1、Universal Neuro 2,1.2mm Upper-Face Module 1.2mm上面部模块,1.7mm Mid-Face Module 1.7mm面中部模块,Universal Mandible 下颌通用套件,Mini-Plating System 迷你接骨板系列,Universal Neuro2系列,Mini-Plating System 迷你接骨板系列,Upper Face/ Mid Face 上面部/面中部,Midface面中部,The Midface is comprised primarily by Two Bones: 面中部主要包括两块骨骼： The Maxilla
2、 & the Zygoma上颌骨和颧骨Maxillary fractures account for approximately 10% to 20% of all facial fractures 在所有面部骨折中上颌骨骨折的发生率约为10%-20%。,Buttresses支柱效应,Support pillars of the face and they transmit forces to the base of the skull. 像柱子一样支撑面部并将压力传导到头盖骨底部。Reconstruction of these buttresses is the key to maxilla
3、ry/midfacial repair (and the general principle of plate osteosynthesis) 在上颌骨/面中部骨折的修复中重建这些支柱非常关键（这也是颌面修复接骨板应用的普遍原则）。,Buttresses支柱效应,Vertical垂直的Pterygomaxillary (posterior)翼突上颌（后面）Zygomatico-maxillary (lateral)颧骨上颌 （侧面） Nasomaxillary (medial) 鼻上颌（中间）Horizontal水平的Nasofrontal (supraorbital rims)鼻骨额骨（眼眶
4、上缘）Nasomaxillary (inferior orbital rims)鼻上颌（眼眶下壁）Inferior border of mandible下颌骨下缘,Horizontal Vertical 水平的 垂直的,Frontal Bone额骨Nasal Bones鼻骨Ethmoid筛骨Lacrimal Bone泪骨Zygoma颧骨Maxilla上颌骨Alveolar Process牙槽突,Craniomaxillofacial (CMF) Trauma 颅颌面（CFM）外伤,Direct exposure and fixation of these buttresses provides
5、 anatomical restoration. 直接暴露并固定这些支柱有助于解剖结构的恢复。 Main goal is to restore:修复的主要目标： Height高度 Width宽度 Projection 投影,Surgical Exposure Selection 术野选择,Cosmetic appearance, inconspicuous area 对外表影响较小的不明显的区域。 Avoid when possible muscles and nerves尽量避开肌肉及神经。 Sensory nerves and cranial nerves感觉神经及颅神经 Also con
6、sider unique anatomy of patient 还要考虑到患者解剖结构的特殊性。 Utilize open wounds for exposure to fracture site 利用开放的伤口暴露出骨折的位置。,Exposure of the maxilla: 暴露上颌骨 Intraoral: vestibular incision/ Sublabial/Gingivobuccal sulcus 口内入路：前庭切口/唇下/牙槽沟 Periorbital:眶周入路 Subciliary 睫下 Transconjunctival经结膜 Subtarsal 跗骨下 Infraor
7、bital眶下 Lateral brow眉弓外侧 Coronal冠状 Upper Eyelid/Blephoroplasty 上睑/内眼角,Zygoma:颧骨： Gillies Gillies入路 Coronal冠状 Lateral brow眉弓外侧 Blepharoplasty眼睑成形术Naso-orbital-ethmoidal:鼻-眶-筛 bicoronal incision 双侧冠状切口,Upper/MidFace Surgical Approaches 上面部/面中部手术入路,Coronal Approach冠状入路,To access: Zygomatic arch, Superi
8、or, medial & lateral orbital rims, Naso ethmoidal Region, and Frontal Sinus 可进入：颧弓、眼眶前部、中间及后部、鼻筛区及额陡,Coronal Approach 冠状入路,Pericranium颅骨膜,Coronal Approach 冠状入路,Gillies Approach Gillies 入路 For Closed Reduction of a Zygoma Fracture 用于颧骨骨折的闭合性复位,Upper Lid Blepharoplasty 上眼睑成形术入路,Zygoma Fractures, Front
