Gruss J S, Mackinnon S E
Plast Reconstr Surg. 1986 Jul;78(1):9-22.
Between 1978 and 1984, 558 patients with complex facial fractures have been treated. One hundred and seventy-one of these patients have had complex Le Fort fractures of the maxilla. In this group of patients, the importance of direct anatomic reconstruction of the anterior maxillary buttresses has been assessed. Complete exposure of the injured buttresses will facilitate assessment of the exact fracture pattern. Direct fixation of the medial and lateral maxillary buttresses on each side, in combination with immediate bone-graft reinforcement or replacement of comminuted or missing buttresses, will facilitate the reconstruction of even the most severely injured maxilla in one stage. This approach is combined with similar reconstructive techniques in other areas of the craniofacial skeleton. Associated mandibular fractures are managed with rigid internal fixation utilizing A-O techniques. The use of these techniques dramatically facilitates airway management and simplifies the treatment of the edentulous patient, the patient with bilateral condylar neck fractures, and those patients with sagittal splitting of the maxilla and palate. The use of both internal craniofacial suspension wires and external craniofacial suspension devices has become largely unnecessary, and reconstruction of even the most complex injuries in one stage with minimal complications and secondary deformities is made possible.
1978年至1984年间,共治疗了558例复杂面部骨折患者。其中171例患者发生了上颌骨复杂的Le Fort骨折。在这组患者中,对上颌前支柱进行直接解剖重建的重要性进行了评估。充分暴露受伤的支柱将有助于评估确切的骨折类型。在每一侧对上颌内侧和外侧支柱进行直接固定,并结合立即进行骨移植加强或替代粉碎或缺失的支柱,将有助于一期重建即使是最严重受伤的上颌骨。这种方法与颅面骨骼其他区域的类似重建技术相结合。相关的下颌骨骨折采用A-O技术进行坚固内固定治疗。这些技术的应用极大地促进气道管理,并简化了对无牙患者、双侧髁突颈部骨折患者以及上颌骨和腭部矢状劈开患者的治疗。使用颅面内悬吊线和颅面外悬吊装置在很大程度上已无必要,并且能够一期重建即使是最复杂的损伤,并发症和继发畸形最少。