Koury M E, Perrott D H, Kaban L B
Department of Oral and Maxillofacial Surgery, University of California, San Francisco.
J Oral Maxillofac Surg. 1994 Nov;52(11):1114-9. doi: 10.1016/0278-2391(94)90525-8.
Reports on treatment of "infected" mandibular fractures with open reduction and rigid internal fixation (RIF) consist of either isolated cases or mixed series of patients with soft tissue infections or inadequately documented osteomyelitis. The definition of "infected fracture" is often vague and may include both soft tissue or bone sepsis.
In this retrospective study, seven patients with mandibular fractures and documented osteomyelitis were treated by a protocol that included open reduction and RIF. Technetium-99m methylene diphosphonate (99mTc) and Indium 111 (111In) radionuclide scans, bone cultures, and microscopic examination were used to document the diagnosis of osteomyelitis. The infections were treated with antibiotics, incision and drainage, and surgical debridement. Reconstruction plates that were large enough to provide four holes in each bone segment were used for RIF of the fractures and simultaneous reconstruction of the osseous defects.
After an average follow-up of 26 months, all patients remained infection free, and the fracture sites were stable. Five of the seven patients had inferior alveolar nerve dysfunction after treatment; no other significant complications were noted.
The results of this study indicate that the protocol of simultaneous debridement, reduction, and RIF is a satisfactory method for treatment of mandibular fractures complicated by osteomyelitis. Prospective studies and longitudinal follow-up of larger numbers of patients would be desirable to confirm these findings.
关于采用切开复位内固定术（RIF）治疗“感染性”下颌骨骨折的报告，要么是孤立病例，要么是软组织感染或骨髓炎记录不充分的患者混合系列。“感染性骨折”的定义通常模糊，可能包括软组织或骨脓毒症。
在这项回顾性研究中，7例下颌骨骨折并确诊骨髓炎的患者接受了包括切开复位内固定术的方案治疗。使用锝-99m亚甲基二膦酸盐（99mTc）和铟-111（111In）放射性核素扫描、骨培养及显微镜检查来确诊骨髓炎。感染采用抗生素、切开引流及手术清创治疗。使用足够大以在每个骨段提供四个孔的重建钢板进行骨折的切开复位内固定术及同时修复骨缺损。
平均随访26个月后，所有患者均无感染，骨折部位稳定。7例患者中有5例治疗后出现下牙槽神经功能障碍；未发现其他严重并发症。
本研究结果表明，同时进行清创、复位和切开复位内固定术的方案是治疗并发骨髓炎的下颌骨骨折的一种令人满意的方法。需要进行前瞻性研究和对更多患者的长期随访以证实这些发现。
