儿童髁突骨折不同治疗方式的选择及疗效回顾性分析

潘志燕 马旭亮 代福月 王云肖 孙红蕾 王钰宁

[關键词]髁突骨折;保守治疗;手术治疗;下颌骨;内固定

[中图分类号]R782.2    [文献标志码]A    [文章编号]1008-6455（2021）11-0090-04

Retrospective Analysis of Different Treatment Options and Curative Effects of Condyle Fractures

PAN Zhi-yan1，MA Xu-liang2，DAI Fu-yue1 ，WANG Yun-xiao3，SUN Hong-lei4， WANG Yu-ning5

（1.Department of Stomatology，the Third Hospital of Xingtai City，Xingtai 054000， Hebei，China;2. Department of Oral and Maxillofacial Surgery， Hebei Eye Hospital，Xingtai 054000， Hebei，China;3. Department of Stomatology，Xingtai People's Hospital，Xingtai 054000，Hebei，China;4.Department of Oral Medicine，Hebei Eye Hospital，Xingtai 054000，Hebei，China;5.Department of Stomatology，the Second Affiliated Hospital of Xingtai Medical College，Xingtai 054000， Hebei，China）

Abstract： Objective  To explore the difference in curative effect between conservative treatment and surgical treatment in children with condylar fractures. Methods  The medical records of 90 children with condyle fractures treated in the department of stomatology of xingtai third hospital from May 2018 to May 2019 were selected for retrospective analysis. All children were divided into a control group and an observation group according to the difference of treatment methods， with 45 cases in the control group and 45 cases in the observation group. The control group used surgical treatment， and the observation group used conservative treatment. Compare the treatment effects， imaging results classification， mandibular three-dimensional reconstruction indexes， mandibular motor function， and adverse reactions of the two groups. Results  The effective rate of treatment in the observation group was 93.33%， and that in the control group was 88.89%， the difference was not statistically significant （P>0.05）. The effective rate of imaging changes in the observation group was 91.11%， and the effective rate of imaging changes in the control group was 86.67%， the difference was not statistically significant （P>0.05）. Six months after treatment， there was no significant difference in the depth of the temporomandibular joint between the two groups （P>0.05）. The transverse diameter of the condyle of the observation group was higher than that of the control group， and the width of the condyle and the deviation of bony mental point were lower than those of the control group （P<0.05）. Six months after treatment， the mouth opening of the observation group was greater than that of the control group （P<0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups during treatment （P>0.05）. Two years after treatment， all children recovered well， with an average maximum mouth opening of （42.81±3.92） mm. Conclusion  For pediatric patients with condylar fractures， conservative treatment methods can obtain similar effects as surgical treatments. Conservative treatment methods have more advantages in improving the children's mandibular motor function and maintaining the symmetry of the mandible.

Key words： condyle fracture; conservative treatment; surgical treatment; mandible; internal fixation

髁突骨折属于人体下颌骨骨折中占比最高的一类，有统计结果显示，人群下颌骨骨折中髁突骨折的比例可逼近40%，因此，针对髁突骨折的研究已成为医学重点科研方向之一[1]。根据患者个体骨折线的位置以及水平差异，髁突骨折又可以细分为囊内骨折、颈部骨折以及颈下骨折三种亚型，其中以囊内骨折的构成比最高，接近65%[2-3]。髁突骨折对于儿童发育的影响较大，该类骨折的部位属儿童下颌骨发育过程中的核心，另外，也是局部运动的枢纽，若该类骨折处理不当，容易诱发颞下颌关节功能紊乱、关节强直等，甚至有造成下颌骨发育障碍[4]。国外的研究结果显示，髁状突是人体下颌骨生长以及发育的核心区域，该部位的改建以及重生能力很强，尤其是儿童髁突骨折人群，具有极强的生长发育潜能，这也成为儿童发生该类骨折后可使用保守治疗的理论基础[5]。但是，对于国内儿童髁骨骨折的患者，应采用手术治疗方式还是保守治疗方式，目前仍然存在较大的争议。有观点认为保守治疗的方法操作较为便利，没有手术并发症的风险，不另外增添组织损伤以及患者的痛苦，可保证骨折的恢复以及咬合关系。但也有专家认为目前医学技术的进步，骨折内固定技术不断完善，辅助固定材料也在持续更新，采取手术方法复位髁突骨折的软硬组织已成为成熟的技术[6]。本研究……