Leuin Shelby C, Frydendall Emily, Gao Dexiang, Chan Kenny H
Department of Otolaryngology, University of Colorado Denver, USA.
Arch Otolaryngol Head Neck Surg. 2011 Jan;137(1):10-4. doi: 10.1001/archoto.2010.237.
To collect demographic and clinical data on pediatric mandibular fractures and to assess temporomandibular joint (TMJ) dysfunction in patients with condylar and subcondylar (C/SC) fractures.
Retrospective case series of pediatric mandibular fractures (1999-2009) with follow-up telephone questionnaire of patients with C/SC fractures. Collected data included age, gender, unilateral vs bilateral C/SC fracture, presence of concomitant fracture, velocity of injury, and treatment modality.
Tertiary care children's hospital.
Of 164 patients with mandibular fractures, 83 (50.6%) had C/SC fractures, of which 45 (54.2%) completed the questionnaire.
Helkimo Anamnestic Dysfunction Index (A(i)) quantification of TMJ dysfunction after C/SC fracture and treatment modality of C/SC fractures.
Of the 164 patients, 122 (74.4%) were male (median age, 10.4 years; age range, 0.6-19.0 years). Of the 83 patients with C/SC fractures, 61 (73.5%) were male (median age, 9.1 years; age range, 1.1-18.7 years); 66 (79.5%) had unilateral fractures and 17 (20.5%) had bilateral fractures. The A(i) distribution of the 45 patients who completed the questionnaire was as follows: 15 (33.3%) none, 6 (13.3%) mild, and 24 (53.3%) severe. Females have more severe dysfunction than do males (95% confidence interval, 1.6-140.0; P = .02). No other significant predictors of treatment modality or TMJ dysfunction were identified. Patients with bilateral fracture are 8.1 times (95% confidence interval, 1.0-66.1 times; P = .05) more likely to have closed reduction than are those with unilateral fracture.
This is one of the largest series of pediatric C/SC fractures reported in the recent literature. Findings are significant for increased severity of TMJ dysfunction in females and higher incidence of closed reduction in patients with bilateral C/SC fracture.
收集小儿下颌骨骨折的人口统计学和临床数据，并评估髁突及髁突下（C/SC）骨折患者的颞下颌关节（TMJ）功能障碍情况。
对小儿下颌骨骨折（1999 - 2009年）进行回顾性病例系列研究，并对C/SC骨折患者进行随访电话问卷调查。收集的数据包括年龄、性别、单侧与双侧C/SC骨折、是否存在合并骨折、损伤速度及治疗方式。
三级护理儿童医院。
164例下颌骨骨折患者中，83例（50.6%）为C/SC骨折，其中45例（54.2%）完成了问卷调查。
采用Helkimo记忆功能障碍指数（A(i)）对C/SC骨折后TMJ功能障碍进行量化，并观察C/SC骨折的治疗方式。
164例患者中，122例（74.4%）为男性（中位年龄10.4岁；年龄范围0.6 - 19.0岁）。83例C/SC骨折患者中，61例（73.5%）为男性（中位年龄9.1岁；年龄范围1.1 - 18.7岁）；66例（79.5%）为单侧骨折，17例（20.5%）为双侧骨折。45例完成问卷调查患者的A(i)分布如下：无功能障碍15例（33.3%），轻度功能障碍6例（13.3%），重度功能障碍24例（53.3%）。女性功能障碍比男性更严重（95%置信区间，1.6 - 140.0；P = 0.02）。未发现其他治疗方式或TMJ功能障碍的显著预测因素。双侧骨折患者采用闭合复位的可能性是单侧骨折患者的8.1倍（95%置信区间，1.0 - 66.1倍；P = 0.05）。
这是近期文献报道中最大的小儿C/SC骨折系列之一。研究结果表明，女性TMJ功能障碍的严重程度增加，双侧C/SC骨折患者闭合复位的发生率更高，具有重要意义。
