下颌髁突骨折切开复位与闭合治疗的疗效比较
Outcomes of open versus closed treatment of mandibular subcondylar fractures.
作者信息
Haug R H, Assael L A
机构信息
The University of Kentucky, Division of Oral and Maxillofacial Surgery, Lexington, USA.
出版信息
J Oral Maxillofac Surg. 2001 Apr;59(4):370-5; discussion 375-6. doi: 10.1053/joms.2001.21868.
OBJECTIVES
The purpose of this study was to compare the long-term treatment results of open reduction and rigid internal fixation (ORIF) with closed reduction and maxillomandibular fixation (CRMMF) for subcondylar fractures when guided by specific indications and contraindications.
PATIENTS AND METHODS
A protocol for the treatment of condylar process fractures was developed that included absolute and relative indications and contraindications as well as a technique regimen. To evaluate the results of this protocol, 10 patients treated with CRMMF and 10 treated by ORIF were recalled after a minimum of 6 months and examined for gender, race, diagnosis, age at injury, time since operation, and cause of the fracture. Each group was assessed by 2 blinded investigators for maximum interincisal opening, right lateral excursion, left lateral excursion, protrusive movement, deviation on opening, scar perception, motor function, sensory perception, contour perception, occlusion, and perception of pain. Nonparametric data were compared for statistical significance with a chi-square analysis and parametric data with an independent samples t-test (P < .05).
RESULTS
No statistically significant differences existed between the ORIF and CRMMF groups for gender, race, diagnosis, or cause. Moreover, no differences existed for age at injury, maximum interincisal opening, right lateral excursion, left lateral excursion, protrusive movement, deviation on opening, or occlusion. Differences were noted between groups for time since operation, scar perception, and perception of pain. Using the protocol outlined, there were no differences between the ORIF and CRMMF groups for ranges of motion, occlusion, contour, and motor or sensory function. The ORIF group was associated with perceptible scars. The CRMMF group was associated with chronic pain.
CONCLUSIONS
Using a treatment protocol, there were few differences in outcomes between patients treated with CRMMF and ORIF for subcondylar fractures.
目的
本研究的目的是比较在特定适应证和禁忌证的指导下，髁突骨折采用切开复位坚强内固定（ORIF）与闭合复位颌间固定（CRMMF）的长期治疗效果。
患者与方法
制定了髁突骨折治疗方案，其中包括绝对和相对适应证、禁忌证以及技术方案。为评估该方案的效果，对至少6个月后复诊的10例行CRMMF治疗的患者和10例行ORIF治疗的患者进行了性别、种族、诊断、受伤年龄、术后时间及骨折原因的检查。由2名盲法研究者对每组患者的最大切牙间开口度、右侧侧方运动、左侧侧方运动、前伸运动、开口时偏斜、瘢痕感知、运动功能、感觉功能、外形感知、咬合及疼痛感知进行评估。非参数数据采用卡方分析比较统计学意义，参数数据采用独立样本t检验（P <.05）。
结果
ORIF组和CRMMF组在性别、种族、诊断或病因方面无统计学显著差异。此外，在受伤年龄、最大切牙间开口度、右侧侧方运动、左侧侧方运动、前伸运动、开口时偏斜或咬合方面也无差异。两组在术后时间、瘢痕感知和疼痛感知方面存在差异。按照所概述的方案，ORIF组和CRMMF组在运动范围、咬合、外形以及运动或感觉功能方面无差异。ORIF组伴有明显瘢痕。CRMMF组伴有慢性疼痛。
结论
采用治疗方案时，髁突骨折行CRMMF和ORIF治疗的患者在疗效上差异不大。
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