CAJ | 학술논문

目的：分析下颌骨髁突骨折治疗失败的原因，提出防范对策。方法对我院收治并治疗失败的下颌骨髁突骨折17例的临床资料进行回顾性分析，探讨治疗失败的原因。结果本组第2次就诊时间为首次治疗完成后1个月~2年，首次治疗选择非手术治疗9例，手术治疗8例，首次治疗均在外院完成。17例首次治疗方法选择不当10例，其中非手术治疗9例，手术治疗1例，手术方式选择及手术处理不当7例，其中2例同时存在下颌他处合并骨折处理不当。第2次治疗对首次采用非手术治疗骨折段移位明显的9例再手术，恢复盘髁关系；髁突游离再植的6例对局部进行清理，并行关节成形重建术；合并下颌体部及颏部骨折错位的2例再行手术复位内固定；关节强直的2例行关节成形术。所有病例术后下颌功能运动及咬合关系恢复良好，随访半年，效果满意。结论对下颌骨髁突骨折治疗认识不足、随意选择治疗方法是治疗失败的主要原因。规范髁突骨折的治疗可降低失败率。
목적：분석하합골과돌골절치료실패적원인，제출방범대책。방법대아원수치병치료실패적하합골과돌골절17례적림상자료진행회고성분석，탐토치료실패적원인。결과본조제2차취진시간위수차치료완성후1개월~2년，수차치료선택비수술치료9례，수술치료8례，수차치료균재외원완성。17례수차치료방법선택불당10례，기중비수술치료9례，수술치료1례，수술방식선택급수술처리불당7례，기중2례동시존재하합타처합병골절처리불당。제2차치료대수차채용비수술치료골절단이위명현적9례재수술，회복반과관계；과돌유리재식적6례대국부진행청리，병행관절성형중건술；합병하합체부급해부골절착위적2례재행수술복위내고정；관절강직적2례행관절성형술。소유병례술후하합공능운동급교합관계회복량호，수방반년，효과만의。결론대하합골과돌골절치료인식불족、수의선택치료방법시치료실패적주요원인。규범과돌골절적치료가강저실패솔。
Objective To analyze the causes of treatment failure of mandibular condylar fractures and to suggest the preventive measures. Methods A total of 17 adult cases failed treatment of mandibular condylar fractures before being admit-ted to our hospital and received secondary treatment with good results. All data were retrospectively studied. The causes of treatment failure were analyzed. Results Of these patients, the hospitalization times were 1 month to 2 years after first treat-ment in other hospitals. 9 of them received non-surgical treatment while the other 8 underwent surgery. Of these cases, 10 were due to improper treatment selection including 9 with non-surgery and 1 with surgery, and the other 7 were due to improper surgical methods including 2 with improper management of combined mandibular fractures. During the second treatment, disc-condyle operation was performed again in 9 cases with obvious displacement of fractured fragments after primary non-surgery;debridement and reconstruction of temporomandibular joints were performed in 6 cases undergoing condylar replantation;Reop-eration for reduction of combined mandibular fractures was performed in 2 cases and anthroplasty was conducted in 2 case with ankylosis. All the cases were followed up for 6 months and all achieved satisfactory outcomes with good oral function and oc-clusion. Conclusion Lack of full understanding of mandibular condylar fracture and improper selection of therapeutic method are main causes of treatment failure. Standard treatment of condylar fractures may reduce the failure rate.