Chao Albert H, Hulsen John
Assistant Professor, Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH.
Resident, Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH.
J Oral Maxillofac Surg. 2015 Feb;73(2):306-13. doi: 10.1016/j.joms.2014.08.025. Epub 2014 Aug 27.
Titanium arch bars that are directly fixated to the maxilla and mandible with self-drilling locking screws combine features of Erich arch bars and bone-supported devices and present an alternative method of intermaxillary fixation (IMF) that possesses potential advantages over existing techniques. The objective of this study was to compare IMF using this device with Erich arch bars secured with circum-dental wires.
A retrospective cohort study was performed of patients who were surgically treated for mandibular fractures from 2012 through 2013. The primary predictor variable was fixation technique, which was IMF using Erich arch bars secured with circum-dental wires (group I) or titanium arch bars fixated with maxillary and mandibular screws (group II). The outcome variables were complication rates, time necessary for device application and removal, glove perforation rate, and cost. Statistical analysis was performed with InStat (GraphPad, Inc, La Jolla, CA) using the Fisher, χ(2), or Mann-Whitney test, as appropriate.
Twenty-five consecutive cases in group I and in group II were reviewed. There were 43 male patients (86%) and 7 female patients (14%) with a mean age of 28.4 years. Mean follow-up was 2.0 months. Overall complication rates for groups I and II were similar (16.0% vs 12.0%, respectively; P = 1.00). In group II, there were 3 instances of delayed wound healing at the sites of gingivobuccal incisions attributed to the close proximity of the arch bar eyelets. The time necessary for device application was faster in group II than in group I (42 vs 62 minutes, respectively; P = .02).
Bone-supported arch bars may be a comparable alternative to Erich arch bars secured with circum-dental wires for IMF. Careful planning of transoral incisions in relation to locking screw eyelets may help minimize wound complications.
使用自钻式锁定螺钉直接固定在上颌骨和下颌骨上的钛制牙弓夹板结合了埃里希牙弓夹板和骨支持装置的特点，提供了一种颌间固定（IMF）的替代方法，与现有技术相比具有潜在优势。本研究的目的是比较使用这种装置的颌间固定与用环绕牙弓丝固定的埃里希牙弓夹板。
对2012年至2013年接受下颌骨骨折手术治疗的患者进行回顾性队列研究。主要预测变量是固定技术，即使用用环绕牙弓丝固定的埃里希牙弓夹板进行颌间固定（I组）或用上下颌螺钉固定的钛制牙弓夹板（II组）。结果变量是并发症发生率、装置应用和拆除所需时间、手套穿孔率和成本。使用InStat（GraphPad公司，加利福尼亚州拉霍亚）进行统计分析，根据情况使用Fisher检验、χ²检验或Mann-Whitney检验。
回顾了I组和II组连续的25例病例。有43例男性患者（86%）和7例女性患者（14%），平均年龄28.4岁。平均随访时间为2.0个月。I组和II组的总体并发症发生率相似（分别为16.0%和12.0%；P = 1.00）。在II组中，有3例牙龈颊侧切口部位伤口愈合延迟，原因是牙弓夹板小孔位置过近。II组装置应用所需时间比I组快（分别为42分钟和62分钟；P = 0.02）。
对于颌间固定，骨支持牙弓夹板可能是用环绕牙弓丝固定的埃里希牙弓夹板的可比替代物。与锁定螺钉小孔相关的经口切口的仔细规划可能有助于将伤口并发症降至最低。
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