Ellis E, Sinn D P
Department of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9109.
J Oral Maxillofac Surg. 1993 Sep;51(9):969-73. doi: 10.1016/s0278-2391(10)80036-9.
Sixty-five consecutive patients with fractures of the mandibular angle were treated by open reduction and internal fixation using two dynamic compression plates placed through a transoral incision using transbuccal trochar instrumentation and 2.4-mm screws. In the first 20 cases, the screws were inserted without tapping the drill holes. In the remaining 45 cases, the drill holes were tapped. No patient was placed into postsurgical maxillomandibular fixation or training elastics. Overall, 21 fractures (32%) developed infections requiring secondary surgical intervention. The infection rate was higher in those fractures where the holes were not tapped (40%) than those cases when the holes were tapped (29%). Of the 21 fractures that required hardware removal, 9 fractures were healed and required no further treatment; 12 had no firm bony union and required postsurgical maxillomandibular fixation. Only one case resulted in a malunion with resulting malocclusion. The use of two dynamic compression plates was found to be relatively easy, but resulted in an unacceptable rate of infection.
65例下颌角骨折患者采用经口内切口，通过穿颊套管器械置入两块动力加压钢板及2.4 mm螺钉进行切开复位内固定治疗。前20例患者，钻孔后未攻丝即拧入螺钉。其余45例患者钻孔后进行了攻丝。所有患者术后均未行颌间固定或使用训练弹力带。总体而言，21例骨折（32%）发生感染，需要二次手术干预。未攻丝组骨折的感染率（40%）高于攻丝组（29%）。在21例需要取出内固定物的骨折中，9例骨折愈合，无需进一步治疗；12例未形成牢固骨愈合，术后需要行颌间固定。仅1例出现畸形愈合并导致错牙合。结果发现，使用两块动力加压钢板操作相对容易，但感染率令人难以接受。
