The Role of External Fixation in Complex Mandibular Fractures-Case Report

骨外固定術在複雜性下顎骨骨折治療所扮演之角色－病例報告

林協弘(Shye-Horng Lin) ； 陳建宗(Chien-Tzung Chen) ； 賴瑞斌(Jui-Bin Lai) ； 陳昱瑞(Yu-Ray Chen)

《中華民國整形外科醫學會雜誌》 10卷4期 (2001/12) Pp. 274-288

https://doi.org/10.7096/JPSA.200112.0274

摘要

在治療開放性下顎骨粉碎骨折，雖然骨內固定術之應用已日趨成熟，但在部分特殊情況下，如傷口嚴重污染，或軟組織及骨缺損，仍有不足之處。在過去481例下顎骨骨折之中，有2例特殊開放性下顎骨粉碎骨折合併有骨折處之感染軟組織缺損以及其他嚴重外傷，採取骨外固定術治療；其優點在於：(1)骨外固定術能避免過度剝離骨折處之骨膜及軟組織，藉以保留骨折處殘存之血液供應 (2)此外骨外固定術能提供合適的骨復位及齒咬合而不需做顎間固定 (3)骨外固定術所須手術時間短且容易使用，術後亦能多次調整，而拔除骨外固定可於門診實施不需全身麻醉。骨外固定術治療在合併有骨缺損之病患為過渡性治療，在其他問題解決之後，仍須接受後續手術，如骨移植術以及置換為內固定骨釘。此外缺點在於外露骨釘之照護以及固定器本身過重，外觀不良，都增加病患生理及心理負擔，而且外固定骨釘會造成明顯的孔徑疤痕，對於年輕女性病患，較難被接受。雖然骨外固定術並不是常規的治療方式，然而在少數的特殊情況下，骨外固定術提供了手術者替代性的選擇。

並列摘要

The disastrous open comminuted mandibular fractures were difficult in management. Although rigid internal fixation became a standard modality for treatment of facial bone fractures, it might not be satisfied for complex mandibular fractures associated with contamination or tissue loss. In the past, we had 481 cases of mandibular fractures. There were two cases of this series treated with modified external fixation which were mandibular fractures with infection, bony defect, soft tissue avulsion and unstable general condition. The advantages of external fixation were:(1) prevention of striping the fractures site and denuding the remaining blood supply from the small, partially devitalized segments, which tallied with the basic consideration in management of facial fracture;(2) offering the strong support, adequate dental occlusion and immediate mobilization of the temporo-mandibular joint without intermaxillary fixation (IMF);(3) easily applying with less operative time, removing as an outpatient procedure without general anesthesia and being able to adjust the alignment in the postoperative period. On the other hand, external fixation might act as a temporary procedure when there was a bony defect. After resolving concomitant problems, ex. infection, the bone grafts were applied and fixed with internal fixator. The other disadvantages included inconvenience of outer pine care, extra weighted loading, psychological or mental effect caused by the appearance. The obvious pin-tract scar was another straitened problem especially in young female patients. However, external fixation provided an alternative choice in some special conditions.

並列關鍵字

external fixator/external fixation ； internal fixation ； mandibular fractures ； comminuted fractures ； bone defect