穿腮腺手术径路治疗下颌骨髁突骨折的临床效果评价

doi:10.3877/cma.j.issn.1674-1366.2016.06.007

中华口腔医学研究杂志(电子版) ›› 2016, Vol. 10 ›› Issue (06) : 402 -407. doi: 10.3877/cma.j.issn.1674-1366.2016.06.007

所属专题：专题评论；文献；

临床研究

穿腮腺手术径路治疗下颌骨髁突骨折的临床效果评价

谢奕文¹, 林嘉旭¹, 林玉娇¹, 吴晓平¹, 王友山¹, 王成², 侯劲松²^,^†(

)

^1. 515031　汕头，中山大学附属汕头医院·汕头市中心医院口腔科
^2. 510055　广州，中山大学光华口腔医学院·附属口腔医院，广东省口腔医学重点实验室

收稿日期:2016-10-06 出版日期:2016-12-01
通信作者: 侯劲松
基金资助:
广东省基础与应用基础研究专项（省自然科学基金）粤东西北创新人才联合培养项目(2014A030307003); 汕头市科技计划(汕府科〔2015〕132号123)

Assessment of clinical effects using the transparotid approach for open treatment of condylar fractures

Yiwen Xie¹, Jiaxu Lin¹, Yujiao Lin¹, Xiaoping Wu¹, Youshan Wang¹, Cheng Wang², Jingsong Hou²^,^†()

^1. Department of Stomatology, Affiliated Shantou Hospital, Sun Yat-sen University, Shantou 515031, China
^2. Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China

Received:2016-10-06 Published:2016-12-01
Corresponding author: Jingsong Hou
About author:
Corresponding author: Hou Jingsong, Email: houjsgz@aliyun.com

全文 ( ) 下载PDF ( ) 导出引用

引用本文：

谢奕文, 林嘉旭, 林玉娇, 吴晓平, 王友山, 王成, 侯劲松. 穿腮腺手术径路治疗下颌骨髁突骨折的临床效果评价[J/OL]. 中华口腔医学研究杂志(电子版), 2016, 10(06): 402-407.

Yiwen Xie, Jiaxu Lin, Yujiao Lin, Xiaoping Wu, Youshan Wang, Cheng Wang, Jingsong Hou. Assessment of clinical effects using the transparotid approach for open treatment of condylar fractures[J/OL]. Chinese Journal of Stomatological Research(Electronic Edition), 2016, 10(06): 402-407.

目的

评价穿腮腺手术径路治疗下颌骨髁突骨折的临床效果。

方法

对31例（共36侧）下颌骨髁突骨折的患者，穿腮腺入路行下颌骨髁突骨折切开复位钛钉钛板坚固内固定术、髁突骨折碎片取出术并髁突成形术。术后观察面型、张口度、咬合关系、面神经损伤、有无唾液腺瘘及复查颌面部CT观察骨折段的复位情况等。

结果

24例（共29侧）行下颌骨髁突骨折切开复位钛钉钛板坚固内固定术，7例（共7侧）髁突骨折碎片取出术并髁突成形术，术后随访6 ~ 18个月（平均11.3个月）；通过穿腮腺手术径路骨折断端复位准确、固定良好、咬合功能恢复正常、面部外形均满意；4例患者早期出现Ⅰ~Ⅱ度张口受限，经过张闭口训练后恢复正常；5例患者出现面神经暂时性麻痹，8周后均恢复正常；1例患者出现唾液腺瘘，经过加压包2周后扎后创口愈合；4例患者出现创伤性关节紊乱症，有关节弹响、疼痛等。

结论

穿腮腺手术径路治疗下颌骨髁突骨折安全有效，手术并发症少，值得临床推广应用。

关键词: 下颌骨髁状突, 骨折, 口腔外科手术, 穿腮腺径路

Objective

To evaluate the clinical effects of the transparotid approach for open treatment of condylar fractures.

Methods

In this study, 31 patients with mandibular condylar fractures (36 sides) , were treated using a transparotid approach for open treatment of condylar fractures. Follow-up examinations and postoperative CT scan were performed. The degree of mouth opening, occlusal relationship, facial nerve function, and other complications in the patients were assessed and evaluated.

Results

24 patients with mandibular condylar fractures (29 sides) were treated through the transparotid approach with rigid internal fixation using miniplates; 7 patients whose condyle fracture′ fragments were removed and had arthroplasty of temporomandibular joints. Follow-up examinations were performed for a minimum of 6 months and a maximum of 18 months (average 11.3 months) after surgical treatment. Postoperative CT scan showed that all the condyles had been repositioned and fixed in the normal position; Occlusal function recovered well and facial symmetry was achieved in all of the patients; 4 patients developed Ⅰor Ⅱgrade of limited mouth opening in the early period, and returned to normal after serial trainings; 5 patients developed palsy of the facial nerve that was completely recovered after 8 weeks; 1 patient developed a fistula of the parotid gland who had a second wound healing after bandage treatment for 2 weeks; 4 cases developed traumatic articular diseases that the relevant symptoms such as joint snapping and ache.

Conclusion

The transparotid approach for the open treatment of condylar fractures is feasible and safe, also worthy of clinical application and popularization.

