Furr Andrea Marie, Schweinfurth John M, May Warren L
Department of Otolaryngology, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
Laryngoscope. 2006 Mar;116(3):427-30. doi: 10.1097/01.MLG.0000194844.87268.ED.
At the conclusion of this paper, the participants should be able to identify, compare, and discuss the natural history of complications of mandible fractures and repair.
To analyze factors affecting the incidence of long-term complications after the repair of mandible fractures. To determine whether the use of antibiotics at any time in the course of treatment impacted the development of complications.
Retrospective medical record review.
Medical records for patients with mandibular fractures treated surgically over a 5 year period were reviewed for demographics, history of substance abuse, etiology, location of fracture, any associated facial injury, type and timing of repair, pre-, peri-, and postoperative antibiotic treatment, length of hospitalization, and lag time to repair. The development of infectious and other complications after surgery, specifically, the development of abscesses, fistulae, mal/nonunion, hardware exposure, or extrusion, were recorded.
Of 273 subjects, 56 fractures were repaired using open reduction internal fixation (ORIF) alone, 112 mandibulomaxillary fixation (MMF), and 105 with a combination of MMF and ORIF. Eighteen (6.6%) patients developed an infectious or related long-term complication. These included abscess (n = 4), infected hardware (n = 1), mal/nonunion (n = 8), and hardware exposure/extrusion (n = 9). Smoking and alcohol abuse (P = .021) and the use of plating techniques (P = .04) correlated with a higher incidence of long-term complications. Patient age, sex, location and etiology of fracture, associated facial injury, lag time to repair, length of hospitalization, and the use of antibiotics at any time after injury or repair were unrelated to the development of complications.
The development of infection, nonunion, and related complications after the repair of mandibular fractures correlates with a history of tobacco and alcohol use and ORIF of multiple fractures, but there were no statistically significant relationships to patient demographics, fracture site, lag time to repair, length of hospitalization, or the use of antibiotics. In this series, antibiotic therapy appears to have had no impact on the development of postoperative complications.
在本文结束时，参与者应能够识别、比较和讨论下颌骨骨折及修复并发症的自然史。
分析影响下颌骨骨折修复后长期并发症发生率的因素。确定在治疗过程中任何时间使用抗生素是否会影响并发症的发生。
回顾性病历审查。
回顾了5年内接受手术治疗的下颌骨骨折患者的病历，内容包括人口统计学资料、药物滥用史、病因、骨折部位、任何相关面部损伤、修复类型和时间、术前、术中及术后抗生素治疗、住院时间和修复延迟时间。记录术后感染及其他并发症的发生情况，特别是脓肿、瘘管、骨不连/骨愈合不良、内固定物外露或脱出的发生情况。
273名受试者中，56例骨折仅采用切开复位内固定术（ORIF）修复，112例采用颌间固定（MMF），105例采用MMF与ORIF联合治疗。18例（6.6%）患者发生感染或相关长期并发症。这些并发症包括脓肿（n = 4）、内固定物感染（n = 1）、骨不连/骨愈合不良（n = 8）和内固定物外露/脱出（n = 9）。吸烟和酗酒（P = 0.021）以及使用钢板技术（P = 0.04）与长期并发症的较高发生率相关。患者的年龄、性别、骨折部位和病因、相关面部损伤、修复延迟时间、住院时间以及受伤或修复后任何时间使用抗生素与并发症的发生无关。
下颌骨骨折修复后感染、骨不连及相关并发症的发生与吸烟和酗酒史以及多处骨折的ORIF有关，但与患者人口统计学资料、骨折部位、修复延迟时间、住院时间或抗生素使用无统计学显著关系。在本系列研究中，抗生素治疗似乎对术后并发症的发生没有影响。
