关键词: 外伤, 颌面部骨折, 开放性颌面部骨折, 一期治疗, 复位内固定

Abstract:

Objective To discuss the clinical efficacy and feasibility of one-stage fracture reduction and internal fixation in the patients with maxillofacial skin and soft tissue contusions and lacerations complicated with fractures caused by trauma， and to clarify the basis for optimizing the treatment plan for open maxillofacial fractures. Methods A total of 47 patients with open maxillofacial fractures were selected as subjects. All the patients underwent pre-operative multi-departmental joint assessment or treatment to exclude life-threatening emergencies such as craniocerebral， injury limb fracture， and spinal injury. After admission， all the patients underwent surgery under general anesthesia with endotracheal intubation or tracheostomy. Thorough debridement of the traumatic wound was performed， followed by fracture reduction and fixation using metal internal fixators. The patients were followed up for 6 months to observe the healing situation and the occurrence of complications. Results Among the 47 patients， 45 patients healed well， with a healing rate of 95.7% （45/47）； only 2 patients developed complications， including 1 patient with mandibular fracture who developed postoperative wound infection and achieved delayed healing after secondary debridement； 1 patient presented with a non-healing intraoral wound and exposure of the titanium plate for fracture of anterion wall of maxillary sinus， and the wound was repaired after the removal of the fixator. The reason was that both patients had intraoral mucosal wounds， possibly due to poor postoperative oral hygiene care leading to infection. Conclusion For the patients with maxillofacial trauma as the main injury， stable vital signs， fully exposed fractures， without need for additional auxiliary incisions， one-stage reduction and internal fixation can achieve satisfactory reduction results in those with clean wounds or after strict debridement. The one-stage surgery simultaneously treats facial trauma and facial bone fractures， can effectively reduce the physical and economic burden caused by secondary surgery， and promote good recovery of facial appearance and function.

Key words: Trauma, Maxillofacial fracture, Open maxillofacial fracture, One-stage treatment, Reduction and internal fixation