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目的:探讨全面部骨折临床治疗的最佳手术方案。方法:对26例全面部骨折病例采用螺旋CT三维重建定位,设计术式,切开复位,钛板坚强内固定治疗,线型骨折处辅助内镜、90°侧壁螺丝刀从口内或口外隐蔽小切口进路复位固定,术后CT三维重建、牙颌模型复查与术前对比观察。结果:26例术后骨折复位良好,面部外形突度和对称性恢复良好、无明显疤痕。23例咬合关系恢复良好,张闭口运动、咀嚼功能恢复正常;3例咬合关系有后牙早接触,经颌间牵引和调牙合后基本恢复正常。结论:螺旋CT三维重建能显示全面部骨折的立体结构和骨折线的全貌,精确定位分析、设计手术方式,使术中有明确的路经和程序。辅助内镜、90°侧壁螺丝刀,可从口内或口外隐蔽小切口进路复位固定线型骨折,减少组织损伤及避免面部瘢痕,符合微创和美学手术原则,适用于下颌角、升支、颧骨颧弓的线型骨折。
Objective: To explore the best surgical treatment of total fractures of the program. Methods: Twenty-six patients with total fracture were treated with three-dimensional reconstruction of spiral CT. Designing operation, open reduction and internal fixation with titanium plate were performed. The endoscopic linear fracture was assisted by endoscope. The 90 ° lateral screwdriver was concealed from the mouth or outside the mouth Incision approach fixation, three-dimensional reconstruction of postoperative CT, dental model review and preoperative comparison. Results: Twenty - six cases of fractures were well resected and the facial appearance and symmetry recovered well with no obvious scar. In 23 cases, the occlusal relationship recovered well, the motion of opening and closing of the mouth closed and the masticatory function returned to normal. The occlusion of the 3 patients had early contact with the posterior teeth and returned to normal after intermaxillary traction and adjustment of the occlusion. Conclusion: Three-dimensional reconstruction of spiral CT can show the whole structure of the fracture and fracture line three-dimensional panoramic view of the precise positioning and analysis of the design of surgical procedures, so that surgery clear path and procedures. Auxiliary endoscopy, 90 ° side-wall screwdriver, hidden from the mouth or outside the mouth of a small incision approach Reduction and fixation of linear fractures, reduce tissue damage and avoid facial scars, in line with minimally invasive and aesthetic principles of surgery for mandibular angle, ascending, Zygomatic zygomatic bow linear fracture.