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目的:探讨腮腺前缘咬肌表面面神经间入路复位固定下颌骨髁突中低位骨折的方法。方法:37例43侧髁突中低位骨折患者随机分为两组,A组:16例19侧耳前切口穿腮腺入路复位固定骨折;B组:21例24侧髁状突中低位骨折患者采用绕下颌角皮肤切口,腮腺前缘、咬肌表面面神经间入路,直视下复位固定骨折。对两组的临床疗效进行比较。结果:B组术后第2 d咬合关系恢复情况,涎瘘发生情况及术后1月下颌运动时关节局部牵拉不适感等方面均优于A组,差异有统计学意义(P<0.05);面神经功能障碍、术后CT三维重建骨折断端对位及术后1月患者主观满意度等方面差异无统计学意义(P>0.05)。结论:腮腺前缘、咬肌表面面神经间入路可获得较为理想的术野,直视下保护面神经、复位固定骨折,不需分离腮腺,发生涎瘘和面神经损伤的危险性大大降低,并能用于下颌支粉碎性骨折等较为复杂的骨折的治疗,是安全有效的手术路径之一。
OBJECTIVE: To explore the method of reduction and fixation of middle and low fractures of mandibular condyle by means of interphalangeal intermedic approach on the frontal masseter muscle. Methods: Thirty-seven patients with middle and low condylar fractures of 43 condyles were randomly divided into two groups. Group A: 16 cases of 19 anterior anterior incisions were treated by parotid approach for reduction and fixation. Group B: 21 cases of middle- Around the mandibular angle skin incision, the anterior parotid gland, facial masseter muscle intervertebral approach, reset under the fixation of fixed fractures. The clinical efficacy of the two groups were compared. Results: The recovery of occlusal relationship, the incidence of salivary fistula and the local discomfort of joint in mandibular movement in group B at 2 days after operation were better than those in group A (P <0.05) There was no significant difference in facial nerve dysfunction, posterior end alignment of postoperative CT three-dimensional reconstruction fracture and subjective satisfaction of patients in January after surgery (P> 0.05). CONCLUSIONS: The parotid gland frontal and masseter muscle facial interphalangeal approach can obtain the ideal operative field. The facial nerve can be protected under direct vision, and the fixed fractures can be reset. There is no need to separate the parotid gland, and the risk of salivary fistula and facial nerve injury is greatly reduced. For the treatment of comminuted fractures of lower jaw and other more complex fractures, is one of the safe and effective surgical pathways.