Alpha Craig, O'Ryan Felice, Silva Alessandro, Poor David
Highland General Hospital-Pacific Medical Center, Oakland, CA, USA.
J Oral Maxillofac Surg. 2006 Apr;64(4):659-68. doi: 10.1016/j.joms.2005.12.013.
Titanium plates and monocortical screws are commonly used to stabilize the mandible following sagittal split ramus osteotomies. Despite widespread use of this type of fixation, there is a paucity of large studies evaluating the infection rate and need for hardware removal.
This study is a retrospective cohort evaluation of 1,066 consecutive mandibular sagittal ramus osteotomies in 533 patients, performed between January 2002 and December 2003. All osteotomies were stabilized with 4-hole miniplates and 2.0 mm x 5.0 mm monocortical screws. Study variables included disturbances of wound healing, age, gender, plate and screw position, direction of mandibular movement, adjunctive procedures performed, and the patient's medical history. Data were collected by chart and radiographic review. The above variables were analyzed using Fisher's exact test, Chi-square, Cochran-Armitage Trend Test, and multiple logistic regression.
Of 533 patients 26% (138) demonstrated wound healing problems. This occurred in 15% of all 1,066 osteotomy sites. 6.5% of plates required removal in 10% of patients. In no case did disturbance of wound healing or plate removal result in non-union or relapse of the osteotomy. Wound healing problems were fewer when mandibular osteotomies were done in conjunction with maxillary surgery (18.9% versus 29.1%). Disturbances of wound healing were not related to the direction of movement of the mandible and were lower when hardware was placed closer to the inferior border.
An overall low incidence (6.5%) of hardware infection requiring plate removal was found in this study. Screw proximity to the osteotomy site did not correlate with higher rates of healing problems, but there was a statistically significant trend of fewer disturbances of healing when the hardware was placed closer to the inferior border of the mandible.
钛板和单皮质螺钉常用于下颌升支矢状劈开截骨术后稳定下颌骨。尽管这类固定方法被广泛使用，但缺乏评估感染率及内固定取出需求的大型研究。
本研究是一项回顾性队列评估，对2002年1月至2003年12月期间533例患者连续进行的1066例下颌升支矢状劈开截骨术进行评估。所有截骨均采用4孔微型钛板和2.0mm×5.0mm单皮质螺钉固定。研究变量包括伤口愈合障碍、年龄、性别、钛板和螺钉位置、下颌运动方向、辅助手术以及患者病史。通过病历和影像学检查收集数据。使用Fisher精确检验、卡方检验、 Cochr an-Armitage趋势检验和多因素逻辑回归分析上述变量。
533例患者中，26%（138例）出现伤口愈合问题。这发生在所有1066个截骨部位的15%。6.5%的钛板需要取出，涉及10%的患者。在任何情况下，伤口愈合障碍或钛板取出均未导致截骨不愈合或复发。下颌截骨术与上颌手术联合进行时，伤口愈合问题较少（18.9%对29.1%）。伤口愈合障碍与下颌运动方向无关，当内固定物放置更靠近下颌下缘时，发生率较低。
本研究发现需要取出钛板的内固定感染总体发生率较低（6.5%）。螺钉与截骨部位的距离与较高的愈合问题发生率无关，但当内固定物放置更靠近下颌下缘时，愈合障碍在统计学上有显著减少的趋势。