Key words: Mandibular condyle, Fractures, bone, Oral surgical procedures, Transparotid approach

图1 典型病例术前口腔全颌曲面断层片（红色箭头所示为下颌骨左侧髁突、右侧体部骨折处）

图2 典型病例术前三维CT重建左侧面图像（红色箭头所示为下颌骨左侧髁突骨折）

图3 典型病例术前三维CT重建从颅骨后方观察左侧髁突骨折（红色箭头所示为下颌骨左侧髁突骨折）

图4 典型病例穿腮腺手术径路行切开复位钛钉钛板内固定手术切口

图5 典型病例穿腮腺径路术中显露面神经及钛钉钛板固定情况

图6 典型病例术后6个月复诊张口度正常、无面神经麻痹

图7 典型病例术后6个月复诊咬合关系恢复良好

图8 典型病例术后6个月复诊口腔全颌曲面断层片（红色箭头所示为下颌骨左侧髁突、右侧体部骨折坚固内固定处）

图9 典型病例术后三维CT重建左侧面图像（红色箭头所示左髁突骨折复位准确、钛板钛钉固定良好）

图10 典型病例术后三维CT重建从颅骨后方观察（红色箭头所示左髁突骨折复位准确、钛板钛钉固定良好）

[1]	Weiss JP, Sawhney R. Update on mandibular condylar fracture management[J]. Curr Opin Otolaryngol Head Neck Surg，2016，24(4):273-278.
[2]	Berner T, Essig H, Schumann P，et al. Closed versus open treatment of mandibular condylar process fractures：A meta-analysis of retrospective and prospective studies[J]. J Craniomaxillofac Surg，2015，43(8):1404-1408.
[3]	Eckelt U, Schneider M, Erasmus F，et al. Open versus closed treatment of fractures of the mandibular condylar process-a prospective randomized multi-centre study[J]. J Craniomaxillofac Surg，2006，34(5):306-314.
[4]	Klatt J, Pohlenz P, Blessmann M，et al. Clinical follow-up examination of surgically treated fractures of the condylar process using the transparotid approach[J]. J Oral Maxillofac Surg，2010，68(3):611-617.
[5]	Vesnaver A, Gorjanc M, Eberlinc A，et al. The periauricular transparotid approach for open reduction and internal fixation of condylar fractures[J]. J Craniomaxillofac Surg，2005，33(3):169-179.
[6]	Güerrissi JO. A transparotid transcutaneous approach for internal rigid fixation in condylar fractures[J]. J Craniofac Surg，2002，13(4):568-571.
[7]	Ellis E 3rd, Throckmorton GS, Palmieri C. Open treatment of condylar process fractures：assessment of adequacy of repositioning and maintenance of stability[J]. J Oral Maxillofac Surg，2000，58(1):27-34;discussion 35.
[8]	Kanno T, Sukegawa S, Tatsumi H，et al. Does a retromandibular transparotid approach for the open treatment of condylar fractures result in facial nerve injury[J]. J Oral Maxillofac Surg，2016，74(10):2019-2032.
[9]	徐兵，姚隆浩，唐友盛，等.翼外肌-髁状突骨折开放手术功能恢复的关键[J].口腔颌面外科杂志，2001，11(1):26-29.

[1]	李焕玺, 何淳诺, 田志敏, 周胜虎, 吴昊越, 张浩强. 全膝关节置换术后股骨远端假体周围骨折治疗现状[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 630-637.
[2]	曾敬, 吴冬冬, 邵明, 范震波, 王治国, 刘培谊, 兰海峰. 高龄髋部骨折患者不同手术时机的围手术期疗效评估[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 445-449.
[3]	于威, 王艺凯, 杨文博, 孟春庆, 王洪, 黄玮. 陈旧性前交叉韧带胫骨止点撕脱骨折的诊疗进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 532-537.
[4]	郭杰坤, 王楹, 杨轩, 晏欢欣, 钟豪. Ilizarov 骨搬移技术在急诊一期修复GustiloⅢB 型胫骨长段开放粉碎性骨折的临床效果[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 507-510.
[5]	于同, 矫健航, 姜炜博, 王中汉, 王洋, 伍旭辉, 吴敏飞. 体位复位与椎板切除减压内固定术治疗胸腰段爆裂性骨折的对比性研究[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 331-339.
[6]	黄韬, 杨晓华, 薛天森, 肖睿. 改良“蛋壳”技术治疗老年OVCF及对脊柱矢状面平衡参数、预后的影响[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 340-348.
[7]	谭明明, 战世强, 侯宏涛, 曾翔硕. 经皮微创椎弓根螺钉内固定术对骨质疏松脊柱压缩性骨折患者临床研究[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 349-354.
[8]	王贝贝, 崔振义, 王静, 王晗妍, 吕红芝, 李秀婷. 老年股骨粗隆间骨折患者术后贫血预测模型的构建与验证[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 355-362.
[9]	张峻, 赵建民, 姚晓克, 吉浩宇, 越瑞祥. 增加CT对桡骨远端骨折分型的可靠性及可重复性评价[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 264-272.
[10]	房桂彬, 肖进, 傅光涛, 郑秋坚. 老年髋部骨折患者术后1年行走能力的影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 273-280.
[11]	张于, 程亮亮, 王峰, 赵德伟. 2枚与3枚空心钉治疗无移位股骨颈骨折的疗效对比[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 281-286.
[12]	茹江英, 廖启宇, 温国洪, 潘思华, 刘栋, 张皓琛, 牛云飞. 直接前方入路和后外侧入路半髋关节置换治疗老年痴呆股骨颈骨折的疗效比较[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 287-293.
[13]	单良, 刘怡, 于涛, 徐丽. 老年股骨颈骨折术后患者心理弹性现状及影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 294-300.
[14]	周锐, 罗飞. 骨质疏松椎体骨折的分型进展[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 315-320.
[15]	喻蓉, 周伟力, 雷青, 陈松, 陈立, 刘峰, 丁州, 阳宏奇, 王康, 王大鹏. 改良的内外侧环抱锁定钢板在复杂胫骨平台骨折治疗中的临床疗效观察[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 764-770.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Assessment of clinical effects using the transparotid approach for open treatment of condylar fractures

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Assessment of clinical effects using the transparotid approach for open treatment of condylar fractures