颌后切口穿腮腺入路联合可吸收接骨板治疗髁突基部骨折的疗效观察

陈鹏; 刘冰; 魏博; 冯璐; 郭亚霖; 翟孝庭

doi:10.3969/j.issn.2095-5227.2021.06.007

颌后切口穿腮腺入路联合可吸收接骨板治疗髁突基部骨折的疗效观察

Retromandibular transparotid approach and absorbable bone fixation for treatment of condylar base fractures

摘要

摘要:
背景颌面部骨折中，髁突基部骨折较难处理。对于髁突基部骨折大多采用绕下颌角弧形切口或附加耳屏前切口，因切口距离骨折线远，操作比较困难，不能垂直于骨面进行钻孔拧入螺钉，从而无法应用可吸收接骨板钉进行内固定。
目的本研究拟通过颌后切口穿腮腺入路联合可吸收接骨板治疗髁突基部骨折，并与传统的绕下颌角切口联合钛板钉固定进行比较以评价其疗效。
方法回顾性分析2015年9月- 2019年9月在解放军总医院第一医学中心口腔科进行治疗的髁突基部骨折患者20例，其中观察组10例患者采用颌后切口穿腮腺入路联合可吸收接骨板钉固定，对照组10例患者采用绕下颌角弧形切口及钛接骨板固定。比较两组切口长度、手术时间、出血量、张口恢复时间及术后暂时性面瘫发生例数，并通过咬合情况、伤口愈合情况及X线片评价手术效果。
结果观察组切口长度(4.3 ± 1.1) cm vs (7.5 ± 2.6) cm，P=0.000、手术时间(45.3 ± 18.7) min vs (57.2 ± 7.3) min，P=0.016、出血量(20.3 ± 6.8) mL vs (38.3 ± 7.1) mL，P=0.032、术后并发症(10% vs 100%，P=0.000)及张口度恢复时间(28 ± 7) d vs (43 ± 5) d，P=0.000均明显优于对照组。所有患者切口均甲级愈合，无涎瘘，手术效果良好。
结论以颌后切口穿腮腺入路联合可吸收接骨板行髁突基部骨折坚强内固定，可直视操作，损伤小，并发症少，效果良好，是一种较好的髁突基部骨折治疗方法。

Abstract:
Background Condylar base fracture is one of the most difficult fracture patterns to repair in maxillofacial surgery. For condylar base fractures, an arc-shaped incision around the angle of the mandible or an additional anterior tragus incision will be used commonly. Since the incision is far from the fracture line and the operation is difficult, drilling screws perpendicular to the bone surface cannot be performed, thus absorbable osteosynthesis plate nail also cannot be applied for internal fixation.
Objective To treat condylar base fractures by retrognathic incision through parotid approach combined with absorbable osteosynthesis plate, compare it with the traditional closed mandibular angle incision combined with titanium plate nail fixation, and evaluate its outcomes.
Methods Clinical data about 20 patients aged 18-66 years, including 13 males and 7 females, with condylar base fractures treated in the First Medical Center of Chinese PLA General Hospital from September 2015 to September 2019 were retrospectively reviewed. In the observation group, 10 patients were fixed by retrognathic incision through parotid approach combined with absorbable osteosynthesis plate nail, while 10 patients in the control group were fixed by arc incision around the mandibular angle and titanium osteosynthesis plate. Incision length, operating time, blood loss, recovery time of mouth opening and the number of cases with temporary postoperative facial paralysis were compared, and occlusion, wound healing and radiographs were compared to evaluate the surgical outcomes.
Results The observation group was significantly better than the control group in terms of incision length (cm)(4.3 ± 1.1 vs 7.5 ± 2.6, P＜0.001), operating time (min) (45.3 ± 18.7 vs 57.2 ± 7.3, P=0.016), blood loss (mL) (20.3 ± 6.8 vs 38.3 ± 7.1, P=0.032), postoperative complications (10% vs 100%, P＜0.001) and recovery time of mouth opening (d) (28 ± 7 vs 43 ± 5, P＜0.001), the incision was rated as grade A healing in all patients without sialorrhea fistula, and the surgical results were good.
Conclusion The rigid internal fixation by the retromandibular transparotid approach with the absorbable bone fixation is an effective surgical method to treat condylar base fracture.

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