三维坚强内固定技术在下颌骨前部骨折中的临床应用研究

To Investigate the Clinical Application of Three-Dimensional Rigid Internal Fixation in the Treatment of Anterior Mandibular Fractures

摘要: 下颌骨位于面部下部，具有特殊的弓形，质地坚硬，是颌面部唯一可活动的骨骼。近年来，颌面部骨折呈逐年上升趋势，且损伤程度越来越严重，这是因为下颌骨在颌面部的位置较为突出，受到外力作用后容易发生骨折。传统的内固定方法是将下颌骨固定在外侧，这种方法可以实现二维空间的有效固定，防止骨折产生的弯矩，但不能有效防止骨折产生的扭转。而在下颌骨颏正中和颏孔区的骨折中，骨折段存在明显的扭转。正中联合骨折的固定以两点固定为宜，并尽量增大两点固定的距离，以提高固定的稳定性，同时不损伤重要的解剖结构。因此，下颌骨正中、副中轴骨折的固定，除在根尖水平下水平固定以克服张力外，还应固定下颌骨骨折下缘以克服扭力。因此，钛板下缘与下颌骨下缘的三维固定，骨折段移位小，移位越小，固定越稳定，越有利于骨折的愈合，减少术后并发症的发生。

Abstract: The mandible is located in the lower part of the face, with a special bow shape and hard texture, and it is the only movable bone in the maxillofacial region. In recent years, maxillofacial fractures have been on the rise year by year, and the degree of injury is getting worse and worse, because the mandible is in a more prominent position in the maxillofacial region, and it is prone to fracture after being subjected to an external force. The traditional internal fixation method is to fix the mandible at the lateral side, which can achieve effective fixation in two-dimensional space and prevent the bending moment generated by the fracture, but it cannot effectively prevent the torsion generated by the fracture. And there was obvious torsion of the fractured segment in the fracture of the mandibular chin median and chin foramen region. Two-point fixation is preferred in the fixation of median union fracture, and the distance between the two points of fixation should be increased as much as possible in order to improve the stability of fixation without injuring the important anatomical structures. Therefore, for the fixation of median and paramedian fractures of the mandible, in addition to fixing the fracture horizontally under the apical level to overcome the tension, the fracture of the mandible should be fixed at the lower margin to overcome the torque. Therefore, the three-dimensional fixation of the lower edge of the titanium plate to the lower edge of the mandible has a small displacement of the fracture segment, and the smaller the displacement, the more stable the fixation, and the more favorable to the healing of the fracture to reduce the occurrence of postoperative complications.