Ashok Anvika, Hadhimane Amith, Rai Kirthikumar, Upasi Amarnath P, Shivakumar H R
Department Of Oral And Maxillofacial Surgery, Bapuji Dental College And Hospital, Davangere, Karnataka India.
Present Address: Department Of Oral And Maxillofacial Surgery, Srinivas Institute Of Dental Sciences, Mangalore, Karnataka India.
J Maxillofac Oral Surg. 2025 Jun;24(3):628-635. doi: 10.1007/s12663-025-02464-w. Epub 2025 Feb 7.
Numerous osteosynthesis techniques are available for the fixation of intracapsular condylar fractures but a definite gold standard method has yet to be established. Condyle consists of thin cortical bone with a friable cancelous centre and may not permit fixation with large and bulky hardware. Headless cannulated screws, often used in many forms of minimally invasive trauma surgery, provide functional and stable fracture fixation which can reduce the trauma to condylar fragments and surrounding soft tissue while treating intracapsular condylar fractures (ICF).
The present study proposes to assess the efficacy of headless cannulated screws in open reduction and internal fixation (ORIF) for the treatment of ICF of the mandible.
Six patients with ICF were treated by ORIF using a headless cannulated screw. Occlusion, maximum mouth opening (MMO), pain in TMJ at rest and while chewing, joint function using Helkimo's dysfunction index, radiographic outcome, and complications were recorded.
Mouth opening with and without pain after fixation increased significantly (from 22.33 ± 3.830 mm preoperatively to 38.83 ± 4.32 mm 3 months postoperatively), and all patients had satisfactory occlusion. Pain at rest and while chewing had significantly reduced. All six patients had severe TMJ dysfunction preoperatively, and they recovered by the 3rd follow-up month. The immediate postoperative CT scans of all patients showed an anatomic reduction of fractured fragments. The vertical ramus height restored was not statistically significant.
The study data suggested that there is a significant improvement in the clinical signs after ORIF of ICF using a headless cannulated screw.
目前有多种骨固定技术可用于髁状突囊内骨折的固定，但尚未确立明确的金标准方法。髁状突由薄的皮质骨和易碎的松质骨中心组成，可能无法使用大型笨重的硬件进行固定。无头空心螺钉常用于多种形式的微创创伤手术，在治疗髁状突囊内骨折（ICF）时，能提供功能性和稳定性骨折固定，减少对髁状突碎片和周围软组织的创伤。
本研究旨在评估无头空心螺钉在切开复位内固定（ORIF）治疗下颌骨ICF中的疗效。
6例ICF患者采用无头空心螺钉进行ORIF治疗。记录咬合情况、最大开口度（MMO）、颞下颌关节（TMJ）静息及咀嚼时的疼痛、使用Helkimo功能障碍指数评估的关节功能、影像学结果及并发症。
固定后无痛及有痛时的开口度均显著增加（从术前的22.33±3.830mm增至术后3个月的38.83±4.32mm），所有患者咬合情况均令人满意。静息及咀嚼时的疼痛明显减轻。所有6例患者术前均有严重的TMJ功能障碍，至第3次随访时恢复。所有患者术后即刻CT扫描显示骨折碎片解剖复位。升支垂直高度恢复差异无统计学意义。
研究数据表明，使用无头空心螺钉对ICF进行ORIF后临床体征有显著改善。