9、ozygomatic Suture Line, and Orbital Roof Fractures, Lateral brow 颧骨骨折、额颧缝及眶顶骨折、眉弓外侧,Lateral Brow Incision 眉弓外侧切口,Zygoma Fractures, Frontozygomatic Suture Line, and Orbital Roof Fractures, Lateral brow 颧骨骨折、额颧缝及眶顶骨折、眉弓外侧,Lateral Brow Incision 眉弓外侧切口,Transconjunctival Approach 经结膜入路,Inferior Orbital R
10、im, Orbital Floor, ZMC fractures, Lateral Rim, and Medial Wall 前眶部、眶底、颧颌骨折、眶外侧壁及内侧壁,Subcilliary Approach 睫下入路,Inferior Orbital Rim, Orbital Floor, ZMC fractures and Lateral Rim 眶下缘、眶底、颧颌骨折、眶外侧,Infraorbital Incision 眶下切口,Inferior Orbital Rim, Orbital Floor, ZMC fractures and Lateral Rim 眶下缘、眶底、颧颌骨折、眶
11、外侧,Subtarsal Approach 跗骨下入路,Subtarsal Approach 跗骨下入路,Tarsal Plate 睑板,Periorbital Incisions 眶周切口,Lateral Brow眉弓外侧 Upper Eyelid/Blepharplasty上睑/睑成形术 Transconjunctival经结膜 Subciliary睫下 Subtarsal跗骨下 Infraorbital眶下,Vestibular/Sublabial/ Gingivobuccal Sulcus Incision 前庭/唇下/牙龈槽切口,Vestibular/Sublabial/ Gingi
12、vobuccal Sulcus Incision 前庭/唇下/牙槽沟切口,Vestibular/Sublabial/ Gingivobuccal Sulcus Incision 前庭/唇下/牙槽沟切口,Universal Upperface/Midface 通用上面部/面中部,Zygomaticomaxillary Complex Fracture (ZMC) 颧颌复合体骨折（ZMC）,Most common midface fracture! 是最常见的中面骨折,Zygoma Fracture: Surgical Approaches 颧骨骨折：外科手术入路,Lateral brow inc
13、ision (in or below the eyebrow) for access to the ZF suture 眉弓外侧切口（在眉毛里或在眉毛下）达到颧骨骨折线。Vestibular incision for access to the zygomaticomaxillary buttress 前庭切口可以暴露颧颌支。Subciliary, transconjunctival, subtarsal, or infraorbital for the inferior orbital rim and orbital floor 睫下、经结膜、跗骨下或眶下入路用于暴露眶下部及眶底。Gilli
14、es: Reposition of the zygoma temporally Gillies入路：可用于颧骨的临时复位。Transbuccal (sharp hook or bone repositioning pin) 经颊的（可应用锐钩或骨复位针）,ZMC Fracture: Treatment 颧颌复合体骨折：治疗,Exposure of the fracture sites 暴露骨折位点。 Reduction of the fractured bone with a sharp hook or repositioning pin 用锐钩或复位针将断骨复位。 Functionally
15、stable plate osteosynthesis 功能性稳定的接骨术,ZMC Fracture: Repositioning Pin 颧颌复合体骨折：复位针,Transbuccal Stab Incision 经颊针刺切口,Classification of ZMC Fractures 颧颌复合体骨折的分类,Increasing displacement 位移增大 Occular dystopia异位 Flat cheekbone cosmetic deformity颧弓变平 Increased comminuting 加重粉碎损伤 Floor & lateral wall disrup
16、tion 底部及外侧壁断裂,ZMC Fracture Types 颧颌复合体骨折类型,第1类,第2类,第3类,第4类,Type 1 & 2 ZMC Treatment 第1类及第2类颧颌复合体骨折的治疗,Reduction修复 Two point fixation with rigid miniplates (1.2/1.7mm): 用微型硬接骨板（1.2/1.7mm）进行两点固定ZF suture &Inferior orbital rim 颧颌缝及眶下缘,Type 3 ZMC Treatment 第3类颧颌复合体骨折,Reduction 修复 Wire interfragmentary a
