面骨骨折521例臨床回顧性分析

賀佳妮， 胡 楓， 韓思源， 郭家妍， 李 怒， 冷 冰， 左 娜， 劉海燕

作者單位：110001 遼寧 沈陽，中國醫(yī)科大學(xué)附屬第一醫(yī)院 整形外科

面骨骨折521例臨床回顧性分析

賀佳妮， 胡 楓， 韓思源， 郭家妍， 李 怒， 冷 冰， 左 娜， 劉海燕

作者單位：110001 遼寧 沈陽，中國醫(yī)科大學(xué)附屬第一醫(yī)院 整形外科

頜面部骨折； 面骨骨折； 堅固內(nèi)固定

1 臨床資料

本組患者共521例。男性409例，女性112例；年齡8～67歲，平均32歲。致傷原因：打傷62例，交通事故253例，墜落傷206例；骨折部位：上頜竇前壁460處，顴骨顴弓358處，眶壁238處，鼻骨117處，下頜骨84處，髁狀突19處。合并其他骨折，如肋骨、四肢等219例，伴腦脊液漏56例，眼球破裂傷11例。

2 手術(shù)方法

2.1 術(shù)前準(zhǔn)備 所有患者術(shù)前行頜面部三維CT重建檢查明確診斷，確定骨折位置及移位方向和角度。治療時機(jī)依據(jù)患者傷情而定，大部分患者于傷后1～2周進(jìn)行手術(shù)，合并腦脊液漏的患者在停止腦脊液自耳鼻流出后10～14 d進(jìn)行手術(shù)，對于合并顱腦或重要臟器損傷的患者待病情平穩(wěn)后考慮手術(shù)。

2.3 手術(shù)過程 除11例髁狀突高位骨折行頜墊輔助頜間牽引治療外，其余各部位均經(jīng)局部小切口(如口腔前庭、眶外緣、下瞼緣、顴骨顴弓表面、耳屏前切口等)行面骨骨折切開復(fù)位堅固內(nèi)固定術(shù)，術(shù)中仔細(xì)對比雙側(cè)顴骨突度，合并眶壁骨折且存在復(fù)視或眼球活動受限等癥狀時聯(lián)合眼科行眶壁修補(bǔ)術(shù)。

3 結(jié)果

4 討論

圖1 手術(shù)切開復(fù)位堅固內(nèi)固定治療面骨骨折手術(shù)前后對比 a.術(shù)前 b.術(shù)后6個月 c.術(shù)前正位三維CT重建 d.術(shù)后6個月正位三維CT重建 e.術(shù)前側(cè)位三維CT重建 f.術(shù)后6個月側(cè)位三維CT重建

Fig 1 Comparison between preview and postview of facial fracture treated with open reduction and internal fixation. a. preview. b. postview at 6 months. c. frontal preview of three-dimensional reconstruction. d. frontal postview of three-dimensional reconstruction at 6 months.e. lateral preview of three-dimensional reconstruction. f. lateral postview of three-dimensional reconstruction at 6 months.

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Clinical retrospective analysis of facial fracture on 521 cases

HEJia-ni,HUFeng,HANSi-yuan,etal.

(DepartmentofPlasticSurgery,TheFirstAffiliatedHospitalofChinaMedicalUniversity,Shenyang110001,China)

Objective To summarize the clinical experience of causes of injury, prone position and rigid internal fixation method on patients of facial fracture. Methods Retrospective summary was performed on data from 521 cases of facial fracture patients, including the cause of injury, gender, age, prone position and treatment method.The major treatment method on fracture were open reduction and rigid fixation. Results In all patients, 11 patients with condylar fracture treated with jaw pad between auxiliary jaw traction treatment. Others treated with fractures open reduction and sturdy fixation through small incision, 12 patients with postoperative side zygomatic degree was lower than those of the contralateral slightly, others were stisfied with the results. Conclusion Facial bone fractures are more common in males, occurs in young adults, most are caused by traffic accidents and the prone position is maxillary sinus. Orbital fracture are often complicated with zygoma fracture. For condylar intracapsular fractures and fractures in children, the best treatment method is conservative treatment, and open reduction and internal fixation were used for the rest.

Maxillofacial fracture; Bone fracture; Rigid internal fixation

賀佳妮(1983-)，女，遼寧營口人，主治醫(yī)師，碩士.

韓思源，110001，中國醫(yī)科大學(xué)附屬第一醫(yī)院 整形外科，電子信箱：hansiyuan2013@163.com

10.3969/j.issn.1673-7040.2015.07.006

R782.2

A

1673-7040(2015)07-0400-03

2015-05-13)