Kozakiewicz Marcin, Gabryelczak Izabela
Department of Maxillofacial Surgery, Medical University of Lodz, 113 Żeromskiego Str., 90-549 Lodz, Poland.
J Clin Med. 2022 Apr 5;11(7):2031. doi: 10.3390/jcm11072031.
Currently, an increasing number of medical centers are treating mandibular head fractures surgically. Dedicated screws for compression osteosynthesis have been developed. However, due to the very limited size of the fractured bones and the considerable technical difficulties accompanying the execution of the fixation, there is little room for correction of the positioning and reinsertion of the screws. Therefore, knowing the optimal position of the fixation material is crucial for therapeutic success. The aim of this study is the evaluation of fixation screw position on the mandibular ramus height obtained in the treatment of the condylar head fracture. A total of 57 patients were included in this study. The loss of mandibular ramus height on computed tomography twelve months after mandibular head osteosynthesis was evaluated in relation to the initial distance of the screws from the fracture line, the angle of insertion of the screw into the bone, and the size of the protrusion to the inner side of the condyle. The relationship of the proximity of the screw to the fracture line, angulation, and the size of the protrusion with the loss of ramus height was confirmed. Conclusions: the optimal location for the superior screw is approx. 4 mm below the fracture line (with any angulation), inferior screw is approx. 8 mm (with any angulation), and anterior screw position is approx. 4-5 mm distant from fracture line with the best angulation of 130 degrees to the lateral mandible ramus surface in the coronal plane.
目前，越来越多的医疗中心采用手术治疗下颌骨髁突骨折。专门用于加压接骨术的螺钉已被研发出来。然而，由于骨折部位的骨头尺寸非常有限，且在进行固定操作时存在相当大的技术困难，螺钉定位调整和重新插入的空间很小。因此，了解固定材料的最佳位置对于治疗成功至关重要。本研究的目的是评估在髁突骨折治疗中获得的下颌支高度上固定螺钉的位置。本研究共纳入57例患者。根据螺钉与骨折线的初始距离、螺钉插入骨头的角度以及髁突内侧突出的大小，评估下颌骨髁突接骨术后十二个月计算机断层扫描中下颌支高度的丢失情况。证实了螺钉与骨折线的接近程度、角度以及突出大小与下颌支高度丢失之间的关系。结论：上方螺钉的最佳位置约在骨折线下方4毫米处（任意角度），下方螺钉约为8毫米（任意角度），前方螺钉位置距骨折线约4 - 5毫米，在冠状面与下颌支外侧表面的最佳角度为130度。
