Dai Jiewen, Shen Guofang, Yuan Hao, Zhang Wenbin, Shen Shunyao, Shi Jun
Doctor-in-Charge, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Professor, Department of Oral & Cranio-maxillofacial Science, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Oral Maxillofac Surg. 2016 Feb;74(2):337.e1-337.e11. doi: 10.1016/j.joms.2015.10.003. Epub 2015 Oct 22.
Treating comminuted mandibular fractures remains a challenge. In this study, we used titanium mesh to treat comminuted mandibular fractures.
Nine patients with traumatically comminuted mandibular fractures who received open reduction and internal stable fixation with titanium mesh were retrospectively reviewed. Open reduction-internal stable fixation was performed 7 to 10 days after primary debridement of the facial trauma. After the fractured mandible and the displaced fragments were reduced, the titanium mesh was reshaped according to the morphology of the mandible, and the reduced bone fragments were fixed with the reshaped titanium mesh and screws. Then, the surgical effects were evaluated during routine follow-up.
Most of the displaced fragments were preserved and exhibited a favorable shaping ability in restoring the morphology of the mandible during surgery. No intraoperative complications were encountered. In addition, all patients were infection free, with no obvious resorption in the fixed fragments after surgery. The mandible also exhibited favorable morphology and offered sufficient bone mass for dental implantation or a denture prosthesis.
We conclude that titanium mesh shaping and fixation can effectively treat comminuted mandibular fractures with little bone fragment loss, little soft tissue exposure, a low infection rate, and favorable mandibular morphology.
治疗下颌骨粉碎性骨折仍然是一项挑战。在本研究中，我们使用钛网治疗下颌骨粉碎性骨折。
回顾性分析9例因外伤导致下颌骨粉碎性骨折并接受钛网切开复位内固定术的患者。在面部创伤一期清创术后7至10天进行切开复位内固定术。将骨折的下颌骨和移位的骨碎片复位后，根据下颌骨的形态对钛网进行塑形，并用塑形后的钛网和螺钉固定复位后的骨碎片。然后，在常规随访期间评估手术效果。
大多数移位的骨碎片得以保留，并且在手术过程中在恢复下颌骨形态方面表现出良好的塑形能力。术中未出现并发症。此外，所有患者均未发生感染，术后固定的骨碎片无明显吸收。下颌骨形态良好，为牙种植或义齿修复提供了足够的骨量。
我们得出结论，钛网塑形和固定能够有效治疗下颌骨粉碎性骨折，骨碎片丢失少，软组织暴露少，感染率低，下颌骨形态良好。
