颅面骨骨折鼻内镜下微创修复的临床观察
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摘要
目的探讨多发性颅面骨骨折{包括探讨鼻内镜下眶内下壁(鼻颌筛)复合骨折；探讨鼻内窥镜下泪前隐窝入路修复上颌骨(窦)后外侧壁骨折}的治疗方法和效果；探讨对游离髁状突快速有效的寻找方法和治疗方法；探讨鼻内镜下高密度多聚乙烯(Medpor)植入板和瑞士可吸收固定材料在眼眶骨折整复中的应用效果,以期恢复患者正常面容及功能。方法对不同部位的颅面骨骨折在鼻内窥镜引导下(洗镜器术中冲洗鼻内镜,以利视野清晰)采取不同的手术微创及美容切口或局部疤痕切口并用钛板钛网或快速固定材料等固定方法,以修复颅面骨骨折或矫正眼球内陷等；应用医用耳脑胶(EC)对于颅颌面碎骨片进行复位和固定等。结果患者术后外形全部得到明显改善；双眼眶及面部对称,眼球凹陷在2mm以内；上下咬合关系正常,张口无受限；术后无感染,种植物无排异、无移位,患者面部饱满、自然。医用耳脑胶胶膜与创面镶嵌紧密,粘接后红细胞不能通过,有良好的止血和骨组织粘接固定作用,但数日后胶膜在体内可被降解吸收。结论对不同的颅面骨骨折在鼻内镜引导下采取不同的治疗方法可以起到整形美容效果,对骨折病人可以达到很好的治疗效果；洗镜器术中冲洗鼻内镜,鼻内镜手术过程中不必进进出出,这样可大大缩短手术时间；医用耳脑胶对于颅面碎骨片能进行很好的复位和固定；Medpor植入板是一种良好的骨替代材料.瑞士可吸收固定材料适用于颅颌面部骨折和重建的治疗,包括鼻筛部和面部诸骨的粉碎性骨折,具有组织相容性好、易塑形、可血管化等诸多优点,其最终代谢产物为水和二氧化碳,对人体无害,明显优于其他材料。尤其在鼻内镜引导下手术,更能使骨折断端达到完美的结合,并能避免损伤周围正常组织；鼻内镜引导下的下颌骨髁状突游离骨折的寻找和复位能大大缩短手术时间,是一种快速有效的寻找方法和治疗方法；鼻内窥镜下泪前隐窝入路修复上颌骨(窦)后外侧壁骨折术式简单易行,疗效显著,安全性好,本术式解决了目前困扰整形医生在治疗上颌骨后外侧壁骨折的困惑。
Objective To evaluate the clinical effect and ways of tratment about Skull/face bone fracture (Including to evaluate the clinical effect of the naso-maxilla-ethmoid compound fracture under endoscopic; to evaluate the clinical effect of treatment to posterior and external bone fracture of the maxillae through the hollow of lacrimalis anterior under endoscopic)under endoscopic(The Instrument for washing Endoscopic wash Endoscopic in the operation,so that the vision is clear.); To evaluate the good ways to look for rapidly and to treatment Processus condylaris fracture under endoscopic; To evaluate the clinical effect of surgical treatment to blowout fracture with Medpor implant plate or with Switzerland Rapid resorbable fixation biomaterials under endoscopic,so that it can recover normal facial features and function. Methods All cases with compound fracture have been taken crown incision, micro-plastic incision or scar incision to expose fracture and to repair the rims and to cram Ti (titanium) net or man-made bone and to recover skull/face bone fracture and to correct the hollow of eyeball under endoscopic and to make face well and to eat food well. We use EC to repair and to fix crushing fracture of face and skull bone.Results The result of all cases is satisfied after operation, such as, both sides of the orbit and facial features are symmetric on appearance,Superior orbit is full naturally and no depression,The hollow degree of eyeball is only2mm et al. to gnash teeth is right and to open mouth is normal.The incision is not infection, the implant plate have not exclude outsiders.the place of implant plate is right. The EC membrane connect with surface of bone well,RBC can not pass the membrane,it have good fixation and reducing coming of blood.,but it can be absorbed in the future.Conclusion The surgical treatment with micro-plastic incision to Skull/face bone fracture under endoscopic has cosmetology and plastic effect,The cure of fracture is good under endoscopic. That Instrument for washing Endoscopic wash Endoscopic in the operation can reduce time of surgery, ECs are well to repair crushing fracture of face and skull bone; Medpor implant plate is a good biomaterials. Switzerland Rapid resorbable fixation biomaterials are suit to the treatment of Skull/face bone fracture,. Switzerland Rapid resorbable fixation biomaterials have good tissue compatability,easy for shape and vascularization and was much more better than Other material,H2o and Co2are their product finaily.they are well to body,they are good biomaterials. During the implantation of Switzerland Rapid resorbable fixation biomaterials,there are no significant effect to the motility of Hydroxyapatite prosthesis. They can make the ends of fracture link very well and avoid injury other tissue. The cure of fracture is good under endoscopic. To look for and repair Processus condylaris fracture under endoscopic can reduce time of surgery,it is good way to look for and treat fracture. Treatment to posterior and external bone fracture of the maxillae through the hollow of lacrimalis anterior under endoscopic is a sample and safely way,it have saved the difficulty about treatment to posterior and external bone fracture of the maxillae.
