经颌后切口腮腺前缘入路治疗髁突骨折的对照研究
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摘要
目的:采用颌后切口经腮腺前缘入路与穿腮腺入路2种术式分别治疗髁突骨折,比较2种手术方式的术后疗效。方法:选择2013年1月～2017年6月我院收治的52例髁突骨折病人,随机分为2组,改良切口组采用经颌后切口腮腺前缘入路,对照组采用传统的经颌后切口穿腮腺入路。术后随访6～36月,通过手术时间、骨折复位情况、开口度、咬合关系、面神经损伤及涎瘘发生率方面进行手术疗效的分析评价。结果:改良切口组:手术平均时间为79.60 min;所有患者术后骨折复位、开口度及咬合关系恢复良好;出现1例暂时性面神经损伤;无涎瘘发生。对照组:手术平均时间为86.40 min;所有病人术后骨折复位、开口度及咬合关系恢复良好;出现5例暂时性面神经损伤,1例永久性面神经损伤;4例发生涎瘘。结论:经颌后切口腮腺前缘入路的手术方法行髁突骨折切开复位内固定术可有效降低术中面神经损伤和术后涎瘘的发生率,且缩短了手术时间,没有增加其他并发症的发生,值得临床推广。
Objective: To compare postoperative curative effects of condylar fractures by anteroparotid approach and transparotid approach of retromandibular incisions. Method: This study consisted of 52 cases with condylar fractures treated at the Affiliated Stomatology Hospital of Southwest Medical University between January 2013 and June 2017. Fifty-two cases were randomly divided into modified incision group and control group. The patients of the modified incision group with condylar fractures accepted surgical treatment by the anteroparotid of retromandibular incisions, while the patients of the control group with condylar fractures accepted surgical treatment by the transparotid approach of retromandibular incisions. During the follow-up period of 6-36 months, the curative effects were evaluated based on operation time, fracture restoration, mouth opening, occlusion relationship, facial nerve injury, and salivary fistula. Results: Modified incision group: the average operation time was 79.60 min; all patients recovered well in fracture restoration, mouth opening and occlusion relationship; 1 case of temporary facial nerve injury occurred;and no case of salivary fistulas occurred. Control group: the average operation time was 86.40 min;
Objective: To compare postoperative curative effects of condylar fractures by anteroparotid approach and transparotid approach of retromandibular incisions. Method: This study consisted of 52 cases with condylar fractures treated at the Affiliated Stomatology Hospital of Southwest Medical University between January 2013 and June 2017. Fifty-two cases were randomly divided into modified incision group and control group. The patients of the modified incision group with condylar fractures accepted surgical treatment by the anteroparotid of retromandibular incisions, while the patients of the control group with condylar fractures accepted surgical treatment by the transparotid approach of retromandibular incisions. During the follow-up period of 6-36 months, the curative effects were evaluated based on operation time, fracture restoration, mouth opening, occlusion relationship, facial nerve injury, and salivary fistula. Results: Modified incision group: the average operation time was 79.60 min; all patients recovered well in fracture restoration, mouth opening and occlusion relationship; 1 case of temporary facial nerve injury occurred;and no case of salivary fistulas occurred. Control group: the average operation time was 86.40 min;
引文
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[4] 李蕙,崔军辉,刘磊.下颌骨髁突骨折手术入路研究进展[J].华西口腔医学杂志,2016,34(3):322-324.
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[8] 张益,张兴文.髁突骨折解剖复位及小型接骨板坚强内固定[J].中华口腔医学杂志,2001,36(2): 99-101.
[9] Rozeboom AVJ, Dubois L, Bos RRM, et al. Open treatment of condylar fractures via extraoral approaches: A review of complications [J]. J Craniomaxillofac Surg, 2018, 46(8): 1232-1240.
[10] Yao S, Zhou J, Li Z. Contrast analysis of open reduction and internal fixation and non-surgical treatment of condylar fracture: a meta-analysis [J]. J Craniofac Surg, 2014, 25(6): 2077-2080.
[11] Bhutia O, Kumar L, Jose A, et al. Evaluation of facial nerve following open reduction and internal fixation of subcondylar fracture through retromandibular transparotid approach [J]. Br J Oral Maxillofac Surg, 2014, 52(3): 236-240.
[12] Kim BK, Kwon YD, Ohe JY, et al. Usefulness of the retromandibular transparotid approach for condylar neck and condylar base fractures[J]. J Craniofac Surg, 2012, 23(3): 712-715.
