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目的:探讨下颌骨骨折钛板内固定术失败的原因及其预防发生取出钛板的措施。方法:收集我院口腔颌面外科2007年8月—2015年12月间下颌骨不同类型骨折给予坚强内固定术失败后取钛板的患者184例,就其失败及取出原因进行分析。结果 :184例下颌骨骨折病例因内固定术失败取钛板原因中,螺钉松动29例;钛板断裂17例,钛板外露27例;修复障碍11例;感染及并发症7例;心理因素67例;感染17例;影响发育13例;其他11例。结论:1、下颌骨坚强内固定术后取出钛板的主要原因可归结为:(1)手术因素:钛板钛钉断裂、钛钉松动、钛板外露、修复障碍(2)心理因素:异物感明显及强烈要求取出的患者(3)感染及并发症:术后感染及神经麻木等并发症(4)影响发育:儿童骨折内固定术后。2、钛板内固定术后失败的原因:(1)术者在操作过程中对钛板的塑型固定、钛钉定位不合理是钛板内固定术后失败的主要原因;(2)其次为软组织缺损过多钛板外露、患者术后不能配合颌间牵引及患者的心理因素;(3)术前病例分析准备不足。
Objective: To investigate the causes of failure of internal fixation of mandibular plate with titanium plate and its preventive measures to remove titanium plate. Methods: A total of 184 patients with titanium plate after failure of rigid internal fixation were enrolled in this study from August 2007 to December 2015 in our hospital from August 2007 to December 2015. Their causes of failure and their causes were analyzed. Results: 184 cases of mandibular fracture cases due to failure to take titanium plate due to screw loose in 29 cases; 17 cases of titanium plate rupture, titanium plate in 27 cases; repair disorders in 11 cases; infection and complications in 7 cases; psychological factors 67 cases; 17 cases of infection; 13 cases of developmental impact; the other 11 cases. The main reasons for the removal of titanium plate after strong internal fixation of mandible can be attributed to: (1) surgical factors: titanium plate titanium nail fracture, loose titanium screw, titanium plate exposed, repair obstacles (2) psychological factors: foreign body (3) infection and complications: postoperative infection and neurological complications such as numbness (4) affect the development of children after fracture fixation. 2, titanium plate fixation failure reasons: (1) the surgeon in the operation of the plastic plate fixation, titanium nail positioning unreasonable titanium plate fixation is the main reason for the failure; (2) followed by Excessive soft tissue defects exposed titanium plate, the patient can not cooperate with the intermaxillary traction and the patient’s psychological factors; (3) preoperative case analysis is not enough.