Objective To evaluate the clinical effect and ways of tratment about Skull/face bone fracture (Including to evaluate the clinical effect of the naso-maxilla-ethmoid compound fracture under endoscopic; to evaluate the clinical effect of treatment to posterior and external bone fracture of the maxillae through the hollow of lacrimalis anterior under endoscopic)under endoscopic(The Instrument for washing Endoscopic wash Endoscopic in the operation,so that the vision is clear.); To evaluate the good ways to look for rapidly and to treatment Processus condylaris fracture under endoscopic; To evaluate the clinical effect of surgical treatment to blowout fracture with Medpor implant plate or with Switzerland Rapid resorbable fixation biomaterials under endoscopic,so that it can recover normal facial features and function. Methods All cases with compound fracture have been taken crown incision, micro-plastic incision or scar incision to expose fracture and to repair the rims and to cram Ti (titanium) net or man-made bone and to recover skull/face bone fracture and to correct the hollow of eyeball under endoscopic and to make face well and to eat food well. We use EC to repair and to fix crushing fracture of face and skull bone.Results The result of all cases is satisfied after operation, such as, both sides of the orbit and facial features are symmetric on appearance,Superior orbit is full naturally and no depression,The hollow degree of eyeball is only2mm et al. to gnash teeth is right and to open mouth is normal.The incision is not infection, the implant plate have not exclude outsiders.the place of implant plate is right. The EC membrane connect with surface of bone well,RBC can not pass the membrane,it have good fixation and reducing coming of blood.,but it can be absorbed in the future.Conclusion The surgical treatment with micro-plastic incision to Skull/face bone fracture under endoscopic has cosmetology and plastic effect,The cure of fracture is good under endoscopic. That Instrument for washing Endoscopic wash Endoscopic in the operation can reduce time of surgery, ECs are well to repair crushing fracture of face and skull bone; Medpor implant plate is a good biomaterials. Switzerland Rapid resorbable fixation biomaterials are suit to the treatment of Skull/face bone fracture,. Switzerland Rapid resorbable fixation biomaterials have good tissue compatability,easy for shape and vascularization and was much more better than Other material,H2o and Co2are their product finaily.they are well to body,they are good biomaterials. During the implantation of Switzerland Rapid resorbable fixation biomaterials,there are no significant effect to the motility of Hydroxyapatite prosthesis. They can make the ends of fracture link very well and avoid injury other tissue. The cure of fracture is good under endoscopic. To look for and repair Processus condylaris fracture under endoscopic can reduce time of surgery,it is good way to look for and treat fracture. Treatment to posterior and external bone fracture of the maxillae through the hollow of lacrimalis anterior under endoscopic is a sample and safely way,it have saved the difficulty about treatment to posterior and external bone fracture of the maxillae.
引文
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