of 60 ml) and the postoperative tissue swelling was significantly faster (average 3.0 days shortened). Conclusions PRP gel can promote the rapid healing of skin wounds and fractures, make skin scar thin and smooth, and PRP gel can be used to repair and reconstruct maxillary sinus anterior comminuted fracture. Nasal endoscopic surgery: Good vision, remove necrotic tissue thoroughly clean, less bleeding and time-consuming, it is worth to clinical application.