Dimitroulis George
Consultant Oral and Maxillofacial Surgeon, Plastics and Maxillofacial Surgery Unit, St Vincents Hospital Melbourne, University of Melbourne, Australia.
J Oral Maxillofac Surg. 2002 Dec;60(12):1435-8; discussion 1439. doi: 10.1053/joms.2002.36100.
The aims of this retrospective clinical study were to compare the management of unilateral angle fractures of the mandible using the traditional approach of open reduction with internal fixation (ORIF) and intermaxillary wire fixation (IMF) with the technique of ORIF without IMF.
Thirty-one patients who presented with isolated unilateral angle fractures of the mandible were randomly divided into 2 treatment groups. Both groups underwent open reduction with a single upper border miniplate and screw fixation (ORIF). Eleven of the 31 patients in the study had IMF to aid in the fracture reduction, and 20 patients had no IMF so the fracture was reduced by hand manipulation. Records of operating and discharge times, postreduction radiographs, and occlusal outcomes were examined and tabulated.
Patients in both treatment groups were closely matched in terms of age, gender, site of injury (ie, isolated angle fracture of mandible), and incidence of teeth in the fracture line. The mean operating time for traditional ORIF with IMF of angle fractures of the mandible was 98.5 minutes, and these patients were discharged an average of 1.82 days after surgery. The mean operating time for ORIF of angle fractures of the mandible without the use of IMF was 40.2 minutes, and these patients were discharged an average of 1.35 days after surgery. Postoperative outcomes in terms of the postreduction anatomic alignment of the fractures and functional occlusion at 6 weeks were similar in the 2 treatment groups.
We found that the use of IMF for the management of angle fractures of the mandible is unnecessary provided there is a skilled assistant present to help manually reduce the fracture site for plating. Discarding the use of IMF not only helps improve patient comfort but also reduces the operating time by up to 1 hour and accelerates discharge times by up to half a day.
本回顾性临床研究的目的是比较采用切开复位内固定（ORIF）和颌间结扎固定（IMF）的传统方法与不使用IMF的ORIF技术治疗下颌骨单侧角部骨折的情况。
31例出现孤立性下颌骨单侧角部骨折的患者被随机分为2个治疗组。两组均采用单块上颌骨微型钢板和螺钉固定进行切开复位（ORIF）。研究中的31例患者中有11例采用IMF辅助骨折复位，20例患者未采用IMF，骨折通过手法复位。检查并列表记录手术时间、出院时间、复位后X线片以及咬合结果。
两个治疗组患者在年龄、性别、损伤部位（即下颌骨孤立性角部骨折）以及骨折线处牙齿发生率方面匹配良好。采用传统ORIF联合IMF治疗下颌骨角部骨折的平均手术时间为98.5分钟，这些患者术后平均1.82天出院。不使用IMF的下颌骨角部骨折ORIF的平均手术时间为40.2分钟，这些患者术后平均1.35天出院。两个治疗组在骨折复位后解剖对位以及6周时功能咬合方面的术后结果相似。
我们发现，如果有熟练的助手帮助手动复位骨折部位以便进行钢板固定，那么在治疗下颌骨角部骨折时使用IMF是不必要的。摒弃IMF的使用不仅有助于提高患者舒适度，还能将手术时间缩短多达1小时，并将出院时间加快多达半天。
