下顎顆外骨折に対する観血的治療と閉鎖的治療の比較

Open versus closed treatment for extracapsular fracture of the mandibular condyle.

抄録

目的:

下顎顆部骨折に対する治療法の選択には、依然として議論の余地がある。本研究では、顆部骨折に対する治療法を検討し、観血的治療と閉鎖的治療の適応を決定した。患者および

OBJECTIVES: Selection of treatment methods for mandibular condylar fractures remains controversial. In this study, we investigated treatment methods for condylar fractures to determine the indications for open or closed reduction. Patients and.

方法:

下顎骨顆部骨折の治療を受け、追跡期間が3ヵ月以上の12歳以上の患者を本研究の対象とした。登録患者のカルテについて、性別、年齢、骨折部位、治療方法（観血的再建または閉鎖的再建）、術後の顎間固定期間、手術時間、合併症について検討した。CTおよびパノラマX線撮影を用いて、骨折片の変位および顎骨高さの変化の放射線学的解析を行った。

METHODS: Patients >12 years of age treated for mandibular condylar fractures with a follow-up period of ≥3 months were included in this study. The medical records of enrolled patients were reviewed for sex, age, fracture site, treatment method (open or closed reconstruction), postoperative intermaxillary fixation period, operation time, and complications. Radiological analysis of fracture fragment displacement and changes in ramal height difference was performed using computed tomography and panoramic radiography.

結果:

合計198人の患者が調査され、そのうち48.0％（n=95）が閉鎖整復術を受け、52.0％（n=103）が開放整復術を受けた。縮小方法と患者の性別、年齢、追跡期間との間に有意な相関はみられなかった。合併症の発生率と治療法の間に統計学的有意差は認められなかった。顆頭骨折の観血的整復を受けた患者はいなかった。二項ロジスティック回帰分析によると、顆頭下骨折の患者では、顆頭部骨折の患者と比較して、観血的整復を行う頻度が有意に高かった。骨折片の変位と両群間に統計学的に有意な相関はみられなかった。しかし、治療中の骨折側と非骨折側のramal height differenceの変化量には治療群間で有意差があった。

RESULTS: A total of 198 patients was investigated, 48.0% (n=95) of whom underwent closed reduction and 52.0% (n=103) underwent open reduction. There was no significant correlation between reduction method and patient sex, age, or follow-up period. No statistically significant difference between the incidence of complications and treatment method was observed. None of the patients underwent open reduction of condylar head fracture. Binary logistic regression analysis showed that open reduction was significantly more frequent in patients with subcondylar fracture compared to in those with a fracture in the condylar head area. There was no statistically significant correlation between the groups and fracture fragment displacement. However, there was a significant difference between the treatment groups in amount of change in ramal height difference between the fractured and the nonfractured sides during treatment.

結論:

下顎顆部骨折患者において、観血的整復法と閉鎖整復法の間に臨床的な有意差は認められなかった。骨折部位によると、顆頭骨折では閉鎖整復が好まれた。骨折片の変位と治療方法との間に有意な関係は認められなかった。

CONCLUSION: No significant clinical differences were found between the open and closed reduction methods in patients with mandibular condylar fractures. According to fracture site, closed reduction was preferred for condyle head fractures. There was no significant relationship between fracture fragment displacement and treatment method.