影响髁突囊内骨折非手术治疗效果的因素分析

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (3): 228-233.

影响髁突囊内骨折非手术治疗效果的因素分析

王保利, 何冬梅^*, 杨驰^*, 蔡怡华, 蔡协艺, 杨秀娟, 马志贵

上海交通大学医学院附属第九人民医院·口腔医学院口腔外科, 上海市口腔医学重点实验室,上海 200011

收稿日期:2015-07-22 出版日期:2016-06-20 发布日期:2016-07-04
通讯作者: 何冬梅, E-mail：lucyhe119@163.com; 杨驰,E-mail： yangchi63@hotmail.com。
作者简介:王保利(1980-),女,硕士,主治医师,E-mail：wangbaoli7323581@126.com
基金资助:
上海市卫生和计划生育委员会资助项目（201540115）

Factors affecting the outcomes of non-surgical treatment of intracapsular condylar fractures

WANG Bao-li, HE Dong-mei, YANG Chi, CAI Yi-hua, CAI Xie-yi, YANG Xiu-juan, MA Zhi-gui

Department of Oral Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Stomatology. Shanghai 200011, China)

Received:2015-07-22 Online:2016-06-20 Published:2016-07-04

摘要/Abstract

摘要： 目的探讨髁突囊内骨折非手术治疗效果的影响因素,为囊内骨折的治疗提供依据。方法收集2003年1月—2014年7月上海交通大学医学院附属第九人民医院口腔外科收治的髁突囊内骨折非手术治疗患者,对其受伤1周内和随访3个月以上的冠状CT进行评价,将骨折愈合情况分为1~4级,分析性别、年龄、骨折类型及下颌支残端与关节窝的位置关系对骨折愈合的影响,采用SPSS 18.0软件包对数据进行统计学分析。结果共收集囊内骨折非手术治疗患者106例（145侧）,其中骨折1级愈合31侧（21.4%）,2级愈合66侧（45.5%）,3级愈合43侧（29.7%）,4级愈合5侧（3.4%）。年龄、骨折类型及下颌支残端与关节窝的位置3项因素在骨折愈合间存在显著差异,性别对骨折愈合无显著影响。结论年龄、骨折类型及下颌支残端与关节窝的位置是髁突囊内骨折非手术治疗愈合的重要影响因素,年龄越小,骨折愈合改建越好;粉碎型骨折预后较差;下颌支残端与关节窝底接触或外上脱位者预后差,易引起关节强直。

关键词: 颞下颌关节, 髁突骨折, 囊内骨折

Abstract: PURPOSE: To investigate the factors affecting non-surgical treatment of intracapsular condylar fractures (ICFs) and to provide scientific basis for the treatment of ICFs. METHODS: Patients with ICFs who received non-surgical treatment at the Department of Oral Surgery, Shanghai Ninth People's Hospital between January 2003 and July 2014 were recruited. Coronal computed tomography (CT) images of these patients were taken and evaluated after injury and at least 3 months later during follow-up visits. Fracture healing was classified into 4 grades. SPSS 18.0 software package was used for statistical analysis and comparing the factors that affected fracture healing, including gender, age, fracture type and relative position of the mandibular ramus stump and the articular fossa. RESULTS: A total of 106 cases (145 sides) of ICFs with non-surgical treatment were collected. Thirty-one sides (21.4%) achieved grade 1 healing, 66 sides (45.5%) exhibited grade 2 healing, 43 sides (29.7%) exhibited grade 3 healing, and 5 sides (3.4%) exhibited grade 4 healing. A significant difference was observed in the fracture-healing grade among 3 factors: age, fracture type, and relative position of the mandibular ramus stump and the articular fossa. Gender was not a significant factor regarding to fracture healing. CONCLUSION: Age, fracture type and relative position of the mandibular ramus stump and the articular fossa were important factors for healing of ICFs treated non-surgically. The younger the patient, the better the healing and remodeling of the fracture. Comminuted fractures in general showed a poor prognosis. An unfavourable prognosis was also observed in cases in whom the mandibular ramus stump contacted the bottom of the articular fossa or in cases with superolateral dislocation of the joint, both of which easily led to ankylosis.

Key words: Temporomandibular joint, Condylar fractures, Intracapsular fractures

中图分类号:

R782.4

王保利, 何冬梅, 杨驰, 蔡怡华, 蔡协艺, 杨秀娟, 马志贵. 影响髁突囊内骨折非手术治疗效果的因素分析[J]. 中国口腔颌面外科杂志, 2016, 14(3): 228-233.

WANG Bao-li, HE Dong-mei, YANG Chi, CAI Yi-hua, CAI Xie-yi, YANG Xiu-juan, MA Zhi-gui. Factors affecting the outcomes of non-surgical treatment of intracapsular condylar fractures[J]. China J Oral Maxillofac Surg, 2016, 14(3): 228-233.

