下颌髁突骨折闭合复位与开放复位治疗效果的比较。
Comparison of therapeutic results of closed and open repair of mandibular condylar fractures.
作者信息
Tabatabaee Amir, Javanbakht Amin, Mohammadi Khah Meysam, Shahsavari-Pour Mehrdad, Dehabadi Farnaz
机构信息
Assistant Professor, Nursing Department, Quchan Branch, Islamic Azad University Quchan, Iran.
Department of Medicine, Abadan University of Medical Sciences Abadan, Iran.
出版信息
Int J Burns Trauma. 2021 Oct 15;11(5):385-390. eCollection 2021.
BACKGROUND
Mandibular condylar fractures mostly result from traumatic accidents or strife. There is still dispute on the effectiveness of various therapeutic methods. Here we aimed to evaluate and compare the open or closed repair methods for mandibular condylar fractures.
METHODS
This is a clinical trial that was performed in 2015-2021 in Iran on all patients that referred to our medical centers with mandibular fractures due to traumatic events. Those cases with severe lateral dislocation of the mandibular condyles or severe dislocations of the fractured parts were assigned to the open surgical treatment group. The other patients were treated using Arch bar + intermaxillary fixation (IMF). The patient's abilities of mouth opening were assessed in centimeters within 1 month, 3 months, 6 months, 1 year and 2 years after the operations.
RESULTS
726 mandibular fractures were evaluated. Our data showed that 302 fractures (41.6%) were in the mandibular condyles. Of the 302 condylar fractures, 172 fractures (57.1%) occurred due to automobile accidents and 82 fractures (27.5%) occurred due to direct trauma. 203 patients (67.2%) underwent the close surgical procedures using maxillary and mandibular fixation using arch bar + IMF. 99 patients (32.8%) underwent open mandibular fixation operation and internal fixation (ORIF). Assessments of mouth opening showed significant improvements in this ability within the follow-up period in both groups (P<0.001 for both). Furthermore, we observed that patients treated by the open mandibular fixation procedure had significantly better results within the 6 months and 1 year after the procedures but after 2 years, no significant differences could be observed between groups.
CONCLUSION
Both open and closed surgical approaches for condylar fractures are associated with significant improvements, however, patients that were treated with ORIF had better clinical results in the first year after the surgical procedures.
背景
下颌髁突骨折大多由外伤事故或冲突导致。各种治疗方法的有效性仍存在争议。在此，我们旨在评估和比较下颌髁突骨折的开放或闭合修复方法。
方法
这是一项于2015年至2021年在伊朗对所有因创伤性事件导致下颌骨折而转诊至我们医疗中心的患者进行的临床试验。那些下颌髁突严重侧向脱位或骨折部位严重脱位的病例被分配到开放手术治疗组。其他患者采用牙弓夹板 + 颌间固定（IMF）进行治疗。在术后1个月、3个月、6个月、1年和2年，以厘米为单位评估患者的张口能力。
结果
共评估了726例下颌骨折。我们的数据显示，302例骨折（41.6%）发生在下颌髁突。在这302例髁突骨折中，172例骨折（57.1%）由汽车事故导致，82例骨折（27.5%）由直接创伤导致。203例患者（67.2%）采用牙弓夹板 + IMF进行上下颌固定的闭合手术程序。99例患者（32.8%）接受了下颌开放固定手术和内固定（切开复位内固定术）。张口评估显示，两组在随访期内该能力均有显著改善（两组均P<0.001）。此外，我们观察到，接受下颌开放固定手术治疗的患者在术后6个月和1年时结果明显更好，但2年后，两组之间未观察到显著差异。
结论
髁突骨折的开放和闭合手术方法均与显著改善相关，然而，接受切开复位内固定术治疗的患者在手术后第一年临床结果更好。
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