Pilling Eckart, Schneider Matthias, Mai Ronald, Loukota Richard A, Eckelt Uwe
Department of Oral and Maxillofacial Surgery, Technical University of Dresden, Dresden, Germany.
J Oral Maxillofac Surg. 2006 May;64(5):868-72. doi: 10.1016/j.joms.2005.11.049.
We examined the use of cannulated lag screw osteosynthesis for the treatment of fractures of the mandibular condylar head in providing a high-quality durable fixation, while at the same time reducing the trauma necessary for an open approach to the fracture site.
A preauricular approach was used for exposure, reduction, and osteosynthesis in 5 cases of type B condylar fractures. A cannulated screw system was used that allowed optimum placement of the self-cutting cannulated lag screw following insertion of a guiding wire and using clinical control to ensure its correct position. The joints were submitted to functional exercises immediately following surgery and postoperative radiologic, axiographic, and clinical follow-ups were performed.
Radiologic follow-up revealed correct reduction and fixation in all 5 cases. Axiographic and clinical follow-up showed an initial limitation, but normal mobility of the condyles was achieved within 3 months postoperatively, with a maximum mouth opening of 41.2 +/- 9.4 mm after 6 months. There were no occlusal disturbances, no trismus, no lateral deviations of the mandible, and no nerve lesions. Intraoperatively, the method applied shortened the time necessary for and simplified the procedure of reduction and osteosynthesis.
By using a cannulated lag screw, it was shown that the major factor in the extent of the trauma relating to surgical access was the reduction of the fracture fragments. The method ensured stable fixation of the fracture with a minimum of osteosynthesis material, while reducing the operative time. In combination with intraoperative imaging techniques it can also successfully be applied to other fractures in maxillofacial surgery.
我们研究了使用空心拉力螺钉骨合成术治疗下颌髁突头骨折，以提供高质量的持久固定，同时减少开放手术进入骨折部位所需的创伤。
对5例B型髁突骨折采用耳前入路进行暴露、复位和骨合成。使用空心螺钉系统，在插入导丝后可最佳放置自攻空心拉力螺钉，并通过临床控制确保其正确位置。术后立即对关节进行功能锻炼，并进行术后影像学、轴位片和临床随访。
影像学随访显示所有5例均复位和固定正确。轴位片和临床随访显示最初有一定限制，但术后3个月内髁突活动度恢复正常，6个月时最大开口度为41.2±9.4mm。无咬合紊乱、无牙关紧闭、无下颌骨侧向偏斜，无神经损伤。术中，该方法缩短了复位和骨合成所需时间并简化了操作过程。
通过使用空心拉力螺钉，结果表明与手术入路相关的创伤程度的主要因素是骨折碎片的复位。该方法以最少的骨合成材料确保了骨折的稳定固定，同时减少了手术时间。结合术中成像技术，它也可成功应用于颌面外科的其他骨折。
