髁突形态与髁突矢状骨折发生率之间的关系分析

doi:10.19438/j.cjoms.2023.01.010

摘要/Abstract

摘要： 目的： 分析髁突形态与单侧髁突矢状骨折(sagittal fracture of mandibular condyle, SFMC)发生率之间的关系。方法： 回顾2010年12月—2021年12月河北医科大学第三医院收治的155例单侧髁突矢状骨折患者的病例资料,将其螺旋CT数据以DICOM格式导入RadiAnt DICOM Viewer软件。根据Yale的髁突形态的分类标准,将髁突形态分为平、凸、角、圆4种。根据Hlawitschka的髁突矢状骨折分类标准,将髁突矢状骨折分为A、B、M 3类,分析髁突形态与单侧髁突矢状骨折发生率之间的关系。采用SPSS 26.0软件包对数据进行统计学分析。结果： 155例患者中,健侧髁突形态占比分别是平形41.9%、凸形37.4%、圆形11.6%、角形9.0%,髁突矢状骨折的分类占比分别是A型20.6%、B型42.6%、M型36.8%。不同髁突形态的髁突矢状骨折发生率不同,两者之间存在相关性（P=0.015）。平形髁突相比其他3种类型的髁突更容易发生矢状骨折,角形髁突最不容易发生矢状骨折。结论： 髁突形态不同会影响髁突矢状骨折发生率,平形髁突更容易发生髁突矢状骨折,而角形髁突最不易发生矢状骨折。

关键词: 髁突, 髁突矢状骨折, 髁突形态, 螺旋CT

Abstract: PURPOSE: To analyze the correlation between the shape of the condyle and the occurrence of unilateral sagittal fracture of the mandibular condyle (SFMC). METHODS: A total of 155 patients with unilateral SFMC treated in the Third Hospital of Hebei Medical University from December 2010 to December 2021 were selected. The spiral CT data of the patients were anlysed using RadiAnt DICOM Viewer software in DICOM format. According to the Yale's classification criteria, the condylar head shape was categorized into 4 types as flat, convex, angle and round. According to Hlawitschka's classification, the sagittal condyle fractures was divided into 3 types as A, B and M. The relationship between condylar morphology and the incidence of unilateral sagittal condylar fractures was analyzed. SPSS 26.0 software package was used for statistical analysis. RESULTS: Among the 155 patients, the proportion of condyle shape on the contralateral side was flat (41.9%), convex (37.4%), round(11.6%) and angle(9.0%). The proportion of condyle sagittal fracture classification was type A (20.6%), type B(42.6%) and type M (36.8%). There was correlation between condylar morphology and the incidence of sagittal condylar fracture(P=0.015). The flat-shaped condyle was more prone to SFMC than the other three types of condyle. Angular condyle was less prone to SFMC than the other three types of condyle. CONCLUSIONS: The different condyle shape will affect the occurrence of sagittal condyle fracture, flat condyle was more prone to sagittal fracture, while the angular condyle was less prone to sagittal fractures.

Key words: Mandibular condyle, Sagittal fracture of mandibular condyle, Condylar shape, Spiral CT

中图分类号:

R782.4

王桃仙, 程立军, 魏泽全, 潘祥峰, 赵民朝. 髁突形态与髁突矢状骨折发生率之间的关系分析[J]. 中国口腔颌面外科杂志, 2023, 21(1): 59-63.

WANG Tao-xian, CHENG Li-jun, WEI Ze-quan, PAN Xiang-feng, ZHAO Min-chao. Analysis of correlation between the shape of mandibular condylar head and occurrence of sagittal fracture of the condyle[J]. China J Oral Maxillofac Surg, 2023, 21(1): 59-63.

