Yang Ming-liang, Zhang Bin, Zhou Qing, Gao Xiao-bo, Liu Qiang, Lu Li
Department of Oral-Maxillofacial Surgery, The Affiliated Hospital of Stomatology, China Medical University, 117 Nanjing-Bei Street, Heping District, Shenyang, 110002, China.
Br J Oral Maxillofac Surg. 2013 Apr;51(3):e29-33. doi: 10.1016/j.bjoms.2012.03.005. Epub 2012 Apr 3.
Reduction of intracapsular condylar fractures is difficult, so we have based our technique on preoperative simulation using computer-aided design (CAD), which has proved useful in other surgical specialties. We have treated 11 patients with intracapsular condylar fractures. Before the operation the procedure was shown on the computer using a three-dimensional simulation system. The relation between the stump and the fragment of the condyle, and assessment of the position and the size of the screw, were made preoperatively to obtain a perfect fit. The displaced fragment was reduced by elevators, and fixed with a bicortical screw through a minimised preauricular incision under general anaesthesia. The fragments and the location of the screws were similar on the preoperative simulation and on the postoperative computed tomographic (CT) scan. The reduction and fixation of the fracture showed a perfect fit on the same view in the preoperative CAD simulation in the Mimics 10.01 software and postoperatively. Postoperative clinical examinations showed good occlusion and satisfactory mouth opening. Two patients had temporary paralysis of the occipitofrontalis muscle that recovered within 3 months. All patients regained normal mandibular movements and had short and invisible scars at 6 months' follow up. The technique of CAD simulation could help to improve the accuracy during open treatment for intracapsular condylar fractures.
髁状突囊内骨折的复位很困难，因此我们的技术基于术前使用计算机辅助设计（CAD）进行模拟，这在其他外科专业中已被证明是有用的。我们治疗了11例髁状突囊内骨折患者。术前使用三维模拟系统在计算机上展示手术过程。术前确定髁突残端与骨折块之间的关系，并评估螺钉的位置和大小，以实现完美匹配。在全身麻醉下，通过最小化的耳前切口，用双皮质螺钉固定通过骨膜剥离器复位的移位骨折块。术前模拟和术后计算机断层扫描（CT）上的骨折块及螺钉位置相似。在Mimics 10.01软件中，术前CAD模拟和术后同一视野下骨折的复位和固定均显示完美匹配。术后临床检查显示咬合良好，张口满意。2例患者出现枕额肌暂时麻痹，3个月内恢复。所有患者随访6个月时下颌运动均恢复正常，瘢痕短小且不明显。CAD模拟技术有助于提高髁状突囊内骨折切开治疗的准确性。
