The Application of the Mini-external Fixation in the Mandibular Fracture

迷你外固定在下顎骨骨折的應用

楊佳信(Chia-Sing Young) ； 謝俊昇(Chun-Sheng Hsieh) ； 黃文賢(W. S. Huang) ； 熊震宇(J. Y. Schoung)

《中華民國整形外科醫學會雜誌》 12卷1期 (2003/03) Pp. 35-42

https://doi.org/10.7096/JPSA.200303.0035

摘要

從1998至2001我們利用迷你外固定來治療6位開放性下顎骨骨折的病人，這6位
人都是在接受骨折復位內固定手術後產生了下顎骨骨髓炎的併發症。所有的病人都是
性，平均年齡為39歲。只有一個病人有高血壓及糖尿病。其中一個病人同時有外傷性蜘
膜下出血及額骨骨折，其中有二人同時有顏骨骨折的情況。術後平均追蹤時間為6個月，這6位病人下顎骨骨髓炎的併發症都痊癒，治療的結
包跨了下述：1.下顎骨骨折回復至解剖學上的位置，2．回復外傷後咬合功能性， 3.達到臉部美觀，4．沒有牙關緊閉或顏面神經麻痺的問題，5．對病人而言較為舒服，6．達到較好的口腔衛生。
由於下顎骨為一個非承受重量性的骨頭，因此我們選擇迷你外固定的方法來治療
顎骨骨髓炎的併發症。這樣的治療方法不僅符合治療下顎骨骨折的原則，而治療的結果人滿意。

並列摘要

From 1998 to 2001, we had applied mini-external fixation in 6 patients as a salvage procedure after failed attempts of mandibular fracture treatment using ORIF and IME, which were complicated with post-operative osteomyelitis.
Six patients are all male and the average age was 39 year-old. Only one of these patients had the underlying disease of diabetes mellitus and hypertension. Two cases had concurrent zygomatic fractures, and one patient had sustained traumatic SAH and frontal bone fracture.
Postoperative mandibular osteomyelitis was confirmed primarily by pathologic reports, occurring from 13 days or more after surgery. The surgical procedures are as follows: we set up the mini-external fixations as the first step, then we remove the previous lmplants in order to conduct a thorough debridement and eradicate the infectious nidus. The mean follow-up period was 6 months. All patients were free from the infections. And the other achievements were categorized as follows:
1. It provides a good anatomic reduction and stable fixation.
2. It restores an acceptable facial contour even in the face of the serious complications.
3. It helps to maitain a functional occlusion and avoids further neurologic damage.
4. It facilitates post-operative care in oral hygiene and control of the infection.
Our mini-xternal fixation has long been used in the field of hand surgery for immobilization of the fractured phalanx or metacapals. Since the mandible is not a heavily weight-bearing flat skeleton, its integrity could be easily maintained by the use of mini-external fixation and the results were encouraging. Herein we like to introduce this materials as an auxillary to treat the complicated mandibular fracture.

並列關鍵字

mandibular fracture ； mandibular osteomyelitis ； mini-external fixation