背景:小儿髁突骨折合并骨联合或骨旁骨折是常见的,但治疗具有挑战性。作者介绍了断裂特征,提出了一种治疗算法,并评价小儿髁突联合/髁突骨折的治疗预后。
方法:对2006年1月至2021年1月在创伤中心接受联合/骨副髁突骨折治疗的儿童患者进行了回顾性研究。记录人口统计学和骨折特征。并发症和功能评估,包括最大齿间开口,Helkimo失忆指数,和临床功能障碍指数,在至少1年的随访后进行评估。
结果:筛选后,104名参与者符合纳入标准。其中,50.96%的患者接受切开复位内固定术治疗联合/骨不对称骨折,闭合治疗髁突骨折,45.19%采用流质饮食和功能锻炼,其余3.85%的严重错牙合畸形患者在正畸矫治器的辅助下进行治疗。随访期间,患者的平均最大切缝开口从17±6.29mm增加到41.64±6.33mm。86.54%的患者没有观察到主观症状,79.81%的患者没有或轻度临床症状。除1例患者发生颞下颌关节强直外,未报告其他严重并发症.3例未骨折的髁骨折后重塑。
结论:小儿骨联合/骨旁髁突骨折存在独特的生物力学和解剖学挑战,需要在治疗过程中特别考虑。在这项研究中,实施治疗算法后获得了令人满意的功能预后.
方法:治疗,IV.
BACKGROUND: Pediatric condylar fractures combined with symphyseal or parasymphyseal fractures are common but challenging to manage. The authors present fracture characteristics, propose a treatment algorithm, and evaluate the treatment prognosis of pediatric symphyseal/parasymphyseal-condylar fractures.
METHODS: A retrospective review was conducted on pediatric patients who underwent treatment for symphyseal/parasymphyseal-condylar fractures in a trauma center between January of 2006 and January of 2021. Demographic and fracture characteristics were recorded. Complications and functional evaluations, including maximum interincisal opening, Helkimo anamnestic index, and clinical dysfunction index, were assessed after at least 1 year of follow-up.
RESULTS: After screening, 104 participants met the inclusion criteria. Among them, 50.96% received open reduction and internal fixation for symphyseal/parasymphyseal fractures and closed treatment for condylar fractures, 45.19% were treated by liquid diet and functional exercise, and the remaining 3.85% with severe malocclusion were treated with the assistance of orthodontic appliances. During follow-up, the average maximum interincisal opening of the patients increased from 17 ± 6.29 mm to 41.64 ± 6.33 mm. No subjective symptoms were observed in 86.54% of the patients and 79.81% showed no or mild clinical symptoms. Except for 1 patient who developed temporomandibular joint ankylosis, no other severe complication was reported. Postfracture remodeling of the nonfractured condyle was noted in 3 cases.
CONCLUSIONS: Pediatric symphyseal/parasymphyseal-condylar fractures present unique biomechanical and anatomic challenges that require special consideration during management. In this study, satisfactory functional prognosis was achieved following implementation of the treatment algorithm.
METHODS: Therapeutic, IV.