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  本文選題：頜骨骨折　切入點(diǎn)：治療失敗　出處：《新疆醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:分析頜骨骨折治療失敗的原因,探討術(shù)后并發(fā)癥的特點(diǎn)及二期治療原則和方法。方法:收集2010年1月?2015年6月我院收治的在外院一期治療失敗的頜骨骨折51例,分析一期治療失敗原因。39例拆除原固定鈦板,其中21例重新行鈦板堅(jiān)固內(nèi)固定,12例陳舊性錯位愈合骨折以正頜外科的原理和方法行矯正治療。術(shù)后頜間牽引2周,配合正畸、調(diào)合治療,囑患者行張口鍛煉。結(jié)果:本組一期治療后發(fā)生術(shù)后感染20例,咬合關(guān)系紊亂14例,開口受限11例,顏面畸形6例,伴神經(jīng)損傷7例。分析治療失敗的主要原因:(1)首診醫(yī)師非頜面外科醫(yī)師,術(shù)前評估不足,手術(shù)操作不當(dāng),復(fù)位不準(zhǔn)確。(2)固定材料、方法及位置選擇不當(dāng),不適當(dāng)?shù)膽?yīng)力集中。(3)忽視術(shù)后頜間牽引。(4)患者依從性差。(5)術(shù)后感染,護(hù)理不當(dāng)。全組51例患者術(shù)后骨斷端愈合良好,無嚴(yán)重并發(fā)癥。47例患者術(shù)后咬合關(guān)系恢復(fù)滿意、面形對稱、滿意。4例咬合關(guān)系欠佳,需輔以術(shù)后正畸或調(diào)合治療。4例咬合基本滿意,但顏面畸形有待進(jìn)一步整形矯治。術(shù)后隨訪49例,5例患者術(shù)后3個月中度張口度。結(jié)論:臨床應(yīng)掌握頜面部骨折的治療原則及正確方法,選擇內(nèi)固定材料、方法及部位要得當(dāng),不可過分依賴內(nèi)固定而忽視必要的頜間牽引。拆除原固定鈦板或重新行堅(jiān)固內(nèi)固定可解決頜骨骨折術(shù)后相關(guān)并發(fā)癥,正頜外科手術(shù)在陳舊性錯位愈合骨折矯治中效果肯定,復(fù)雜的上下頜多發(fā)骨折所致并發(fā)癥,需多次手術(shù)方可達(dá)到滿意效果。
[Abstract]:Objective: to analyze the causes of failure in the treatment of jaw fracture and to explore the characteristics of postoperative complications and the principles and methods of secondary treatment.Methods: a total of 51 cases of maxillary fracture treated in our hospital from January 2010 to June 2015 were collected, and the causes of failure in one stage treatment were analyzed. 39 cases were removed from the original fixed titanium plate.Among them, 21 cases were retreated with titanium plate rigid internal fixation and 12 cases of old malposition union fracture were treated with orthognathic surgery principle and method.Postoperative intermaxillary traction 2 weeks, combined with orthodontics, combined with treatment, told patients to open mouth exercise.Results: there were 20 cases of postoperative infection, 14 cases of occlusal disorder, 11 cases of limited opening, 6 cases of facial malformation and 7 cases of nerve injury.Analysis of the main causes of failure in treatment: (1) Non-maxillofacial surgeon, the first physician, the preoperative evaluation was insufficient, the operation was improper, the reduction was not accurate, and the fixation materials, methods and location were not properly selected.Improper stress concentration. 3) neglect of postoperative intermaxillary traction. 4) poor compliance. 5) postoperative infection, improper nursing.51 patients in the whole group healed well after operation. There were no serious complications. The occlusal relationship was satisfactory in 47 patients, the facial shape was symmetrical, and the occlusal relationship was unsatisfactory in .4 patients. The occlusal relationship was basically satisfactory in 4 patients who needed to be treated with orthodontic or adjuvant treatment after operation.But facial deformity needs further plastic treatment.49 patients were followed up for 3 months.Conclusion: we should master the treatment principle and correct method of maxillofacial fracture, select the internal fixation material, the method and position should be appropriate, and we should not rely too much on internal fixation and ignore the necessary intermaxillary traction.Removal of the original titanium plate or re-rigid internal fixation can solve the postoperative complications of maxillary fractures. Orthognathic surgery is effective in the correction of old dislocation healing fractures, and complications caused by complex multiple fractures of the upper and lower jaw.Multiple operations are needed to achieve satisfactory results.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R782.4

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