Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China.
J Craniomaxillofac Surg. 2021 Sep;49(9):830-836. doi: 10.1016/j.jcms.2021.04.002. Epub 2021 Apr 21.
The study aimed at investigating a new three-dimensional classification of healing morphology in condylar fractures in children and adolescents after closed treatment, and establish its association with fracture type and clinical outcomes. The medical records of children and adolescents with condylar fracture were reviewed, retrospectively. The clinical outcomes were assessed by mandibular deviation during mouth opening, Helkimo anamnestic index (Ai), and Helkimo clinical dysfunction index (Di). The condylar healing morphology was evaluated through three-dimensional CT images after 1-2 years of follow-up. In total, 96 patients with 142 condylar fracture sites were included in the study. Condylar healing morphology was classified into three main patterns: unchanged (21.13%), spherical (62.68%), and irregular (16.19% - including the three subtypes triangular, L-shaped, and Y-shaped). There was a significant difference in the distribution of the three main healing patterns among various fracture types (p = 0.0227). Irregular patterns occurred more frequently in adolescents than in children. In unilateral fractures, no obvious association was found between condylar healing morphology and clinical outcomes, including mandibular deviation during mouth opening (p = 0.162), Ai (p = 0.0991) and Di (p = 0.25). Most patients healing in different condylar patterns reached a good clinical outcome after 1-2 years. Although the healing morphology of condylar fractures in children and adolescents remained abnormal, good clinical outcome was achieved over the 2-year follow-up. Therefore, closed treatment remains a good approach.
本研究旨在探讨儿童和青少年髁突骨折闭合治疗后愈合形态的新三维分类，并建立其与骨折类型和临床结果的关系。回顾性分析了儿童和青少年髁突骨折患者的病历资料。通过开口时下颌偏斜、Helkimo 病史指数（Ai）和 Helkimo 临床功能障碍指数（Di）评估临床结果。通过 1-2 年随访后的三维 CT 图像评估髁突愈合形态。共有 96 例患者的 142 个髁突骨折部位纳入本研究。髁突愈合形态分为 3 种主要类型：不变形（21.13%）、球形（62.68%）和不规则形（16.19% - 包括 3 个亚型三角形、L 形和 Y 形）。不同骨折类型之间的 3 种主要愈合形态的分布存在显著差异（p=0.0227）。不规则形态在青少年中比在儿童中更为常见。在单侧骨折中，髁突愈合形态与临床结果之间无明显相关性，包括开口时下颌偏斜（p=0.162）、Ai（p=0.0991）和 Di（p=0.25）。大多数以不同髁突形态愈合的患者在 1-2 年后获得了良好的临床结果。尽管儿童和青少年髁突骨折的愈合形态仍存在异常，但在 2 年随访中仍取得了良好的临床效果。因此，闭合治疗仍然是一种很好的方法。
