兒童髁突骨折治療方法選擇的臨床評價與分析
發(fā)布時間：2018-11-07 11:14
【摘要】：兒童及青少年面部骨折多發(fā)于下頜骨,以髁突骨折最常見,該年齡段頜骨處于發(fā)育狀態(tài),髁突為下頜骨發(fā)育的中心點之一,具有生長發(fā)育及改建功能,該年齡段患者的髁突骨折一直受到較多學(xué)者的關(guān)注。大多數(shù)學(xué)者認(rèn)為,兒童及青少年髁突骨折的首選治療方法為閉合治療法,開放性治療可能破壞髁突結(jié)構(gòu)、損傷關(guān)節(jié)周圍組織,從而引起下頜骨發(fā)育障礙,術(shù)后瘢痕、面神經(jīng)損傷以及手術(shù)本身也可能對患者身心造成影響。也有學(xué)者認(rèn)為,大多閉合治療的研究對象為髁突骨折移位不明顯、臨床癥狀較輕的患者,對開放性治療效果的研究較少,也沒有證據(jù)表明開放性治療效果不佳,并認(rèn)為開放復(fù)位治療在恢復(fù)髁突解剖形態(tài)和下頜升支高度、重建下頜骨連續(xù)性方面更具優(yōu)勢,有利于骨折的早期愈合。不同觀點的存在主要是由于髁突骨折的分類及治療方法選擇至今尚無統(tǒng)一定論。 本研究第一部分對兒童及青少年髁突骨折進(jìn)行流行病學(xué)分析,以了解兒童及青少年髁突骨折的發(fā)病特點。在本研究第二部分,在以往學(xué)者的觀點的基礎(chǔ)上提出一種新的針對兒童及青少年髁突骨折的分類方法,ADP分類法,并根據(jù)分類采用相應(yīng)的治療方法,在患者治療,后進(jìn)行2年進(jìn)行復(fù)診及隨訪,并評價該分類法對兒童及青少年髁突骨折的治療效果。本研究第三部分,主要對12歲以下兒童髁突骨折患者進(jìn)行ADP分類后,進(jìn)行保守與于術(shù)治療的術(shù)后療效的比較,以對該分類方法及治療方法的有效性進(jìn)行分析。第一部分兒童及青少年髁突骨折流行病學(xué)研究 目的：對兒童及青少年髁突骨折進(jìn)行流行病學(xué)分析,以了解兒童及青少年髁突骨折的發(fā)病特點。 方法：回顧分析195例18歲以下髁突骨折患者共268側(cè)髁突骨折的臨床資料,對患者發(fā)病年齡、性別、受傷原因、髁突骨折為單側(cè)或雙側(cè)、髁突骨折部位、骨折塊移位情況等進(jìn)行統(tǒng)計分析。 結(jié)果：195例患者中,男性132例,女性64例；0-6歲患者42例,7-12歲患者58例,13-18歲患者95例；受傷原因依次為自行摔傷、高處墜落傷、交通事故傷、白行車事故傷、摩托車事故傷等；單側(cè)髁突骨折患者123例,雙側(cè)73例；骨折部位：P1髁突骨折側(cè)數(shù)130側(cè),P2髁突骨折側(cè)數(shù)86側(cè),P3髁突骨折側(cè)數(shù)31側(cè),P4髁突骨折側(cè)數(shù)21側(cè)；骨折移位程度D1髁突骨折側(cè)數(shù)21側(cè),D2髁突骨折側(cè)數(shù)101側(cè),D3髁突骨折側(cè)數(shù)110側(cè),D4髁突骨折側(cè)數(shù)36側(cè)；92側(cè)髁突骨折采用保守治療法,172側(cè)采用手術(shù)治療法。 結(jié)論：兒童及青少年髁突骨折患者以男性最為常見,13-18歲年齡段為最高發(fā)年齡,受傷原因以白行摔傷最為常見,單側(cè)較雙側(cè)多發(fā),骨折部位以P1最為常見,移位程度以D3最為常見,多數(shù)骨折采用手術(shù)治療法。 第二部分兒童及青少年髁突骨折的分類及治療方法選擇 目的：探討兒童及青少年髁突骨折分類與治療方法的選擇,為臨床治療作參考。 方法：回顧分析195例18歲以下髁突骨折患者共268側(cè)髁突骨折的臨床資料,并在2年后復(fù)診檢查患者的面型、開口度,開口型,咬合情況,攝X線片檢查骨折愈合情況。 結(jié)果：根據(jù)患者年齡、骨折移位程度和骨折部位分型后,I型171側(cè),II型97側(cè),與實際開放治療及閉合治療的側(cè)數(shù)吻合率達(dá)到97.8%。兩年后的隨訪發(fā)現(xiàn),開放治療與閉合治療均能取得較滿意的臨床效果。 結(jié)論：兒童及青少年髁突骨折患者通過ADP分類法對可獲得較為理想的治療效果；ADP分類法對兒童及青少年髁突骨折的治療方法的選擇有明確的指導(dǎo)作用。 第三部分保守及手術(shù)療法對兒童髁突骨折治療效果的臨床評價 目的：比較開放與閉合治療法對兒童髁突骨折治療后的遠(yuǎn)期臨床效果及影像學(xué)表現(xiàn),為臨床治療方法選擇提供參考。 方法：78例兒童髁突骨折患者,共發(fā)生105側(cè)髁突骨折,根據(jù)分類分別選擇開放或閉合治療法,并在治療后進(jìn)行至少三年的隨訪,檢查患者的面型、開口度、開口型、咬合及髁突重建情況,比較開放治療法與閉合治療法的臨床療效及影像表現(xiàn)差別。 結(jié)果：依據(jù)分類,I型患者14側(cè)均采用開放治療法。II型患者48側(cè)均采用閉合治療法。Ⅲ型中,37側(cè)采用開放治療法,6側(cè)采用閉合治療法�；颊呓�(jīng)開放治療與閉合治療后均取得較滿意的臨床效果,經(jīng)開放治療患者影像表現(xiàn)方面優(yōu)于經(jīng)閉合治療患者。 結(jié)論：依據(jù)綜合分類法,對于I型兒童髁突骨折建議采用開放治療法,II型建議采用閉合治療法,III型應(yīng)根據(jù)具體情況慎重選擇。經(jīng)分類建議的方法治療后均取得較滿意的臨床效果；但在髁突影像表現(xiàn)中,經(jīng)開放治療患者髁突重建效果優(yōu)于經(jīng)閉合治療患者。
[Abstract]:The fracture of children and adolescents is most common in the mandible and the condylar fracture is the most common. The maxilla of the age group is in the development state. The condylar process is one of the central points of the development of the mandible, and has the function of development and reconstruction. The fracture of the condyle of this age group has been paid more and more attention by the scholars. Most scholars believe that the preferred method of treatment for condylar fractures of children and adolescents is a closed treatment, which may destroy the condylar structure and damage the surrounding tissues of the joint, thus causing the development of the mandible and the post-operation scar. Facial nerve injury and the procedure itself may also have an impact on the patient's body and mind. It is also believed that most of the study subjects of closed treatment are the patients with dylar fracture, less clinical symptoms, less research on the effect of open-label treatment, and no evidence that the effect of open-label treatment is not good, It is believed that the open reduction therapy is more advantageous in the restoration of the anatomic morphology of the condyle and the height of the lower jaw and the continuity of the mandible, and is beneficial to the early healing of the fracture. The existence of different views is mainly due to the classification of the condylar fracture and the choice of the treatment method. The first part of this study conducted an epidemiological study of the condylar fractures