Wang Howard D, Susarla Srinivas M, Mundinger Gerhard S, Schultz Benjamin D, Yang Robin, Bojovic Branko, Christy Michael R, Manson Paul N, Rodriguez Eduardo D, Dorafshar Amir H
Baltimore, Md.; and New York, N.Y.
From the Division of Plastic, Maxillofacial, and Reconstructive Surgery and the Department of Oral and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine; the Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital; and the Department of Plastic Surgery, New York University Langone Medical Center.
Plast Reconstr Surg. 2016 Jun;137(6):1813-1821. doi: 10.1097/PRS.0000000000002152.
The purpose of this study was to identify factors associated with the decision to perform open reduction and internal fixation of mandibular condylar fractures.
This was a retrospective cohort study of patients with mandibular condylar fractures managed by the plastic and reconstructive surgery, oral and maxillofacial surgery, and otorhinolaryngology services over a 15-year period. Bivariate associations and a multiple logistic regression model were computed for injury characteristics that were associated with open reduction and internal fixation. For all analyses, a value of p ≤ 0.05 was considered significant.
Six hundred fifty-four condylar injuries were identified in 547 patients. The sample's mean age was 36.0 ± 16.5 years, 20.5 percent were women, and 63 percent were Caucasian. The most common mechanisms of injury were motor vehicle collisions (49 percent), 53.4 percent involved the subcondylar region and 20 percent were bilateral injuries. Associated noncondylar mandibular fractures were present in 60 percent of cases; 20.7 percent were managed with open reduction and internal fixation. The overall complication rate was 21.6 percent. In a multiple logistic regression model, factors associated with an increased likelihood of open reduction and internal fixation were the presence of extracondylar mandibular injuries, condylar neck or subcondylar region injuries, increasing dislocation, and treatment by plastic and reconstructive surgery/oral and maxillofacial surgery (p ≤ 0.04).
Increasing severity of mandibular injury, lower level of fracture, joint dislocation, and treatment by plastic and reconstructive surgery/oral and maxillofacial surgery are associated with open reduction and internal fixation of mandibular condylar injuries.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
本研究的目的是确定与下颌骨髁突骨折切开复位内固定术决策相关的因素。
这是一项回顾性队列研究，研究对象为在15年期间由整形与重建外科、口腔颌面外科以及耳鼻咽喉科诊治的下颌骨髁突骨折患者。对与切开复位内固定相关的损伤特征进行了双变量关联分析和多元逻辑回归模型分析。所有分析中，p≤0.05被认为具有统计学意义。
共识别出547例患者的654处髁突损伤。样本的平均年龄为36.0±16.5岁，女性占20.5%，白种人占63%。最常见的损伤机制是机动车碰撞（49%），53.4%的损伤累及髁突下区域，20%为双侧损伤。60%的病例伴有非髁突下颌骨骨折；20.7%的病例采用切开复位内固定治疗。总体并发症发生率为21.6%。在多元逻辑回归模型中，与切开复位内固定可能性增加相关的因素包括下颌骨髁突外损伤、髁突颈部或髁突下区域损伤、脱位增加以及由整形与重建外科/口腔颌面外科进行治疗（p≤0.04）。
下颌骨损伤严重程度增加、骨折部位较低、关节脱位以及由整形与重建外科/口腔颌面外科进行治疗与下颌骨髁突损伤的切开复位内固定相关。
临床问题/证据级别：风险，III级。
