Chrcanovic Bruno Ramos
Oral Maxillofac Surg. 2012 Sep;16(3):257-65. doi: 10.1007/s10006-012-0337-6. Epub 2012 Jul 28.
The purpose of the study was to review the literature regarding the evolution of current thoughts on management of diacapitular fractures (DFs) of the mandibular condyle.
An electronic search in PubMed was undertaken in March 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies reporting clinical series of DFs, including both animal and human studies, without date or language restrictions.
The search strategy initially yielded 108 references. Twenty-eight studies were identified without repetition within the selection criteria. Additional hand-searching of the reference lists of selected studies yielded three additional papers.
The current indications for open reduction and internal fixation (ORIF) of DFs described in the literature are: (a) fractures affecting the lateral condyle with reduction of mandibular height; (b) fractures in which the proximal fragment dislocates laterally out of the glenoid fossa, which cannot be reduced by closed or open treatment of another part of the mandibular fracture. The indications for conservative treatment are: (a) fractures that do not shorten the condylar height (a fracture with displacement of the medial parts of the condyle); (b) undisplaced fractures; (c) comminution of the condylar head, when the bony fragments are too small for stable fixation; and (d) fractures in children. As the temporomandibular joint disk plays an important role as a barrier preventing ankylosis, it is important to reposition the disk (if displaced/dislocated) during the surgical treatment of DFs. The lateral pterygoid muscle should never be stripped from the medially displaced fragment because its desinsertion disrupts circulation to the medial bony fragment, and also because this muscle helps to restore the muscle function after surgery. ORIF of selected DFs improves prognosis by anatomical bone and soft tissue recovery when combined with physical therapy. If conducted properly, surgical treatment of DFs is a safe and predictable procedure and yields good results.
本研究旨在回顾有关下颌髁突双髁骨折（DFs）治疗的当前观点演变的文献。
2012年3月在PubMed上进行了电子检索。阅读这些结果的标题和摘要，以识别符合选择标准的研究。纳入标准包括报告DFs临床系列的研究，包括动物和人体研究，无日期或语言限制。
检索策略最初产生了108篇参考文献。在选择标准内确定了28项无重复的研究。对所选研究的参考文献列表进行额外的手工检索又得到了3篇论文。
文献中描述的DFs切开复位内固定（ORIF）的当前适应证为：（a）影响外侧髁突且下颌高度降低的骨折；（b）近端骨折块向外侧脱位至关节盂窝外，经下颌骨其他部位的闭合或开放治疗无法复位的骨折。保守治疗的适应证为：（a）未缩短髁突高度的骨折（髁突内侧部分移位的骨折）；（b）无移位骨折；（c）髁突头部粉碎性骨折，当骨碎片过小无法进行稳定固定时；（d）儿童骨折。由于颞下颌关节盘作为防止关节强直的屏障起着重要作用，因此在DFs的手术治疗中重新定位关节盘（如果移位/脱位）很重要。翼外肌绝不应从向内侧移位的骨折块上剥离，因为其附着点的分离会破坏内侧骨碎片的血供，还因为该肌肉有助于术后恢复肌肉功能。选择的DFs进行ORIF并结合物理治疗，通过解剖学上的骨和软组织恢复可改善预后。如果操作得当，DFs的手术治疗是一种安全且可预测的手术，效果良好。