of children and adolescents to understand the incidence of condylar fractures in children and adolescents. Characteristics: In the second part of this study, a new classification method for condylar fracture of children and adolescents was put forward based on the point of view of the past scholars. Follow-up and evaluate the treatment of condylar fractures in children and adolescents Effect. The third part of this study is to compare the curative effect of conservative and operative treatment after the classification of ADP in the children under 12 years of age, in order to evaluate the effectiveness of the method and the treatment method. Analysis. The first part of the children and the adolescent condylar fracture epidemic Objective: To study the epidemiology of condylar fractures of children and adolescents in order to understand the condylar fractures of children and adolescents. Methods: The clinical data of a total of 268 lateral condylar fractures of the patients under 18 years of age were retrospectively analyzed, and the age, sex and the cause of the injury were analyzed. The fracture of the condyle was one or two sides, and the fracture site of the condyle and the displacement of the fracture were observed. Results: Among the 195 patients, there were 132 males and 64 females, 42 patients with 0-6 years of age, 58 patients with 7-12 years of age, and 95 cases of 13-18 years of age. The cause of the injury was the self-injury, the falling injury, the traffic accident injury, the white driving accident, the accident injury of the motorcycle, etc. There were 123 cases of lateral condyle fracture and 73 cases of double side; the fracture site: the side number 130 on the side of the P1 condyle fracture, the side number of the P2 condyle fracture side, the side number of the P3 condyle fracture side, the side number of the P4 condyle fracture side, the fracture degree of the D1 condyle fracture side number 21, the D2 condyle fracture side number 101 side, the D The side number of the 3-condyle fracture side was 110, the side of the D4 condylar fracture was 36 sides, and the 92-side condylar fracture was treated with a conservative treatment. The results were as follows: The most common in male and 13-18 years of age for children and adolescents with condylar fractures were the most common in the age group of 13-18 years. The most common cause of the injury was that the one-sided and double-sided fracture was the most common, and the fracture site was the most common in P1. It is common that the degree of displacement is the most important in D3 The majority of the fractures are common, and most of the fractures are treated surgically. The second part of the child Objective: To study the classification and treatment methods of condylar fractures in children and adolescents: to study the condylar bone of children and adolescents. Methods: The clinical data of a total of 268 lateral condylar fractures of the patients under 18 years of age were retrospectively analyzed, and the surface type and opening of the patients were examined after 2 years. Results: On the basis of the age of the patient, the degree of fracture and the fracture site, the type I 171, the type II, and the fracture were on the side of type I and type II. and the rate of side-to-side anastomosis with the actual open and closed treatment reached 97.8%. Two years later, Conclusion: The results of follow-up show that both open and closed treatment can achieve satisfactory clinical results. The selection of treatment methods for condylar fractures of children and adolescents has clear guidance. The effect of the third part of conservative and surgical therapy on the treatment of children's condylar fractures: a comparative study of open and closed treatment The long-term clinical effect and the imaging performance after the treatment of the children's dylar fracture were provided. Methods: 78 cases of condylar fractures of the children were treated with 105 lateral condylar fractures, and the open or