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儿童髁突骨折非手术治疗的长期结果

Long-term results of nonsurgical management of condylar fractures in children.

作者信息

Hovinga J, Boering G, Stegenga B

机构信息

Department of Oral and Maxillofacial Surgery, Kennemer Hospital, Haarlem, The Netherlands.

出版信息

Int J Oral Maxillofac Surg. 1999 Dec;28(6):429-40.

Abstract

Twenty-five patients with 28 condylar or subcondylar fractures, sustained during their growth period and treated nonsurgically, have been followed for an average period of 15 years. The fractures were classified as intracapsular, high condylar neck and low condylar neck fractures. In 5 patients, two weeks of intermaxillary fixation, followed by elastic traction in order to achieve a proper occlusion, was applied. All the other patients were treated by instruction, exercises and observation. In 4 patients, subsequent orthodontic treatment was provided. It is not advocated to perform orthodontic aftercare as a routine action in all patients. Satisfaction with the treatment results, as measured on a visual analogue scale (VAS), was very high. The masticatory function of all patients at last follow-up was good to excellent. From this study, it appears that especially the commonly occurring high condylar fractures (64%) show good regeneration tendency as observed on radiographs. Low condylar and intracapsular fractures may give rise to some asymmetry. In 4 cases this asymmetry was clearly visible to the experienced observer, but did not concern the patient. One patient (low condylar neck fracture) showed obvious malocclusion and facial asymmetry, which needed to be corrected by orthognathic surgery. Unfortunately, it is impossible to predict which type of fracture is at risk of facial asymmetry. It is concluded that nonsurgical management of condylar fractures of the mandible in children is still the method of choice.

摘要

25例在生长期发生髁突或髁突下骨折且接受非手术治疗的患者,平均随访了15年。这些骨折被分类为囊内骨折、高位髁突颈部骨折和低位髁突颈部骨折。5例患者采用了两周的颌间固定,随后进行弹性牵引以实现合适的咬合。所有其他患者通过指导、练习和观察进行治疗。4例患者接受了后续的正畸治疗。不主张将正畸后续治疗作为所有患者的常规操作。根据视觉模拟量表(VAS)测量,对治疗结果的满意度非常高。在最后一次随访时,所有患者的咀嚼功能均为良好至优秀。从这项研究来看,尤其是常见的高位髁突骨折(64%)在X线片上显示出良好的再生趋势。低位髁突骨折和囊内骨折可能会导致一些不对称。在4例中,经验丰富的观察者能明显看出这种不对称,但患者并未在意。1例患者(低位髁突颈部骨折)出现明显的错颌和面部不对称,需要通过正颌手术进行矫正。不幸的是,无法预测哪种类型的骨折有面部不对称的风险。结论是,儿童下颌髁突骨折的非手术治疗仍然是首选方法。

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