下颌后小切口结合肿胀分离技术在髁突低位骨折内复位固定术中的应用(1)
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[摘要]目的：探讨应用下颌后小切口及肿胀分离技术在髁突低位骨折切开复位内固定术中的应用效果。方法：对36例下颌骨髁突低位骨折患者采用下颌后小切口，术区皮下行肿胀液注射后紧贴皮下分离至咬肌表面，平行于面神经的方向钝性分离咬肌纤维，显露骨折部位，直视下行髁突骨折解剖复位内固定术。结果：术后通过临床及影像学检查随访，复位固定效果满意，无面神经损伤等严重并发症，切口瘢痕隐蔽。结论：下颌后小切口结合皮下肿胀分离技术处理髁突低位骨折具有安全、便捷、美观的优点，值得临床推广。
[关键词]手术切口；髁突骨折；切开复位内固定术
[中图分类号]R782 [文献标识码]A [文章编号]1008-6455(2012)04-0573-03
Application of open reduction and internal fixation on low condylar fractures by mini-retromandibular approach combined with tumescent separation technique
ZHOU Jian-hong,XU Zhen-hua,REN Chang-qun,WANG Wen-feng,HUANG Xin
(Department of Oral and Maxillofacial Surgery,180th Hospital of PLA,Quanzhou 362000,Fujian,China)
Abstract: Objective To evaluate the clinical results of open reduction and internal fixation on low condylar fractures using a mini-retromandibular approach combined with tumescent separation technique. Methods A mini-retromandibular incision was performed for 36 patients with low condylar fracture.The subcutaneous tissue flaps were dissected to masseter muscle after operating field were infiltrated with tumescent solution,the masseter muscle fibres were then blunt dissected paralleling the facial nerve fibres. The fracture field was expoesed and identified,and the straightforward reduction and internal fixation of condylar fractures were performed. Results Through clinical and radiologic postoperative examinations, satisfactory results were obtained with no serious complications such as facial nerve injury.The surgical scars were barely noticeable. Conclusion Combined with subcutaneous tumescent solution infiltration technique,the mini-retromandibular access proved to be a safe,convenient,and cosmetic approach which has been routinely performed in our department.
Key words:surgical approach;condylar fracture;open reduction and internal fixation
一直以来下颌骨髁突骨折的手术治疗都是颌面外科医师所面临的挑战，虽然手术方法及入路有多种[1]，但都因各自的缺点和局限而难以令人满意。自2009年起，通过参阅文献并吸收了面部除皱术的一些优点，笔者采用下颌后小切口联合肿胀分离技术行髁突低位骨折的切开复位内固定术，取得了较好的效果，现总结如下。
1 资料和方法
1.1 临床资料：依照Loukota提出的下颌骨髁突骨折的分类方法[2]，选择2009年1月～2010年12月在我科住院治疗的髁突低位骨折患者36例(男27例，女9例)，年龄20～62岁，所有患者术前均经64排CT三维重建检查确诊为髁突低位骨折且符合髁突骨折切开复位内固定指征[3]。
1.2 手术方法：术前用手扪诊确定并在皮肤上描出颧弓 ......
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