参考文献

[1] Silvennoinen U, Iizuka T, Lindquist C, et al. Different patterns of condylar fractures: an analysis of 382 patients in a 3 year period [J].J Oral Maxillofac Surg, 1992, 50(10): 1032-1037.
[2] Marker P, Nielsen A, Bastian HL. Fractures of the mandibular condyle. Part 1: patterns of distribution of types and causes offractures in 348 patients[J]. Br J Oral Maxillofac Surg, 2000, 38(5): 417-421.
[3] Ellis Er 3rd, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases [J]. Oral Surg Oral Med Oral Pathol, 1985, 59(2): 120-129.
[4] Fridrich KL, Pena-Velasco G, Olson RA. Changing trends with mandibular fractures: a review of 1,067 cases [J]. J Oral Maxillofac Surg, 1992, 50(6): 586-589.
[5] 邹立东, 张益, 何冬梅, 等. 1084 例颌骨骨折的临床回顾性研究 [J].中国口腔颌面外科杂志, 2003, 1(3): 131-134.
[6] Thorén H, Iizuka T, Hallikainen D, et al. Different patterns of mandibular fractures in children. An analysis of 220 fractures in 157 patients [J]. J Craniomaxillofac Surg, 1992, 20(7): 292-296.
[7] Bos RR, Ward Booth RP, de Bont LG. Mandibular condyle fractures: a consensus[J]. Br J Oral Maxillofac Surg, 1999, 37(2): 87-89.
[8] Haug RH, Assael LA. Outcomes of open versus closed treatment of mandibular subcondylar fractures[J].J Oral Maxillofac Surg, 2001, 59(4): 370-375.
[9] Lindahl L. Condylar fractures of the mandible. I. Classfication and relation to age, occlusion, and concomitant injuries of teeth and teeth-supporting structures, and fractures of the mandibular body [J]. Int J Oral Surg, 1977, 6(1): 12-21.
[10] 杨驰, 何冬梅, 陈敏洁, 等. 髁突囊内骨折的临床特点和分类研究 [J].中国口腔颌面外科杂志, 2010, 8(3): 208-211.
[11] 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.
[12] He D, Cai Y, Yang C. Analysis of temporomandibular joint ankylosis caused by condylar fracture in adults[J]. J Oral Maxillofac Surg, 2014, 72(4): 763.e1-9.
[13] 蔡怡华, 何冬梅, 杨驰, 等. 导致颞下颌关节强直的成人髁突骨折类型分析[J]. 中国口腔颌面外科杂志, 2014, 12(1): 39-44.
[14] Lindahl L, Hollender L. Condylar fractures of the mandible. Ⅱ. a radiographic study of remodeling processes in the temporomandibular joint[J]. Int J Oral Surg, 1977, 6(3): 153-165.
[15] Kim YH, Youn S, Kim JT. Early complete bone union after condylar fracture in a child [J]. J Craniofac Surg, 2011, 22(4):1516-1517.
[16] Dahlström L, Kahnberg KE, Lindahl L. 15 years follow-up on condylar fractures [J]. Int J Oral Maxillofac Surg, 1989, 18(1): 18-23.
[17] Dodson TB. Condyle and ramus-condyle unit fractures in growing patients: management and outcomes [J]. Oral Maxillofac Surg Clin North Am, 2005, 17(4): 447-453.
[18] Güven O, Keskin A. Remodelling following condylar fractures in children [J]. J Craniomaxillofac Surg, 2001, 29(4):232-237.
[19] Choi J, Oh N, Kim IK. A follow-up study of condyle fracture in children [J]. Int J Oral Maxillofac Surg, 2005, 34(8):851-858.
[20] Chrcanovic BR. Open versus closed reduction: mandibular condylar fractures in children [J]. J Oral Maxillofac Surg, 2012, 16(3): 245-255.
[21] Chacon GE, Dawson KH, Myall RW, et al. A comparative study of 2 imaging techniques for the diagnosis of condylar fractures in children [J]. J Oral Maxillofac Surg, 2003, 61(6): 668-672.
[22] Schimming R, Eckelt U, Kittner T. The value of coronal computer tomograms in fractures of the mandibular condylar process [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999, 87(5): 632-639.
[23] He D, Ellis E 3rd, Zhang Y. Etiology of temporomandibular joint ankylosis secondary to condylar fractures: the role of concomitant mandibular fractures [J]. J Oral Maxillofac Surg, 2008 , 66(1): 77-84.
[24] He D, Yang C, Chen M, et al. Effects of soft tissue injury to the temporomandibular joint: report of 8 case[J]. Br J Oral Maxillofac Surg, 2013, 51(1): 58-62.
[25] Thorén H, Hallikainen D, Iizuka T, et al. Condylar process fractures in children: a follow-up study of fractures with total dislocation of the condyle from the glenoid fossa [J]. J Oral Maxillofac Surg, 2001, 59(7):768-773.