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目的:总结10年来颌骨骨折的治疗体会,讨论一些有关的问题。方法:选用1996年1月至2006年12月治疗的颌骨骨折165例,男性108例、女性57例。年龄8岁~65岁,平均年龄27.4岁。伤后急诊治疗93例,陈旧性骨折72例。根据就诊时间早晚、致伤原因、骨折部位及分类,治疗方法选择进行总结。结果:治疗有效率98.92%。行紧急气管切开术15例,抗休克12例,手术切开复位骨间固定97例,手法或牵引复位外固定22例,颌间或者单颌固定46例。术后感染骨延迟愈合3例(1.81%)。合并其他损伤救治19例。合并口腔颌面部软组织损伤36例。合并颅脑损伤死亡2例(1.21%),治疗后咬合关系欠佳8例(4.85%)。结论:(1)排除颅脑及内脏损伤,保证无窒息,休克发生,通过临床表现确诊骨折类型。(2)要使移位的骨折片尽早复位,应用坚强内固定技术保证骨块不再移位,恢复伤前的咬合关系,(3)软组织要充分利用、严密缝合,软组织缺损要使用各种皮瓣皮片来修复。(4)正确地运用正颌外科技术,使陈旧性骨折达到三维立体方向复位,恢复面部的外形和功能。
OBJECTIVE: To summarize the experience of treating jaw fractures in the past 10 years and to discuss some related issues. Methods: 165 cases of jaw fracture treated from January 1996 to December 2006 were selected, 108 males and 57 females. Aged 8 years to 65 years, mean age 27.4 years. Emergency treatment of 93 cases of injury, 72 cases of old fractures. According to the treatment time sooner or later, the cause of injury, fracture site and classification, treatment options are summarized. Results: The effective rate of 98.92%. Emergency tracheotomy in 15 cases, anti-shock in 12 cases, 97 cases of surgical resection and reduction of interosseous fixation, manipulation or traction reduction in external fixation in 22 cases, intermaxillary or single jaw fixation in 46 cases. Postoperative infection delayed bone union in 3 cases (1.81%). 19 cases were treated with other injuries. Combined oral and maxillofacial soft tissue injury in 36 cases. There were 2 deaths (1.21%) with combined craniocerebral injury and 8 (4.85%) poor occlusion after treatment. Conclusion: (1) exclude brain and visceral injury, to ensure no asphyxia, shock occurred, confirmed by clinical manifestations of fracture type. (2) to make the displacement of the fracture as soon as possible to reset the application of strong internal fixation to ensure that no longer shift the bone, restore pre-injury occlusion, (3) to make full use of soft tissue, tight suture, soft tissue defects to use a variety of Flap skin flap to repair. (4) the proper use of orthognathic surgery, so that the old fracture to achieve three-dimensional direction of the reset, restore the shape and function of the face.