17、lignment 线性骨折 Three point fixation:三点固定ZF suture颧颌缝Inferior Orbital Rim眶下缘Zygomaticomaxillary buttress颧颌支,Type 4 ZMC Treatment 第4类颧颌复合体骨折,Reduction修复Fragment stabilization稳定断骨片+/- Bone grafting 骨移植4 point fixation:四点固定： ZF suture颧颌缝Inferior Orbital Rim眶下缘 Zygomaticomaxillary buttress颧颌支Zygomatic arc
18、h颧弓,Orbital Involvement with ZMC Fracture 合并有眼眶损伤的颧颌复合体骨折,Fractures of the zygoma are always connected with fractures of the orbital floor 颧骨的骨折总是伴随着与之相连的眶底骨折,Fracture site 骨折点,Optical Canal 视神经管,Zygomatic Suture 颧颌缝,Infraorbital Rim 眶下缘,Infraorbital Foramen 眶下孔,Bones of the Orbit 眶骨的组成,Zygoma(orang
19、e) 颧弓（橙色） Nasal 鼻Lacrimal(Red) 泪骨（红色） Maxilla 上颌骨Frontal(Purple) 额骨（紫色）Ethmoid(Gold) 筛骨（金色）Sphenoid(Green) 蝶骨（绿色）,Lateral Orbital rim 外侧壁 Medial orbital Rim 内侧壁Medial wall 内壁 Inferior orbital rim 下侧壁Superior Orbital Rim 上壁 Behind the eye 后眼窝 Behind the eye 后眼窝,Patients left eye患者的左眼,Superior View of
20、 Inferior Orbital Rim 眶下壁俯视图,Orbital Floor with ZMC Fracture 颧颌复合体复合眶下壁骨折,Fractures are reduced prior to orbital floor reconstruction 将断骨复位后再重建眶底。,Basic Orbital Floor Plate 基本眶底修复板,Connection bars are anchored to infraorbital rim 将连杆锚定在眶下缘。 Floor plates extend over rim plate 底板要长于边缘板。,Superior View
21、of Anterior Orbit 前眶俯视图,Connection bars trimmed off and fixated to inner surface of orbital rim 将连杆平行固定在眶缘表面。 Plate covers 75% of the orbital floor 修复板要覆盖眶底的75%。,“Blow Out” Fracture “眼眶爆裂性”骨折,眶底骨折,脱垂到骨折部位的脂肪和肌肉,包埋组织,Enopthalmos- 眼球内陷recession of the eyeball within the orbit眼球随着眼眶一起下陷associated with
22、ZMC/Orbital floor fractures伴随有颧颌复合体或眶底的骨折,正常,眼球内陷,Isolated Orbital Floor Fracture 眶底离断性骨折,Orbital floor shown with fracture 眶底骨折示意图No ZMC fracture component: Orbital rim and the zygomatic complex stay intact 未合并颧颌复合体骨折因素：眶缘及颧骨保持完整,Isolated Orbital Floor Fracture 眶底离断性骨折,Isolated Orbital Floor Plate
23、眶底离断性骨折接骨板,Small plate is fixated with 1.2mm screws 小接骨板用1.2mm螺钉固定。 Connection bars are bent up and over the infraorbital rim 连杆弯曲向外越过眶下缘。,Naso-Orbital-Ethmoidal (NOE) Fracture Types 鼻-眶-筛（NOE）骨折的类型,Type 1第1类 single segment (lateral or central fragment) 单纯性断裂（侧面或中间部断裂） Type 2第2类 comminuted central f
24、ragment (fractures external to medial canthal tendon insertion) 中部粉碎性断裂（骨折延伸到内眦附着端） Type 3第3类 comminuted central fragment (fractures including bone of canthal tendon insertion) 中部复合性断裂（骨骼包括内眦附着端的骨折）,Types of Midface Fractures 面中部骨折的类型,Dr. Rene Le Fort studied facial fracture patterns Rene Le Fort 医生