参考文献

[1] Mooney S, Gulati R, Yusupov S, et al.Mandibular condylar fractures[J]. Facial Plast Surg Clin North Am, 2022, 30(1): 85-98.
[2] Yamaoka M, Furusawa K, Iguchi K, et al.The assessment of fracture of the mandibular condyle by use of computerized tomography. Incidence of sagittal split fracture[J]. Br J Oral Maxillofac Surg, 1994, 32(2): 77-79.
[3] He D, Yang C, Chen M, et al.Intracapsular condylar fracture of the mandible: our classification and open treatment experience[J]. J Oral Maxillofac Surg, 2009, 67(8): 1672-1679.
[4] Deng T, Liu C, Liu P, et al.Influence of the lateral pterygoid muscle on traumatic temporomandibular joint bony ankylosis[J]. BMC Oral Health, 2016, 16(1): 62-72.
[5] Duan D, Zhang Y.A clinical investigation on disc displacement in sagittal fracture of the mandibular condyle and its association with TMJ ankylosis development[J]. Int J Oral Maxillofac Surg, 2011, 40(2): 134-138.
[6] 彭国光, 杨磊, 王科, 等. 下颌骨髁突矢状骨折骨碎块移动CT影像分析[J]. 中华创伤杂志, 2014, 30(3): 245-248.
Peng GG, Yang L, Wang K, et al.CT analysis of bone fragment motion in sagittal fracture of the mandibular condyle[J]. Chinese Journal of Traumatology, 2014, 30(3): 245-248.
[7] Yale SH, Allison B, Hauptfuehrer JD.An epidemiological assessment of mandibular condyle morphology[J]. Oral Surg, Oral Med, Oral Pathol, 1966, 21(2): 169-177.
[8] Hlawitschka M, Eckelt U.Assessment of patients treated for intracapsular fractures of the mandibular condyle by closed techniques[J]. J Oral Maxillofac Surg, 2002, 60(7):784-791.
[9] Yale SH, Ceballos M, Kresnoff CS, et al.Some observations on the classification of mandibular condyle types[J]. Oral Surg Oral Med Oral Pathol, 1963, 16: 572-577.
[10] Shaikh AH, Ahmed S, Ahmed AR, et al.Assessment of radiographic morphology of mandibular condyles: a radiographic study[J]. Folia Morphol (Warsz), 2022, 81(2): 481-486.
[11] Ceyar R, Panneerselvam E, Balasubramanian S, et al.Evaluating the efficacy of disc repositioning in the management of high condylar fracture-a prospective clinical trial[J]. J Craniomaxillofac Surg, 2022, 50(4): 310-315.
[12] Kolk A, Scheunemann L, Grill F, et al.Prognostic factors for long-term results after condylar head fractures: a comparative study of non-surgical treatment versus open reduction and osteosynthesis[J]. J Craniomaxillofac Surg, 2020, 48(12): 1138-1145.
[13] Wang H, Zhang P, Meng L, et al. Preserving the fibrous layer of the mandibular condyle reduces the risk of ankylosis in a sheep model of intracapsular condylar fracture[J]. J Oral Maxillofac Surg, 2018, 76(9): 1951.e1-1951.e24.
[14] 曾文丽, 周五超, 张静坤, 等. 髁突矢状骨折手术中关节盘复位的应用[J]. 华西口腔医学杂志, 2017, 35(5): 502-505.
Zeng WL, Zhou WC, Zhang JK, et al.Application of temporomandibular joint dics reduction in the operation of condylar sagittal fracture[J]. West China Journal of Stomatology, 2017, 35(5): 502-505.
[15] Guo S, Zhou W, Wan L, et al.Computer-aided design-based preoperative planning of screw osteosynthesis for type B condylar head fractures: a preliminary study[J]. J Craniomaxillofac Surg, 2016, 44(2): 167-176.
[16] Xin P, Jiang B, Dai J, et al.Finite element analysis of type B condylar head fractures and osteosynthesis using two positional screws[J]. J Craniomaxillofac Surg, 2014, 42(5): 482-488.
[17] 周伟, 安金刚, 荣起国, 等. 下颌骨颏部骨折联合双侧髁突囊内骨折致伤机制的三维有限元分析[J]. 北京大学学报(医学版),2021,53(5):983-989.
Zhou W, An JG, Rong QG, et al.Three-dimensional finite element analysis of traumatic mechanism of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures[J]. Journal of Peking University: Health Sciences, 2021,53(5): 983-989.
[18] 许向亮, 荣起国, 郭传瑸. 下颌骨受力时颅底的保护因素分析[J]. 中国口腔颌面外科杂志, 2011, 9(2): 112-118.
Xu XL, Rong QG, Guo CB.Study of protection factors of skull base with loaded mandible[J]. China Journal of Oral and Maxillofacial Surgery, 2011, 9(2): 112-118.
[19] Antoniades K, Karakasis D, Elephtheriades J.Bifid mandibular condyle resulting from a sagittal fracture of the condylar head[J]. Br J Oral Maxillofac Surg, 1993,31(2):124-126.
[20] Zieliński R, Kozakiewicz M, Konieczny B, et al.Mechanical evaluation of titanium plates for osteoesynthesis high neck condylar fracture of mandible[J]. Materials (Basel), 2020, 13(3):592-604.
[21] 黄秀玲, 贺洋, 安金刚, 等. 成人下颌骨髁突矢状骨折151例临床分析[J]. 中华口腔医学杂志, 2019, 54(11): 727-732.
Huang XL, He Y, An JG, et al.Sagittal fracture of mandibular condyle: a review of 151 cases[J]. Chinese Journal of Stomatology, 2019, 54(11): 727-732.
[22] Al-Harbawee A, Ahmed T, Ahmed S, et al.A retrospective analysis of the impaction status of mandibular third molars as a risk factor for fractures of angle or condylar region of the mandible[J]. Adv Oral Maxillofac Surg, 2021, 1: 100018.
[23] Mehra A, Anehosur V, Kumar N.Impacted mandibular third molars and their influence on mandibular angle and condyle fractures[J]. Craniomaxillofac Trauma Reconstr, 2019, 12(4): 291-300.
[24] Ramakrishnan K, Scott C, Sarda PK, et al.Association between shape of the mandibular condylar head and the occurrence of unilateral condylar fracture-a retrospective computed tomographic study[J]. J Cranio-Maxillofac Surg, 2021, 49(6): 488-493.
[25] Walker C, MacLeod S. Anatomy and biomechanics of condylar fractures[J]. Atlas Oral Maxillofac Surg Clin North Am, 2017, 25(1): 11-16.
[26] Yalcin E, Ararat E.Cone-beam computed tomography study of mandibular condylar morphology[J]. J Craniofac Surg, 2019, 30(8): 2621-2624.