Luhr H G, Reidick T, Merten H A
Department of Maxillofacial Surgery, University Hospital of Göttingen,Germany.
J Oral Maxillofac Surg. 1996 Mar;54(3):250-4; discussion 254-5. doi: 10.1016/s0278-2391(96)90733-8.
This article introduces a simple and reproducible classification of the degree of atrophy in fractures of the atrophic edentulous mandible, and evaluates the results of treatment in 84 consecutive fractures based on this classification.
Eight-four fractures of the edentulous mandible, with a height at the fracture site of < or = 20 mm, were included. Using the ratio of actual plate width to plate width on the postoperative radiograph, the actual height of the mandible at the fracture site was calculated. Twenty-five fractures (30%) were in the Class I atrophy group (height at the fracture site 16 to 20 mm), 33 fractures (39%) occurred in Class II atrophic mandibles (height 11 to 15 mm), and 26 fractures (31%) were seen in extremely atrophic Class III mandibles (height < or = 10 mm). The treatment was performed by compression plating without any postoperative MMF. Primary bone grafting was used in six cases (7%) because a partial bone defect was present at the fracture site.
In 81 (96.5%) of the 84 fractures an uncomplicated, solid, bony union was achieved. Three major complications occurred: one osteomyelitis and two nonunions. The two nonunions occurred in bilateral fracture of an extremely atrophied mandible (Class III atrophy). Minor soft tissue infections, without interference with fracture healing, were observed in six cases (7%).
Because there is an obvious relation between the height of the mandible and the incidence of complications in fracture healing, a special classification of the degree of atrophy is needed. In fractures of the extremely atrophic mandible (Class III atrophy) periosteal degloving should be avoided and supraperiosteal placement of plates is recommended. Compression osteosynthesis has proved to be a successful method, with minimal impairment of the patient and a low frequency of serious complications.
本文介绍一种简单且可重复的萎缩性无牙下颌骨骨折萎缩程度分类方法，并基于此分类评估84例连续性骨折的治疗结果。
纳入84例无牙下颌骨骨折，骨折部位高度≤20mm。通过术后X线片上实际钢板宽度与钢板宽度的比值，计算骨折部位下颌骨的实际高度。25例骨折（30%）属于I类萎缩组（骨折部位高度16至20mm），33例骨折（39%）发生在II类萎缩性下颌骨（高度11至15mm），26例骨折（31%）见于极度萎缩的III类下颌骨（高度≤10mm）。治疗采用加压钢板固定，术后未行任何颌间固定。6例（7%）因骨折部位存在部分骨缺损而采用了一期植骨。
84例骨折中有81例（96.5%）实现了无并发症的牢固骨愈合。发生了3例主要并发症：1例骨髓炎和2例骨不连。2例骨不连发生在极度萎缩下颌骨的双侧骨折（III类萎缩）。6例（7%）观察到轻微软组织感染，但未影响骨折愈合。
由于下颌骨高度与骨折愈合并发症发生率之间存在明显关系，需要对萎缩程度进行特殊分类。在极度萎缩下颌骨骨折（III类萎缩）中，应避免骨膜剥离，建议钢板置于骨膜上。加压接骨术已被证明是一种成功的方法，对患者的损伤最小，严重并发症发生率低。
