Hermund Niels Ulrich, Hillerup Søren, Kofod Thomas, Schwartz Ole, Andreasen Jens Ove
Department of Oral and Maxillofacial Surgery, Hillerød Hospital, Copenhagen, Denmark.
Dent Traumatol. 2008 Feb;24(1):22-6. doi: 10.1111/j.1600-9657.2006.00499.x.
The possible relation between treatment delay and healing complications in mandibular fracture treatment (excluding condylar fractures) was reviewed systematically. Twenty-two studies were identified. No randomized studies focused on the effect of immediate or delayed treatment. The main focus of most studies was surgical repositioning and internal skeletal fixation. The healing complications analyzed in this study were infection in the fracture line and malocclusion. Statistical analysis of the influence of treatment delay upon healing complications was possible in six studies. Four studies showed no significant difference between immediate and delayed treatment. One study showed a preference for healing for cases treated within 3 days, whereas another study indicated that treatment time between 3 and 5 days were optimal with the lowest rate of complications. Finally, a few studies identified confounding factors such as alcohol, drug abuse and/or non-compliance, factors which have been shown strongly to influence the likelihood of complications. A significant problem in this analysis was that rather few patients were actually treated on an acute basis (i.e. within 12 or 24 hours after injury), a fact which together with the lack of control of confounding factors made this analysis problematic. In conclusion, there is presently no strong evidence for either acute or delayed treatment of mandibular fractures in order to minimize healing complications; new studies including a substantial number of cases treated on an acute basis are very much needed.
系统回顾了下颌骨骨折治疗（不包括髁突骨折）中治疗延迟与愈合并发症之间的可能关系。共纳入22项研究。没有随机研究关注即刻治疗或延迟治疗的效果。大多数研究的主要重点是手术复位和内固定。本研究分析的愈合并发症为骨折线感染和咬合不正。六项研究对治疗延迟对愈合并发症的影响进行了统计分析。四项研究表明即刻治疗和延迟治疗之间无显著差异。一项研究显示伤后3天内治疗的病例愈合情况较好，而另一项研究表明3至5天的治疗时间最佳，并发症发生率最低。最后，一些研究确定了混杂因素，如酗酒、药物滥用和/或不依从，这些因素已被证明会强烈影响并发症发生的可能性。该分析中的一个重大问题是，实际上很少有患者接受急性治疗（即伤后12或24小时内），这一事实加上混杂因素缺乏控制，使得该分析存在问题。总之，目前没有强有力的证据支持下颌骨骨折进行急性或延迟治疗以尽量减少愈合并发症；非常需要开展包括大量急性治疗病例的新研究。