closed treatment was selected according to the classification. Follow-up for at least three years after treatment, check the patient's surface, open, open, Oral, occlusal and condylar reconstruction, and comparison of open and closed treatment The clinical effect and image performance of the therapy were different. Results: On the basis of the classification, open treatment was used on both sides of type I patients. On the 48 side of type II, closed therapy was used. In type III, open therapy was used at 37 sides, and closed treatment was used at 6 sides. The patient was treated with open treatment Conclusion: According to the comprehensive classification method, I can find a better clinical effect after the treatment and close treatment, and it is superior to the patients with closed treatment. Conclusion: According to the comprehensive classification method, I type The fracture of the children's condyle is recommended to be open therapy. The type II is recommended to be closed, and the type III should be carefully selected according to the specific conditions. After treatment with the method recommended by the classification,
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R782.4
本文編號：2316179
[Abstract]:The fracture of children and adolescents is most common in the mandible and the condylar fracture is the most common. The maxilla of the age group is in the development state. The condylar process is one of the central points of the development of the mandible, and has the function of development and reconstruction. The fracture of the condyle of this age group has been paid more and more attention by the scholars. Most scholars believe that the preferred method of treatment for condylar fractures of children and adolescents is a closed treatment, which may destroy the condylar structure and damage the surrounding tissues of the joint, thus causing the development of the mandible and the post-operation scar. Facial nerve injury and the procedure itself may also have an impact on the patient's body and mind. It is also believed that most of the study subjects of closed treatment are the patients with dylar fracture, less clinical symptoms, less research on the effect of open-label treatment, and no evidence that the effect of open-label treatment is not good, It is believed that the open reduction therapy is more advantageous in the restoration of the anatomic morphology of the condyle and the height of the lower jaw and the continuity of the mandible, and is beneficial to the early healing of the fracture. The existence of different views is mainly due to the classification of the condylar fracture and the choice of the treatment method. The first part of this study conducted an epidemiological study of the condylar fractures of children and adolescents to understand the incidence of condylar fractures in children and adolescents. Characteristics: In the second part of this study, a new classification method for condylar fracture of children and adolescents was put forward based on the point of view of the past scholars. Follow-up and evaluate the treatment of condylar fractures in children and adolescents Effect. The third part of this study is to compare the curative effect of conservative and operative treatment after the classification of ADP in the children under 12 years of age, in order to evaluate the effectiveness of the method and the treatment method. Analysis. The first part of the children and the adolescent condylar fracture epidemic Objective: To study the epidemiology of condylar fractures of children and adolescents in order to understand the condylar fractures of children and adolescents. Methods: The clinical data of a total of 268 lateral condylar fractures of the patients under 18 years of age were retrospectively analyzed, and the age, sex and the cause of the injury were analyzed. The fracture of the condyle was one or two sides, and the fracture site of the condyle and the displacement of the fracture were observed. Results: Among the 