25、对面骨的骨折类型进行了研究。Identified 3 lines of weakness in the facial skeleton 定义了3条面部骨骼最脆弱的线。These lines of weakness correspond to the sites of most frequent midfacial fractures. 这些线的分布与面部骨折频发的位置相符合。Le Fort I, Le Fort II, Le Fort III / Le Fort I、 Le Fort II、Le Fort III,LeFort Fracture Patterns LeFort骨折类型,1: L
26、eFort I 2: LeFort II 3: LeFort III,上颌骨 从下向上骨折,LeFort I Fracture/Treatment LeFort I骨折/治疗,LeFort I Fracture LeFort I骨折Results in a “floating palate”导致“上颚游离”。Fracture goes through piriform aperature and is considered bilateral 骨折线穿过前鼻孔向两侧延伸。LeFort I Fracture Treatment LeFort I骨折的治疗 Approaches入路 Intraor
27、al(Vestibular incision )1.口内入路（前庭切口） MMF to reestablish the correct occlusion 利用MMF重建正常的闭合结构。 Reduction of the fracture to the anatomically correct position 修复断骨重建正常解剖结构。 Functionally stable osteosynthesis by means of miniplates on the buttresses 在支柱上使用迷你型接骨板保持接骨术的功能性稳定。 Exposure of the fracture sit
28、e intraorally 经口内暴露骨折位点,LeFort I Fracture: Placement of Mini Plates LeFort I 型骨折：迷你型接骨板的放置,Two plates on each side每侧放置两块接骨板 One straight or L-shape plate (1.7 or 2.0 mm) on the nasomaxillary buttress or piriform aperture 在鼻上颌支或前鼻孔处放置一块直型或L型接骨板(1.7 mm 或 2.0 mm) 。 One straight or L-shape plate (1.7 or
29、 2.0 mm) on zygomaticomaxillary buttress 另一块直型或L型接骨板(1.7 mm 或2.0 mm) 放在颧颌支上。,LeFort II Fracture/Treatment LeFort II 型骨折/治疗,LeFort II Fracture LeFort II 型骨折 LeFort II fractures result in mobility of the maxillary and nasal complex LeFort II型骨折会导致上颌及鼻骨的游离。 Goes through zygomaticomaxillary suture (late
30、ral orbital rim) 骨折线穿过颧颌缝（眶侧面）LeFort II Fracture Treatment LeFort II 型骨折的治疗 Approaches入路 Infraorbital: subciliary or transconjunctival眶下入路：睫下或经结膜的 Intraoral (vestibular): maxilla口内入路（前庭）上颚 Coronal: nasoe thmoidal冠状入路：经鼻筛的 MMF to reestablish the correct occlusion利用MMF来恢复正常的密闭结构 。 Reduction of the fra
31、cture in anatomically correct position恢复断骨的正常解剖位置。 Functionally stable osteosynthesis using miniplates使用迷你型接骨板保持接骨术的功能性稳定。,LeFort II Fracture: Placement of Mini Plates LeFort II 型骨折：迷你型接骨板的放置,One 1.2 or 1.7 mm plate to stabilize the nasofrontal region 鼻额区固定一块1.2mm或1.7mm的接骨板。One 1.2 or 1.7 mm plate o
32、n the infraorbital rim 眶下缘放置一块1.2mm或1.7mm的接骨板。One 1.7/2.0 mm plate on the nasomaxillary buttress 在鼻上颌支上放置一块1.7mm或2.0mm的接骨板。,One 1.7/2.0 mm plate on the zygomaticomaxillary buttress 在颧上颌支上放置一块1.7mm或2.0mm的接骨板。,LeFort III Fracture/Treatment LeFort III 型骨折/治疗,LeFort III Fracture LeFort III 型骨折 Le Fort I
33、II fractures result in disconnection of the face from the craniumLeFort III 型骨折会导致面部与头盖骨的离断。 Goes through nasomaxillary and nasofrontal sutures 骨折线贯穿鼻额缝及鼻上颌缝LeFort III Fracture Treatment LeFort III 型骨折的治疗 MMF to re-establish the correct occlusion 通过MMF恢复正常的密闭结构。 Reduction of the fracture in anatomic
