Two-Year Treatment Outcomes of Mandibular Fractures in a Suburban Hospital of Taiwan

鄕村區醫院之下顎骨折表現－兩年期病例回溯分析

鄭智文(Chih-Wen Cheng) ； 楊榮武(Rong-Wu Yong) ； 林哲毅(Che-Yi Lin) ； 張敏德(Min-Te Chang) ； 陳俊榮(Chun-Jung Chen) ； 蔣維凡(Wei-Fan Chiang)

《臺灣口腔顎面外科學會雜誌》 22卷3期 (2011/09) Pp. 175-188

https://doi.org/10.7104/TJOMS.201109.0175

摘要

目的：台灣地區下顎骨骨折的成因、型態、手術治療與相關預後，甚少在文獻被提出，甚至以鄉村地區爲背景進行的研究更是付之闕如。本文針對一所鄉村區醫院之病例進行分析，除了有利臨床醫師暸解鄉村區之下顎骨骨折病例表現特色與相關治療成果，也提供公共衛生學家進行相關政策制定之參考。病患與方法：本研究針對2009年至2010年間在柳營奇美醫院口腔顎面外科治療之67名病患共102處下顎骨骨折點進行回溯性分析，所有病患之治療皆遵從固定之準則，並在單一醫師指導下進行。結果：男女比爲1.4比1，下顎骨骨折之主要成因爲摩托車事故(72%)，發生部位以正中聯合區最多(41%)，其次依序爲體區(15.7%)、角區(14.7%)。68.7%病患爲多處下顎骨骨折或是合併中顏面骨骨折之複合式骨折。共有55位病患的67處骨折位接受開放式復位及內固定之手術，其中包括：21處以l.6mm迷你骨板固定、36處以2.0mm系統骨板固定、9處以2.3mm系統骨板固定、1處以lag screw進行固定。手術後超時住院（超過5日）之相關因子有：外傷嚴重指數、複雜形態之骨折、合併中顏面骨骨折等等因素，醫源相關性之併發症共有3例(4.5%)。結論：摩托車交通意外爲鄉村區下顎骨骨折之主要因素並且造成較高分數之外傷嚴重指數。術後超時住院與否必須端賴身體其他外傷情形與下顎骨折之型態來決定。本院以1.6mm迷你骨釘骨板和2.0mm骨釘骨板針對不同部位之下顎骨骨折進行手術治療，相關成果尚稱理想，值得參考運用。

關鍵字

下顎骨骨折 ； 鄉村 ； 摩托車 ； 術後超時住院 ； 併發症

並列摘要

Purpose: The etiology, type, and surgical outcomes of mandibular fractures in Taiwan have rarely been described. A study of the current trends in mandibular fractures at a suburban hospital would help clinicians and public health researchers better understand the differences between urban and suburban mandibular fractures and to design appropriate treatment strategies. Patients and Methods: This retrospective study analyzed 67 patients with mandibular fractures between 2009 and 2010 at the Department of Oral and Maxillofacial Surgery, Chi-Mei Hospital, Liouying. Under the supervision of a single surgeon (Chiang), 102 fractured subsites were treated. Results: The male-to-female ratio was 1.4:1. Motorcycle accidents were the most common cause of mandibular fractures (72%). Symphysis was the major subsite of fractures (41%), followed by body fractures (n=16, 15.7%) and angle fractures (n=15, 14.7%). In this study, 68.7% of the patients displayed combined fracture, which was defined as multiple mandibular subsites or midface fracture. In this study, 67 (66%) fractured sites among 55 patients were treated by surgical reduction and bone plate fixation, including 21 sites treated by the 1.6-mm miniplate system, 36 sites treated by the 2.0-mm bone plate system, 9 sites treated by the 2.3-mm reconstruction plate system and one site by the lag screw technique. Injury Severity Score, comminuted/splitting fracture, and combined midfacial bone fracture displayed a significant association with a prolonged postoperative stay. Iatrogenic complications, such as postoperative aseptic abscesses and screw loosening, appeared in 3 (4.5%) cases. Conclusion: Motorcycle accident is a major etiology of mandibular fracture in the suburb and usually results in a more severe Injury Severity Score. The optimal duration of the hospital stay must be evaluated while taking into consideration the associated injuries and the type of fracture. The osteosynthesis of mandibular fractures involving the use of 1.6-mm miniplates, 2.0-mm/2.3-mm nonlocking bone plates yielded ideal outcomes.

並列關鍵字

Mandibular fracture ； Suburb ； Motorcycle ； Prolonged postoperative stay ； Complications