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題名 | 開放式手術治療複雜性顴骨骨折--9年回顧=Open Treatments of ZMC Fracture--9 Year Overview |
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作者姓名(中文) | 羅正興; 林廷宣; 許文祥; 李芳輝; | 書刊名 | 中華民國口腔顎面外科學會雜誌 |
卷期 | 17:1 民95.03 |
頁次 | 頁14-30 |
分類號 | 416.956 |
關鍵詞 | 複雜性顴骨骨折; ZMC fracture; |
語文 | 中文(Chinese) |
中文摘要 | 複雜性顴骨骨折(ZMC fr.)屬側中顏面骨骨折,在顏面骨骨折中為常見之骨折。ZMC骨折若不處理或處理不當,易引起美觀、複視、張口不全或咬合不正等問題。於此,在較複雜之ZMC骨折可能不是傳統的一道切線即能解決問題,可能需要兩道或參道切線,甚至需使用頭皮冠狀切線才能將骨折區做最適當之復位及固定。本篇報告的目的是在探討不同組合的切線,可以適合何種型式之ZMC骨折期能在手術前可以依據臨床之影像來判斷術中應用何種組合之切線,以達到最快速、最有效之復位及固定。本院口腔外科自84年7月至93年6月,共有240位患者屬於1972年Spiessl及Schroll所提出對於ZMC骨折之分類的Ⅲ到Ⅶ之分類。這240位患者中有213位共221側之ZMC骨折接受本科之手術治療。手術方法(Approaches)共分五種type,type Ⅰ為一道切口(眉弓或口內),typeⅡ為兩道切口(眉弓+眶下,眉弓十口內,眶下+口內),typeⅢ為兩道切口(眉弓+口內十眶下),typeⅣ為半冠狀切線(Hemicoronal),typeⅤ為全冠狀切線(Bicoronal)。固定方式依展示之骨折區狀況,分別或混合26、28號鋼絲,標率型、超薄型迷你鋼板或微迷你型鋼板固定骨折區。患者若合併有眼眶壁破損,則大部分以自體骨修補之。自體骨之選擇分別是上顎骨前壁、顱骨及腸骨。結果:共126側(57%)ZMC骨折使用typeⅢ Approach,其中98側為屬於Gr.Ⅳ,25側屬於Gr.Ⅴ,2側屬於Gr.Ⅵ,1側屬於Gr.Ⅶ;67側(30.3%)使用typeⅡApproach,其中31側屬於Gr.Ⅲ,30側屬於Gr.Ⅳ;5側屬於Gr.Ⅴ,1側屬於Gr. VI;13側(6%)使用typeⅠ Approach,其中12側屬於Gr.Ⅲ,1側屬於Gr. IV;4側(1.8%,Gr. V)使用type IV Approach;11側(4.9%)使用typeⅤ Approach,9側屬於Gr.Ⅶ,2側屬於Gr. Ⅵ。共有30側(13.6%)合併有眼眶壁(Floor及Medial Wall)修補。9位(4.2%)患者有氣切。結論:94%以上的ZMC骨折需使用至少兩道以上的切線才能理想的復位及固定。 |
英文摘要 | ZMC fr. belongs to midface fracture. It is quite commonly seen on facial injuries. This type of fracture, if not treated properly, may cause problems such as facial asymmetry, trismus, diplopia or enophthalmos. Treatments of ZMC fr. are often very different depending on surgeons, therefore results are also sometimes disappointing during clinical follow ups. From clinical experience, we believe that in complex cases, the traditional one incision line for ZMC fr. is not good enough for reduction and fixation. So the purpose of this study is to try to find the best incision couples and sequences for the cases of ZMC fr. based on Spiessl & Schroll classification. This is a retrospective study. We review and analyze our cases of ZMC fr. over a 9-year period. Results show that over 94% of cases need at least 2 incision lines for proper reduction and fixation of ZMC fr. The best incision sequence we suggest would be eyebrow incision first, but a) if cases belong to at least Gr. Ⅳ level, b) if the fr. can not be lifted properly during the operation, or c) if it is combined with occlusion problems, then we should go into the second-oral incision. If it is combined with orbital floor defects, only then should we do the third-subciliary incision. The coronal incisions are suitable for malunion or combined with frontal or orbital wall defects. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。