Department Head, Department of Maxillofacial and Oral Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Clinical Professor, Department of Oral and Maxillofacial Surgery, University of Florida College of Dentistry, Gainesville, FL; Department of Oral and Maxillofacial Surgery, University of Oklahoma, OK.
J Oral Maxillofac Surg. 2022 Oct;80(10):1641-1654. doi: 10.1016/j.joms.2022.06.023. Epub 2022 Jun 30.
Despite decades of study, a consensus on therapeutic approaches to condylar fractures remains elusive, and the vexing question of invasive or noninvasive therapy remains to be definitively answered. This randomized clinical study aimed to compare the outcomes of mandibular condylar fractures (MCFs) treated by closed reduction (CR) with those treated by open reduction and internal fixation (ORIF).
The investigators designed and implemented a randomized controlled trial composed of patients with unilateral or bilateral MCFs. Patients were randomly allocated into the ORIF and CR groups. The primary predictor variable was treatment, either CR or ORIF. The primary outcome variable was temporomandibular joint function (pain and range of motion) assessed at 1 and 6 weeks and at 3, 6, and 12 months. The secondary outcomes included occlusion and complications (deviation, facial nerve injury, and scarring). Perioperative covariates included fracture displacement, ramus height loss, and associated mandibular fractures. The effect of treatment group on each of the 12-month outcomes was assessed using the χ test or the independent samples t test. A 5% significance level was used.
A total of 116 patients with MCFs were included in the study. Sixty-eight (59%) and 48 (41%) patients were treated by CR and ORIF, respectively. No statistically significant differences were observed between the 2 groups for mouth opening (P = .073, protrusion (P = .71), laterotrusive movements toward fractured side (0.080), and nonfractured side (P = .28). The median pain scores decreased from 4 (interquartile range [IQR] 3 to 4) at 6 weeks to 0 (IQR 0 to 0) at 52 weeks and 6 (IQR 5 to 6) at 6 weeks to 0 (IQR 0 to 0) at 52 weeks in the CR and ORIF groups, respectively. Statistically significant differences between the groups were observed for the outcome of malocclusion (P = .040) and deviation (P < .0001). Ramal height loss (P = .013) and angle of displacement (P = .0084) were significantly associated with the presence of complications in the CR group.
The results of the present study have shown that both treatment options for MCFs yield acceptable results. However, CR yielded more complications, especially in patients with bilateral MCFs, ramus height loss greater than 5 mm, and angle of displacement greater than 15°.
尽管已经进行了数十年的研究，但对于髁突骨折的治疗方法仍未达成共识，而侵入性或非侵入性治疗的棘手问题仍有待明确回答。本随机临床研究旨在比较髁突骨折（MCF）经闭合复位（CR）和切开复位内固定（ORIF）治疗的结果。
研究者设计并实施了一项包含单侧或双侧 MCF 患者的随机对照试验。患者被随机分配到 ORIF 和 CR 组。主要预测变量为治疗方法，即 CR 或 ORIF。主要结局变量为 1 周和 6 周以及 3 个月、6 个月和 12 个月时的颞下颌关节功能（疼痛和运动范围）。次要结局包括咬合和并发症（偏斜、面神经损伤和瘢痕）。围手术期协变量包括骨折移位、升支高度丢失和相关的下颌骨骨折。使用 χ检验或独立样本 t 检验评估治疗组对每个 12 个月结局的影响。采用 5%的显著性水平。
本研究共纳入 116 例 MCF 患者。68 例（59%）和 48 例（41%）患者分别接受 CR 和 ORIF 治疗。两组患者张口度（P=0.073）、前突度（P=0.71）、患侧（P=0.080）和健侧（P=0.28）侧方运动差异均无统计学意义。CR 和 ORIF 组的疼痛评分中位数分别从 6 周时的 4 分（四分位距[IQR]3 到 4）降至 52 周时的 0 分（IQR 0 到 0）和 6 周时的 6 分（IQR 5 到 6）降至 52 周时的 0 分（IQR 0 到 0）。两组间错牙合（P=0.040）和偏斜（P<0.0001）的结局差异有统计学意义。CR 组中，髁突高度丢失（P=0.013）和移位角度（P=0.0084）与并发症的发生显著相关。
本研究结果表明，MCF 的两种治疗选择均能获得可接受的结果。然而，CR 会导致更多的并发症，特别是在双侧 MCF、升支高度丢失大于 5mm 和移位角度大于 15°的患者中。
