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目的探讨从口内和穿颊的手术入路复位内固定下颌骨升支及下颌角骨折的手术方法及疗效。方法选择2005年10月-2011年12月28例下颌骨升支及下颌角骨折患者,采用穿颊器经过颊部小切口联合口内切口复位内固定(口内组)。随机选取同期34例同类型骨折患者,按照传统口外入路行手术切开复位内固定(口外组),对两组患者的临床疗效及并发症进行对比分析。结果口内组患者无面神经损伤,面、颈皮肤无手术瘢痕,口内组18例患者术中咬合关系恢复理想。口外组20例患者内固定术后咬合关系欠佳,需行术后颌间结扎固定。口外组14例患者内固定术后出现暂时性面瘫,28例患者出现面部瘢痕,2例出现涎瘘。两组术后面部瘢痕及暂时性面瘫发生率比较差异有统计学意义(P<0.05)。结论口内和穿颊手术入路具有无外部瘢痕形成、不会损伤面神经等优势,是下颌骨升支及下颌角骨折的一种理想的治疗方法。
Objective To study the surgical methods and curative effects of internal fixation of mandibular ascending and lower extremity fractures from intraoral and cheek operative approaches. Methods From October 2005 to December 2011, 28 patients with mandibular ascending and lower extremity fractures were treated with mini-incision and intra-oral incision through the buccal device. Thirty-four patients with the same type of fracture were randomly selected, and their clinical curative effect and complication were analyzed by surgery and open reduction and internal fixation. Results The patients in the oral group had no facial nerve injury, no surgical scar on the face and neck, and the occlusal relationship recovered well in 18 patients in the oral group. Oral group of 20 patients with poor postoperative internal fixation of bite, the need for postoperative intermaxillary ligation fixed. In the oral group, 14 patients had temporary facial paralysis after internal fixation, 28 patients had facial scar, and 2 patients had salivary fistula. The postoperative facial scar and temporary facial paralysis incidence difference was statistically significant (P <0.05). Conclusion The intraoral and buccal approach has the advantages of no external scar formation, no facial nerve damage, etc. It is an ideal treatment for mandibular ascending branch and mandibular angle fractures.