195 patients, there were 132 males and 64 females, 42 patients with 0-6 years of age, 58 patients with 7-12 years of age, and 95 cases of 13-18 years of age. The cause of the injury was the self-injury, the falling injury, the traffic accident injury, the white driving accident, the accident injury of the motorcycle, etc. There were 123 cases of lateral condyle fracture and 73 cases of double side; the fracture site: the side number 130 on the side of the P1 condyle fracture, the side number of the P2 condyle fracture side, the side number of the P3 condyle fracture side, the side number of the P4 condyle fracture side, the fracture degree of the D1 condyle fracture side number 21, the D2 condyle fracture side number 101 side, the D The side number of the 3-condyle fracture side was 110, the side of the D4 condylar fracture was 36 sides, and the 92-side condylar fracture was treated with a conservative treatment. The results were as follows: The most common in male and 13-18 years of age for children and adolescents with condylar fractures were the most common in the age group of 13-18 years. The most common cause of the injury was that the one-sided and double-sided fracture was the most common, and the fracture site was the most common in P1. It is common that the degree of displacement is the most important in D3 The majority of the fractures are common, and most of the fractures are treated surgically. The second part of the child Objective: To study the classification and treatment methods of condylar fractures in children and adolescents: to study the condylar bone of children and adolescents. Methods: The clinical data of a total of 268 lateral condylar fractures of the patients under 18 years of age were retrospectively analyzed, and the surface type and opening of the patients were examined after 2 years. Results: On the basis of the age of the patient, the degree of fracture and the fracture site, the type I 171, the type II, and the fracture were on the side of type I and type II. and the rate of side-to-side anastomosis with the actual open and closed treatment reached 97.8%. Two years later, Conclusion: The results of follow-up show that both open and closed treatment can achieve satisfactory clinical results. The selection of treatment methods for condylar fractures of children and adolescents has clear guidance. The effect of the third part of conservative and surgical therapy on the treatment of children's condylar fractures: a comparative study of open and closed treatment The long-term clinical effect and the imaging performance after the treatment of the children's dylar fracture were provided. Methods: 78 cases of condylar fractures of the children were treated with 105 lateral condylar fractures, and the open or closed treatment was selected according to the classification. Follow-up for at least three years after treatment, check the patient's surface, open, open, Oral, occlusal and condylar reconstruction, and comparison of open and closed treatment The clinical effect and image performance of the therapy were different. Results: On the basis of the classification, open treatment was used on both sides of type I patients. On the 48 side of type II, closed therapy was used. In type III, open therapy was used at 37 sides, and closed treatment was used at 6 sides. The patient was treated with open treatment Conclusion: According to the comprehensive classification method, I can find a better clinical effect after the treatment and close treatment, and it is superior to the patients with closed treatment. Conclusion: According to the comprehensive classification method, I type The fracture of the children's condyle is recommended to be open therapy. The type II is recommended to be closed, and the type III should be carefully selected according to the specific conditions. After treatment with the method recommended by the classification,
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R782.4
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