Raveh J, Vuillemin T, Lädrach K, Roux M, Sutter F
Dept. of Maxillofacial Surgery, University of Bern, Switzerland.
J Craniomaxillofac Surg. 1987 Oct;15(5):244-53. doi: 10.1016/s1010-5182(87)80061-6.
Experience in the management of 916 fractures of the mandible stimulated us to develop new methods and surgical techniques for functionally-stable intraoral internal plate osteosynthesis. The development of a fixation bar which is adapted to the alveolar process of the fractured mandible enables a compression of this area prior to the plate osteosynthesis. This procedure facilitates the plate application from the intraoral approach so that in 358 cases all types of fractures of the body, angle and ascending ramus can be reduced using this access, and not only the selected favourable cases. A new plate and screws of our own design have been successfully used in cases with comminuted multifragmentary and defect fractures. The rigid fixation of the head of the screws to the plate produces an optimal functional stability compared with conventional systems. The combination of the advantages of an external fixation device and those of stable internal osteosynthesis produces a long term functional stability even in cases with extensive defects where delayed consolidation is to be expected; tilting and loosening of the screws or resorption of the compact bone underneath the plate do not occur. Thus the extraoral approach and visible skin incisions can be avoided. This procedure is time sparing and less traumatic to the soft tissues compared with the extraoral approach. The extremely low complication rate in 358 fractures managed by plate osteosynthesis using the intraoral approach confirms the efficiency of this method.
916例下颌骨骨折的治疗经验促使我们开发用于功能稳定的口内钢板内固定的新方法和手术技术。一种适用于下颌骨骨折牙槽突的固定杆的开发，使得在钢板内固定之前能够对该区域进行加压。这一操作便于从口内途径应用钢板，从而在358例病例中，通过该入路可以复位所有类型的体部、角部和升支骨折，而不仅仅是选定的有利病例。我们自行设计的一种新型钢板和螺钉已成功应用于粉碎性多段骨折和缺损骨折的病例。与传统系统相比，螺钉头部与钢板的刚性固定产生了最佳的功能稳定性。外固定装置的优点与稳定的内固定的优点相结合，即使在预期会延迟愈合的广泛缺损病例中也能产生长期的功能稳定性；不会出现螺钉倾斜和松动或钢板下方密质骨吸收的情况。因此，可以避免采用口外入路和可见的皮肤切口。与口外入路相比，该操作节省时间且对软组织的创伤较小。采用口内入路进行钢板内固定治疗的358例骨折的极低并发症发生率证实了该方法的有效性。
