Wang Howard D, Susarla Srinivas M, Yang Robin, Mundinger Gerhard S, Schultz Benjamin D, Banda Abhishake, MacMillan Alexandra, Manson Paul N, Nam Arthur J, Dorafshar Amir H
Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
Craniomaxillofac Trauma Reconstr. 2019 Sep;12(3):211-220. doi: 10.1055/s-0038-1668500. Epub 2018 Sep 21.
The purpose of this study was to compare the functional outcomes of different types of bilateral mandibular condylar fractures. This was a retrospective study of patients with bilateral mandibular condylar fractures at a level-1 trauma center over a 15-year period. The primary predictor variable was fracture pattern, classified as type I (bilateral condylar), type II (condylar-subcondylar), or type III (bilateral subcondylar). Secondary predictor variables were demographic, injury-related, and treatment factors. Bivariate associations between the predictors and complication rates were computed; a multiple logistic regression model was utilized to adjust for confounders and effect modifiers. Thirty-eight subjects with bilateral condylar injuries met the inclusion criteria. The sample's mean age was 37.6 + 18.2 years, and 16% were female. The most common mechanisms of injury were motor vehicle collisions (53%) and falls (29%). Seventy-four percent had associated noncondylar mandibular fractures, and 32% of cases had concomitant midface fractures. Fifty-three percent of cases were classified as type I, 21% as type II, and 26% as type III. Ten subjects (26%) were managed with open reduction and internal fixation. The average length of follow-up was 4.5 + 6.3 months. After adjusting for confounders and effect modifiers, the type of fracture was a significant predictor of functional complications with type II injuries having the highest likelihood of a poor functional outcome (odds ratio: 7.77, 95% confidence interval: 1.45-41.53, = 0.02). Asymmetric bilateral mandibular condylar fractures may be associated with an increased risk of poor functional outcomes.
本研究的目的是比较不同类型双侧下颌髁突骨折的功能预后。这是一项对一级创伤中心15年间双侧下颌髁突骨折患者的回顾性研究。主要预测变量为骨折类型，分为I型（双侧髁突）、II型（髁突-髁颈）或III型（双侧髁颈）。次要预测变量为人口统计学、损伤相关及治疗因素。计算预测变量与并发症发生率之间的双变量关联；采用多元逻辑回归模型调整混杂因素和效应修饰因素。38例双侧髁突损伤患者符合纳入标准。样本的平均年龄为37.6±18.2岁，16%为女性。最常见的损伤机制是机动车碰撞（53%）和跌倒（29%）。74%的患者伴有非髁突下颌骨骨折，32%的病例伴有面中份骨折。53%的病例为I型，21%为II型，26%为III型。10例患者（26%）接受切开复位内固定治疗。平均随访时间为4.5±6.3个月。在调整混杂因素和效应修饰因素后，骨折类型是功能并发症的显著预测因素，II型损伤功能预后不良的可能性最高（比值比：7.77，95%置信区间：1.45 - 41.53，P = 0.02）。不对称双侧下颌髁突骨折可能与功能预后不良风险增加有关。
