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1、 联合切口结合内镜辅助治疗颧骨颧弓骨折临床效果分析 孙强 朱梅 邓佳蕴摘要目的:探討联合切口结合内镜辅助治疗颧骨颧弓骨折的临床效果。方法:选取2016年1月-2018年9月在笔者医院接受治疗的56例颧骨颧弓骨折患者,按随机数字表法将其分为实验组和对照组,每组28例。实验组采用联合切口内镜辅助下颧弓骨折切开复位内固定治疗,对照组采用联合切口结合微型钛板治疗。比较两组治疗效果、术后3个月双侧颧弓突度差值及面部软组织对称性评分、术后并发症和患者满意度。结果:两组患者骨折断端复位良好,伤口均达到一期愈合。两组患者术后3个月双侧颧弓突度差值无显著性差异(1.210.32)mm vs(1.400.41)m
2、m(P0.05)。与术前比较,术后3个月两组患者面部软组织对称性评分均明显降低,且两组间无显著性差异(2.220.85)分 vs(2.181.10)分(P0.05)。两组总并发症发生率无明显差异10.71% vs 14.29%(P0.05)。两组患者对术后颧弓外形、面部外形、张口受限及术后反应满意度评分均无显著性差异(8.141.11)分vs(8.231.05分)、(8.431.02)分vs(8.081.33)分、(8.501.14)分vs(8.731.42)分、(8.651.23)分vs(8.891.10)分(P0.05)。结论:联合切口内镜辅助下颧弓骨折切开复位内固定治疗颧骨颧弓骨折均可明
3、显改善患者面部软组织对称性,平衡双侧颧弓突度,提高患者满意度,临床效果较好,安全性高。关键词联合切口;微型钛板;内镜辅助下颧弓骨折切开复位内固定;颧骨颧弓骨折R782.2 文献标志码A 1008-6455(2019)07-0092-03Clinical Effect of Combined Incision Combined with Endoscopy in the Treatment of Zygomatic Arch FractureSUN Qiang1,ZHU Mei1,DENG Jia-yun1,ZHANG Jie2(1.Department of Stomatology, Suin
4、ing Peoples Hospital,Xuzhou 221220,Jiangsu,China; 2.Department of Stomatology, Xuzhou Central Hospital,Xuzhou 221000,Jiangsu,China)Abstract: Objective To investigate the clinical effect of combined incision and micro titanium plate in treatment of comminuted zygoma fracture. Methods 56 patients with
5、 comminuted zygoma fracture treated in our hospital from January 2016 to September 2018 were selected and divided into the experiment group and the control group according to the random number table method, 28 cases in each group. The experiment group was treated with combined incision and endoscopi
6、c assisted zygomatic arch fracture open reduction and internal fixation, the control group was treated with combined incision and micro titanium plate, the therapeutic effects, the difference of bilateral zygoma margin and the facial soft tissue symmetry scores, postoperative complications and patie
7、nt satisfaction of the 2 groups were compared. Results The fracture ends were well restored of the 2 groups, and the wounds all reached the first stage of healing. The difference of bilateral zygoma margin at 3 months after the operation had no statistical difference between the 2 groups (1.210.32)
8、mm vs (1.400.41) mm (P0.05). Compared with preoperation, the facial soft tissue symmetry scores of the 2 groups significantly decreased at 3 months after the operation, and there was no statistical difference between the 2 groups (2.220.85) scores vs (2.181.10) scores (P0.05). The incidence of total