34、ally correct position恢复断骨的正常解剖位置。 Functionally stable osteosynthesis by the means of miniplates使用迷你型接骨板保持接骨术的功能性稳定。,LeFort III Approaches LeFort III 型骨折手术入路,Lateral brow, upper lid blepharoplasty, or bicoronal 眉弓外侧：上睑成形术入路或双侧冠状切口 ZF suture颧颌缝 Bicoronal incision双侧冠状切口 Naso-orbital-ethmoidal fracture鼻
35、-眶-筛骨折 Subcilliary, Transconjunctival, Infraorbital Rim睫下、经结膜、眶下缘 Infrorbital rim, orbital floor眶下缘、眶底 Intraoral/Vestibular Incision经口内/前庭切口 Maxilla (LeFort I fracture)上颚（LeFort I 型骨折）,LeFort III Fracture: Placement of Mini Plates LeFort III型骨折：迷你型接骨板的放置,One 1.2 mm plate to stabilize the naso-orbita
36、l-ethmoidal fracutre 用一块1.2mm的接骨板稳定鼻-眶-筛的骨折。 One 1.2 or 1.7mm plate to stabilize the zygomaticofrontal suture 用一块1.2或1.7mm的接骨板稳定颧额缝。,LeFort III Fracture Stabilization LeFort III型骨折的稳定,Stabilization! 稳定,LeFort Osteotomies LeFort式截骨术,LeFort osteotomies follow the fracture lines described by LeFort. Le
37、Fort截骨术是按照LeFort提出的骨折线进行截骨的术式。,LeFort I,LeFort III osteotomy for midface advancement LeFort III截骨术用于面中部前突的矫形。,Frontal Bone/Sinus Fractures 额骨/额窦骨折,Includes the following anatomy 包括以下解剖结构：Frontal sinus 额窦 Inner (posterior) and outer (anterior) tables 内部的（后）及外部的（前）格 Nasofrontal duct鼻额管,Frontal Sinus F
38、racture- Anterior and Posterior Tables 额窦骨折及前后格,包括鼻额管,包括鼻额管,硬脊膜撕裂和CFS漏液,Clinical Example: Frontal Sinus Fracture 临床病例：额窦骨折,Treatment of Frontal Bone Fractures 额骨骨折的治疗,Anatomic reduction 解剖位置修复 Supraorbital bar contour眶上缘轮廓 Orbital roof fixation 眶底固定 Plates接骨板 Mesh 网板Remove sinus septum去除窦隔Obliterati
39、on for fronto-nasal duct injury解除鼻额管损伤,Pan Facial Fractures 全面部骨折,Complete loss of reference points 参照点全部丢失 HEIGHT高度 PROJECTION投影 WIDTH宽度High energy/velocity injury 高能/高速损伤Most all major structures/buttresses fractured 大部分主要结构/支柱都发生骨折。,Panfacial Fractures 全面部骨折,Lateral外侧 Zygomatic arch颧弓 Lateral Orb
40、ital Rim眶外侧Superior上部 Frontal Bone额骨 Naso-orbital-ethmoidal鼻-眶-筛 Medial 中部 Infraorbital rim眶下缘 Maxillary buttresses 上颌支 Inferior下部 Mandible下颌骨,Panfacial Treatment Basics 全面部骨折的基础治疗,Good pre-operative planning良好的术前规划 accurate imaging & fracture classification精确的影像及骨折分类Restore premorbid occlusion 恢复闭合结构 MMF key to establishing bite MMF的关键是锚定Priority of fracture fixation骨折固定的优先顺序 superior, middle, inferior thirds上部、中部、下部Approaches to Repair: Bottom up, top down, inside out, outside in 修复顺序：由下到上、由上到下、由内及外、由外到内,