[13] Yang L, Patil PM. The retormandibular transparotid approach to mandibular subcondylar fractures [J]. Int J Oral Maxillofac Surg, 2012, 41(4): 494-499.
[14] Shi J, Yuan H, Xu B, et al. Treatment of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision: experience with 31 cases [J]. PLoS One, 2013, 8(12): e83525.
[15] Shi D, Patil PM, Gupta R. Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures [J]. J Craniomaxillofac Surg, 2015, 43(3): 402-407.
[16] Tang W, Gao C, Long J, et al. Application of modified retromandibular approach indirectly from the anterior edge of the parotid gland in the surgical treatment of condylar fracture [J]. J Oral Maxillofac Surg, 2009, 67(3): 552-558.
[17] Balaji SM. Parotid fistula from transparotid approach for mandibular subcondylar fracture reduction [J]. Ann Maxillofac Surg, 2013, 3(2):182-184.
[18] Hou J, Chen L, Wang T, et al. A new surgical approach to treat medial or low condylar fractures: the minor parotid anterior approach [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2014, 117(3): 283-288.
[2] Zhou Z, Li Z, Ren J, et al. Digital diagnosis and treatment of mandibular condylar fractures based on Extensible Neuro imaging Archive Toolkit (XNAT) [J]. PLoS One, 2018, 13(2): e0192831.
[3] Rozeboom A, Speksnijder C, Dubois L, et al. Is masticatory performance affected after a unilateral condylar fracture? A cross-sectional study [J]. J Oral Rehabil, 2018, 45(10):777-782.
[4] 李蕙,崔军辉,刘磊.下颌骨髁突骨折手术入路研究进展[J].华西口腔医学杂志,2016,34(3):322-324.
[5] Boffano P, Benech R, Gallesio C, et al. Current opinions on surgical treatment of fractures of the condylar head [J]. Craniomaxillofac Trauma Reconstr, 2014, 7(2):92-100.
[6] Costa FW, Bezerra MF, Ribeiro TR, et al. Biomechanical analysis of titanium plate systems in mandibular condyle fractures: a systematized literature review [J]. Acta Cir Bras, 2012, 27(6): 424-429.
[7] 刘慧,胡露露,王岳森,等.下颌骨髁突骨折手术治疗失败原因及防治分析——附13例病例报告[J].口腔医学研究,2018,34(3):278-281.
[8] 张益,张兴文.髁突骨折解剖复位及小型接骨板坚强内固定[J].中华口腔医学杂志,2001,36(2): 99-101.
[9] Rozeboom AVJ, Dubois L, Bos RRM, et al. Open treatment of condylar fractures via extraoral approaches: A review of complications [J]. J Craniomaxillofac Surg, 2018, 46(8): 1232-1240.
[10] Yao S, Zhou J, Li Z. Contrast analysis of open reduction and internal fixation and non-surgical treatment of condylar fracture: a meta-analysis [J]. J Craniofac Surg, 2014, 25(6): 2077-2080.
[11] Bhutia O, Kumar L, Jose A, et al. Evaluation of facial nerve following open reduction and internal fixation of subcondylar fracture through retromandibular transparotid approach [J]. Br J Oral Maxillofac Surg, 2014, 52(3): 236-240.
[12] Kim BK, Kwon YD, Ohe JY, et al. Usefulness of the retromandibular transparotid approach for condylar neck and condylar base fractures[J]. J Craniofac Surg, 2012, 23(3): 712-715.
[13] Yang L, Patil PM. The retormandibular transparotid approach to mandibular subcondylar fractures [J]. Int J Oral Maxillofac Surg, 2012, 41(4): 494-499.
[14] Shi J, Yuan H, Xu B, et al. Treatment of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision: experience with 31 cases [J]. PLoS One, 2013, 8(12): e83525.
[15] Shi D, Patil PM, Gupta R. Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures [J]. J Craniomaxillofac Surg, 2015, 43(3): 402-407.
[16] Tang W, Gao C, Long J, et al. Application of modified retromandibular approach indirectly from the anterior edge of the parotid gland in the surgical treatment of condylar fracture [J]. J Oral Maxillofac Surg, 2009, 67(3): 552-558.
[17] Balaji SM. Parotid fistula from transparotid approach for mandibular subcondylar fracture reduction [J]. Ann Maxillofac Surg, 2013, 3(2):182-184.
[18] Hou J, Chen L, Wang T, et al. A new surgical approach to treat medial or low condylar fractures: the minor parotid anterior approach [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2014, 117(3): 283-288.