中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (3): 253-256.

• 临床总结 • 上一篇    下一篇

68 例髁突骨折临床分析

李永平, 罗秀娟, 袁晓琴, 郭建姝, 郭蕾, 文志春   

  1. 云南省楚雄州人民医院 口腔科, 云南 楚雄 675000
  • 收稿日期:2015-05-20 出版日期:2016-06-20 发布日期:2016-07-04
  • 通讯作者: 李永平,E-mail:liyp307@163.com
  • 作者简介:李永平（1969-）,男,学士,副主任医师

Analysis of mandibular condylar fracture in 68 patients

LI Yong-ping, LUO Xiu-juan, YUAN Xiao-qin, GUO Jian-shu, GUO Lei, WEN Zhi-chun   

  1. Department of Stomatology, Chuxiong People's Hospital of Yunnan Province.Chuxiong 675000,Yunnan Province, China)
  • Received:2015-05-20 Online:2016-06-20 Published:2016-07-04

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摘要： 目的：总结髁突骨折（mandibular condylar fractures,MCF）的临床特点、分类及治疗原则,为 MCF 的治疗提供理论依据。方法选取我院口腔科 2006 年 4 月—2014 年 4月 68 例（91 侧）MCF 患者作为研究对象;从流行病学、骨折临床特点、分类、治疗方法及并发症角度对 MCF 进行分析。采用 SPSS12.0 软件包对结果进行统计学分析。结果68 例 MCF 患者中,男 49 例（72.06%）、女 19 例（27.94%）,男性患者显著多于女性患者（P<0.05）;7~40 岁 MCF 患者 56 例,显著大于 41~70 岁 MCF 患者 （12例,P<0.05）。MCF 的主要诱发因素是暴力创伤及交通事故。从髁突骨折部位、骨折移位方式及骨折移位块与关节窝的位置 3 个层面进行 MCF 分类,囊内骨折 32 例（47.06%）、髁颈骨折 16 例（23.53%）、髁突下骨折 20 例（29.41%）;囊内骨折中, A 型骨折 13例,B 型骨折 8 例,C 型骨折 6 例,M 型骨折 5 例。68 例 MCF 患者接受闭合性治疗 11 例（16.18%）,开放性治疗 57 例（83.82%）。57 例接受开放性治疗的患者术后 2 周开口度、咬合关系及开口型均显著改善（P<0.05）,改善程度显著大于闭合性治疗（P<0.05）。囊内骨折、髁颈骨折及髁突下骨折的疗效存在显著差异（P<0.05）。颌后穿腮腺入路可显著提高开口度,降低咬合关系紊乱及开口型偏斜（P<0.05）;耳前入路组术后面神经损伤发生率为 40.0%,与传统下颌下入路组及下颌后穿腮腺入路组相比,具有显著差异（P<0.05）,耳前入路组、颌后穿腮腺入路组及传统下颌下入路的感染及流涎发生率无显著差异（P>0.05）。结论MCF 的临床分类及治疗方法具有多样性,其中囊内骨折是 MCF 最常见的类型; MCF 的治疗应根据临床特点及分类,选取适合的治疗方法：闭合性治疗或开放性治疗包括合适的手术入路、手术摘除骨折块术、螺钉或钛板固定术等。

关键词: 髁突骨折, 临床特点, 分类

Abstract: PURPOSE: To summarize the clinical characteristics, classification and principles of treatment of mandibular condyle fracture (MCF), to provide a theoretical basis for treatment of MCF. METHODS: Sixty-eight patients (91 sides) with MCF treated from April 2006 to April 2014 were selected. The epidemiology, clinical characteristics, classification, treatment methods and complications of MCF were retrospectively analyzed. The data were processed with SPSS 12.0 software package. RESULTS: Among 68 patients with MCF, 49 (72.06%)were male, 19 (27.94 %) were female; the proportion of male patients with MCF was significantly larger than that of female patients (P<0.05); 56 patients were 7-40 years old while 12 patients were 41 to 70 years old(P<0.05). The most commonly causes of MCF were violence and traffic accident. Encapsulation fractures were seen in 32 (47.06%)cases, condylar neck fractures in 16(23.53%) cases and subcondylar fractures in 20 (29.41%) cases. Among 32 cases with encapsulation fracture, type A fracture was in 13 cases, type B in 8 cases, type C in 6 cases and type M in 5 cases. Eleven（16.18%) patients were treated by conservative therapy and 57（83.82%） patients were treated by open surgery. Mouth opening and occlusion were significantly improved 2 weeks after operation (P<0.05), and the degree of improvement was significantly greater than conservative treatment (P<0.05). Significant difference was noted in final outcomes among encapsulation fractures, condylar neck fractures and subcondylar fractures after treatment(P<0.05); trans-parotid approach can significantly improve mouth opening, reduce malocclusion and mouth deviation(P<0.05); the rate of postoperative complications via pre-auricular approach was 40%, which was significantly higher (P<0.05) than traditional submandibular approach and trans-parotid approach; while the incidence of postoperative infection and salivation was not significantly different (P>0.05) among preauricular approach, trans-parotid approach and traditional submandibular approach. CONCLUSIONS: Intracapsular fracture is the most common type of MCF; treatment of MCF should be based on the patient's clinical characteristics and classification. Conservative treatment or open surgery can be applied in selected cases with good clinical results.

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