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目的 :探讨下颌骨颏部骨折合并髁突囊内骨折伴脱位的治疗方法 ,并比较髁突骨折不同处理方法对治疗效果的影响。方法:2008—2013年间收治28例、44侧颏部骨折合并髁突囊内骨折患者,22侧髁突囊内骨折采用手术治疗,手术中注意保护翼外肌的附着;其余22侧采取保守治疗,术前或术中取模,术后配戴垫并配合弹性牵引及开口训练。应用SPSS17.0软件包对治疗结果进行Wilcoxon秩和检验。结果:手术治疗组髁突骨折22侧,术后髁突位置基本回复到关节窝内17侧,其牙弓宽度及咬合关系基本恢复,术后髁突仍然脱出关节窝5侧;保守治疗组22侧,术后髁突成功回复到关节窝内4侧,其余18侧脱出关节窝,其面下1/3仍有不同程度增宽。手术治疗组疗效评分显著优于保守治疗组(P<0.01)。结论:对颏部骨折合并髁突囊内骨折伴脱位患者,应在保持翼外肌良好附着的前提下,对脱位的髁突骨折进行复位和固定,这样有利于脱位的髁突恢复到正常的生理位置,维持下颌骨的正常宽度。
Objective: To investigate the treatment of mandibular chin fracture combined with intra-condylar fracture and dislocation, and to compare the effect of different treatment of condylar fracture on the treatment effect. Methods: From 2008 to 2013, 28 patients with 44 chin fractures complicated with intra-condylar fractures were treated. Surgical treatment of 22 intra-articular fractures of the condyles was performed. At the time of operation, attention should be given to the attachment of the pterygoid muscles. The remaining 22 patients were treated conservatively , Preoperative or intraoperative mode, postoperative wear pad and with flexible traction and opening training. The results of Wilcoxon rank sum test were applied with SPSS17.0 software package. RESULTS: On the 22 sides of the condylar fracture, the position of the condyles was restored to 17 sides in the joint socket. The width of the arch and the occlusal relationship basically recovered. The condyles remained out of the 5 sides of the joint socket after operation. The conservative treatment group 22 Lateral and postoperative condyle successfully returned to the 4 sides of the joint socket, the remaining 18 side prolapse of the joint nest, its surface 1/3 are still varying degrees of widened. The score of surgical treatment group was significantly better than conservative treatment group (P <0.01). CONCLUSIONS: For chin fractures with condyle intracapsular fracture and dislocation, the dislocated condylar fractures should be reset and fixed under the premise of keeping the pterygoid muscles well attached, so that the condyles favoring dislocation return to normal Physiological position, maintaining the normal width of the mandible.