Kallela I, Söderholm A L, Paukku P, Lindqvist C
Department of Maxillofacial Surgery, Helsinki University, Finland.
J Oral Maxillofac Surg. 1995 Dec;53(12):1397-404; discussion 1405-6. doi: 10.1016/0278-2391(95)90663-0.
This study evaluates the clinical and radiologic results after open reduction and lag-screw osteosynthesis of fractured mandibular condyles.
Eleven adult patients underwent surgery for displaced or dislocated mandibular condyle fractures via a submandibular approach. The repositioned fragments were fixed using lag screws designed by Krenkel or Eckelt. Maxillomandibular fixation was used postoperatively for 2.6 weeks on average (range, 1 to 4 weeks) in nine patients.
Slight transient weakness of the mandibular branch of the facial nerve occurred in three cases. Occlusal adjustment was needed in another three cases. Radiologically, the fracture line disappeared at 22.5 weeks on average (range, 8 to 38 weeks). Three screws had to be removed because of loosening. There were signs that the screws had migrated caudally from their original position in seven cases. Twenty-one months on average after operation (range, 8 to 31 months), patients were satisfied with treatment. Clinically, all patients had a stable occlusion and symmetry of the face. All had greater than 5-mm symmetrical lateral jaw excursions. Ten patients had wide (> 40 mm) painless mouth opening. Healing in malposition occurred in four cases and there was considerable shortening of the mandibular ramus in four cases.
Despite good clinical results, lag screws do not meet the needs for rigid internal fixation in the treatment of mandibular condyle fractures.
本研究评估下颌骨髁突骨折切开复位及拉力螺钉内固定术后的临床和影像学结果。
11例成年患者经下颌下入路接受移位或脱位下颌骨髁突骨折手术。使用Krenkel或Eckelt设计的拉力螺钉固定复位后的骨折块。9例患者术后平均使用颌间固定2.6周（范围1至4周）。
3例出现面神经下颌支轻度短暂性无力。另外3例需要进行咬合调整。影像学上，骨折线平均在22.5周消失（范围8至38周）。3枚螺钉因松动需要取出。7例出现螺钉从其原始位置向尾侧移位的迹象。术后平均21个月（范围8至31个月），患者对治疗满意。临床上，所有患者咬合稳定、面部对称。所有患者双侧颌侧向运动均大于5mm。10例患者张口度宽（>40mm）且无痛。4例出现错位愈合，4例下颌升支明显缩短。
尽管临床效果良好，但拉力螺钉不能满足下颌骨髁突骨折坚强内固定的需求。
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