9、 complications had no statistical difference between the 2 groups 10.71% vs 14.29% (P0.05). The satisfaction scores of posterior zygomatic arch shape, facial shape, mouth opening restriction and postoperative response had no statistical difference between the 2 groups (8.141.11) scores vs (8.231.05)
10、 scores, (8.431.02) scores vs (8.081.33) scores, (8.501.14) scores vs (8.731.42) scores, (8.651.23) scores vs (8.891.10) scores (P0.05). Conclusion Combined incision combined with endoscopic assisted zygomatic arch fracture open reduction and internal fixation for the treatment of comminuted zygoma
11、fracture can significantly improve the facial soft tissue symmetry, balance the bilateral sacral arch protrusion, improve patient satisfaction, the clinical effect is good, and it has high safety.Key words: combined incision; micro titanium plate; endoscopic assisted zygomatic arch fracture open red
12、uction and internal fixation; comminuted zygoma fracture; effect顴骨颧弓位于面中部前1/3处,是面部双侧突出的骨性支架及最为突出的部位,颧弓是由颧突和颧骨颞突组成的薄弱、细长的弓形结构,在外力的作用下易发生骨折,骨折段又容易发生凹陷错位;颧骨是眶底、眶壁、颞凹及上颌窦的组成部分,由于其特殊的解剖结构,骨折后易导致面部畸形、张口受限或眼部并发症等,影响口腔咬合功能及面部美观1-2。手术内固定是治疗颧骨颧弓骨折的最佳方法,然而,颌面部组织解剖结构复杂,面部神经血管丰富,术后并发症较多3。采用联合切口可更清晰地显露骨折部位,直视下完成手
13、术操作,且不会留有瘢痕4。本文旨在探讨联合切口内镜辅助下颧弓骨折切开复位内固定治疗颧骨颧弓骨折的临床效果,现将其报道如下。1 资料和方法1.1 研究对象:选取2016年1月-2018年9月在笔者医院接受治疗的56例颧骨颧弓骨折患者,均符合口腔颌面外科学5中颧骨颧弓骨折诊断标准,且经X线及CT三维重建确诊。纳入标准:单侧颧骨颧弓骨折者;类、类、类骨折者;依从性良好者;签署知情同意书者。排除标准:伴有眼睑闭合不全、额纹消失等面神经损伤症状者;不能耐受手术治疗者;妊娠及哺乳期女性。本研究经笔者医院伦理委员会审核批准。按随机数字表法将患者分为实验组和对照组,每组28例。实验组:男19例,女9例。年龄1
14、356岁,平均(34.56.6)岁。骨折原因:交通事故伤11例,坠落伤7例,砸伤4例,撞击伤4例,其他2例;骨折类型:类9例,类10例,类9例;合并骨折情况:上颌骨骨折5例、鼻骨骨折4例、颞骨关节窝骨折2例;对照组:男16例,女12例。年龄1558岁,平均(35.25.7)岁。骨折原因:交通事故伤14例,坠落伤5例,砸伤5例,撞击伤3例,其他1例;骨折类型:类11例,类9例,类8例;合并骨折情况:上颌骨骨折6例,鼻骨骨折3例,颞骨关节窝骨折3例。两组基础资料比较无显著性差异(P0.05),具有可比性。1.2 治疗方法:骨折部位肿胀基本消退后手术,患者头偏向健侧,采用鼻腔插管静脉复合麻醉,合并开
15、放性骨折者选取近伤口部位做切口。实验组:采用联合切口内镜辅助下颧弓骨折切开复位内固定治疗,类骨折者在睑下缘与口内前庭沟处做切口,类骨折者在眉弓、睑下缘与口内前庭沟处做切口,类骨折者在半冠状部位、睑下缘与口内前庭沟处做切口;切开皮肤,钝性分离皮下组织至颧弓表面,切开骨膜,并向前剥离直至与口内切口连通,充分暴露颧弓骨折线。在骨表面与骨膜下建立隧道供内镜操作,置入30视角内镜,直视下复位骨折断端,根据骨折情况,选择不同形状的钛板并在内镜下塑形及就位,采用自钻螺钉以固定钛板。术中检查患者被动张口情况,要求恢复正常张口度;对照组:采用联合切口结合微型钛板治疗,联合切口同实验组,在骨膜剥离器辅助下暴露骨折
16、线,直视下刮除骨折缝内的肉芽组织、血块等,将骨膜剥离器深入骨折区下方撬抬或采用克氏钳咬住塌陷的骨折段,用力向外提拉直至移位骨折段尽可能上抬解剖复位;随后采用微型钛板进行固定,将微型钛板紧贴于骨面,钛合金螺钉固定,术中检查患者被动张口情况,要求恢复正常张口度,确保所有骨折均予处理。对于有明显移位的骨折患者至少在眶下缘、颧额缝及颧牙槽嵴三处进行内固定。1.3 观察指标:术后1个月比较两组治疗效果;术后3个月检查,采用三维CT测量面部健患两侧颧骨突度,以双侧颧弓突度差值评价颧骨体移位情况;拍摄患者正位及仰头位照片,比较两组患者术前及术后3个月面部软组织对称性,完全对称计0分,轻度不对称计5分,完全不对称计10分;比较两组术后睑外翻、下眼睑水肿、伤口感染、神经损伤、咬合异常等并发症发生情况;采