外固定支架手术与内镜切开复位内固定治疗颧弓骨折的疗效比较

摘要

[目的]比较外固定支架手术与内镜切开复位内固定术治疗颧弓骨折的临床效果.[方法]回顾性分析2011年6月至2013年4月在本院行外固定支架手术(外固定组,n=40)和内镜切开复位内固定术(内固定组,n=40)的80例颧弓骨折患者临床资料.所有受试者均随访3年,比较其切口Ⅰ期愈合率、术后并发症发生率及预后情况(残留瘢痕率、咬合优良率、骨折断端完全对位率)及手术前后张口度差异.[结果]两组患者切口均为Ⅰ期愈合,且无面瘫、头面部皮肤麻木、咀嚼功能受限、面部凹陷等并发症(P>0.05);内固定组术后轻度脱发、面部轻度肿胀各1例,均自行缓解;外固定组术后轻度张口受限1例,予以1~2个月的开口功能训练后恢复正常.两组患者术后3年时张口度均较术前明显提高(P<0.05),但组间比较差异无统计学差异(P>0.05).两组末次随访时均可见面部基本对称,CT复查结果显示颧弓骨折愈合良好,无残留瘢痕率,咬合优良率及骨折断端完全对位率均为100%(P>0.05),咬合关系同伤前基本一致.[结论]外固定支架手术与内镜切开复位内固定术均在颧弓骨折患者的临床治疗中有较高的应用价值,患者可根据实际情况选择最佳术式,为提高预后恢复效果创造条件.%[Objective]To compare the clinical effects between external fixation and endoscopic open reduction with internal fixation in the treatment of zygomatic arch fractures. [Methods]The clinical data of 80 patients with zygomatic arch fractures who underwent external fixation ( control group, n =40) and endoscopic open reduction with internal fixation ( study group, n =40) in our hospital between June 2011 and April 2013 were analyzed retrospectively. All subjects were followed up for 3 years. The one-stage healing rate of incision, incidence of postoperative complications and prognosis of the patients (incidence of residual scar, excellent and good rate of occlusion, complete reduction rate of fractures) were com-pared. The differences in mouth-opening degree before and after operation were recorded. [Results]After operation, the in-cision of both groups showed one-stage healing and there were no cases of facial paralysis, head and face skin numbness, limited chewing function, facial depression or other complications ( P>0.05) . There was 1 case of mild hair loss and 1 case of slight swelling of the face in study group after operation, and the symptoms spontaneously remitted. In the control group, there was 1 case with mild restriction of mouth-opening, and after 1 ~ 2 months of mouth-opening function training, it re-turned to normal. At 3 years after operation, the mouth-opening degree of both groups was significantly higher than that of before operation ( P<0.05) , but there was no significant difference between the two groups ( P>0.05) . At the last follow-up, there was presence of facial symmetry and the CT review showed good healing of zygomatic arch fractures, without resid-ual scarring. The effective rate of occlusion and complete reduction rate of fractures was 100% ( P>0.05). The occluding relation was basically the same as before injury. [Conclusion]Both external fixation and endoscopic open reduction with in-ternal fixation are of high application value in the clinical treatment of patients with zygomatic arch fractures. Patients can choose the optimal operation according to the actual situation to create conditions for improving the recovery effect of progno-sis.