Ghazali Naseem, Benlidayi M Emre, Abizadeh Neilufer, Bentley Robert P
Maxillofacial Unit, Guy's, King's & St Thomas' Dental Institute, King's College Hospital, London, England.
J Oral Maxillofac Surg. 2012 May;70(5):1131-8. doi: 10.1016/j.joms.2011.10.024. Epub 2012 Jan 21.
To retrospectively audit outcomes of using Leonard buttons (LBs) as intraoperative intermaxillary fixation in conjunction with open reduction-internal fixation of bilateral mandibular fractures.
Seventy-seven patients were included in this study. The fracture reduction score was obtained from postoperative radiographs by use of 3-tiered scoring system. Medical case notes were obtained for clinicodemographic data, including operation length, postoperative occlusion scores, periodontal status, and complications.
The cohort predominantly comprised male patients (87%), with a mean age of 26 years. The major cause of injury was interpersonal violence (87%). The fracture pattern most treated was angle-parasymphysis fracture (70.1%). The mean length of follow-up was 83.81 ± 79.33 days. The mean overall reduction score was 6.95 ± 1.03 in the LB group and 6.40 ± 1.68 in the arch bar (AB) group (P = .275). When the occlusion scores were evaluated, the difference between the 2 groups was statistically significant (P = .027). The mean operation length was shorter in the LB group compared with the AB group (142.05 ± 32.31 minutes vs 161.00 ± 24.04 minutes, P = .013). Oral hygiene was poor in 7 patients in the LB group (11.3%) and in 5 patients in the AB group (33.3%) (P = .05). No significant correlation was observed between number of LBs placed with overall reduction and occlusion scores. No significant relation was observed for number of LBs and periodontal status, infection, and nonunion.
This pilot study suggests that LBs are able to achieve equally good reduction as ABs but have better occlusion scores, with a shorter operating time, and show better gingival health. LBs are a viable alternative to ABs in providing intraoperative intermaxillary fixation for bilateral mandibular fractures. However, further prospective, randomized studies should be undertaken to obtain conclusive evidence.
回顾性分析使用伦纳德纽扣（LB）作为术中颌间固定并结合双侧下颌骨骨折切开复位内固定的效果。
本研究纳入77例患者。通过使用三级评分系统从术后X线片获取骨折复位评分。获取医疗病历以收集临床人口统计学数据，包括手术时长、术后咬合评分、牙周状况及并发症。
该队列主要为男性患者（87%），平均年龄26岁。主要损伤原因是人际暴力（87%）。最常治疗的骨折类型是角部-颏孔区骨折（70.1%）。平均随访时长为83.81±79.33天。LB组的平均总体复位评分为6.95±1.03，牙弓夹板（AB）组为6.40±1.68（P = 0.275）。评估咬合评分时，两组间差异具有统计学意义（P = 0.027）。LB组的平均手术时长比AB组短（142.05±32.31分钟对161.00±24.04分钟，P = 0.013）。LB组有7例患者口腔卫生较差（11.3%），AB组有5例患者口腔卫生较差（33.3%）（P = 0.05）。放置的LB数量与总体复位及咬合评分之间未观察到显著相关性。LB数量与牙周状况、感染及骨不连之间未观察到显著关系。
这项初步研究表明，LB与AB能实现同样良好的复位，但咬合评分更高，手术时间更短，牙龈健康状况更好。在为双侧下颌骨骨折提供术中颌间固定方面，LB是AB的可行替代方法。然而，应进行进一步的前瞻性随机研究以获得确凿证据。
