摘要目的:探讨植入式钛钉颌间牵引联合钛板内固定对下颌角骨折患者疼痛、咀嚼和张口受限的影响。方法:本研究为随机对照试验。选取2019年9月至2023年9月延安大学附属医院收治的下颌角骨折患者108例，使用随机数字表法分为观察组与对照组，每组54例。观察组男31例，女23例；年龄（46.21±5.03）岁，骨折部位：左侧26例，右侧28例，接受植入式钛钉颌间牵引联合钛板内固定治疗；对照组男33例，女21例；年龄（45.79±6.18）岁，骨折部位：左侧29例，右侧25例，接受牙弓夹板颌间牵引外固定联合钛板内固定治疗。比较两组手术前后视觉模拟评分法（VAS）评分、咀嚼功能、张口度、下颌活动度变化，并评估两组术后3个月时愈合情况。采用 χ2检验、秩和检验、 t检验。 结果:术后1个月、3个月，两组VAS评分均低于术前，且观察组均低于对照组［（2.03±0.86）分比（2.49±0.71）分、（0.22±0.05）分比（0.29±0.07）分］（ t=3.031、5.980，均 P<0.05）；两组咀嚼功能评分均高于术前，且观察组均高于对照组［（5.76±1.13）分比（5.02±1.07）分、（8.65±0.67）分比（8.23±0.59）分］（ t=3.494、3.457，均 P<0.05）；两组张口度、下颌前后活动度均大于术前，且观察组均大于对照组（均 P<0.05）。观察组一期愈合29例、二期愈合23例、三期愈合2例，对照组一期愈合22例、二期愈合21例、三期愈合11例，差异有统计学意义（ Z=3.971， P=0.046）。 结论:植入式钛钉颌间牵引联合钛板内固定治疗下颌角骨折效果显著，可以减轻患者疼痛，改善咀嚼功能和张口受限程度，促进骨折愈合。

abstractsObjective:To investigate the effects of implantable titanium nail intermaxillary traction combined with titanium plate internal fixation on pain, mastication, and limitation of mouth opening in patients with mandibular angle fracture.Methods:This study was a randomized controlled trial. A total of 108 patients with mandibular angle fracture admitted to Affiliated Hospital of Yan'an University from September 2019 to September 2023 were enrolled in this study and were divided into an observation group and a control group using the random number table method, with 54 cases in each group. In the observation group, there were 31 males and 23 females, aged (46.21±5.03) years, and the fracture site was on the left side in 26 cases and on the right side in 28 cases. In the control group, there were 33 males and 21 females, aged (45.79±6.18) years, and the fracture site was on the left side in 29 cases and on the right side in 25 cases. The observation group received implantable titanium nail intermaxillary traction combined with titanium plate internal fixation, and the control group received arch splint intermaxillary traction external fixation combined with titanium plate internal fixation. The changes of Visual Analogue Scale (VAS) score, masticatory function, mouth opening degree, and mandibular mobility before and after surgery were compared between the two groups, and the healing status of the two groups at 3 months after surgery was evaluated. χ2 test, rank sum test, and t test were used. Results:At 1 month and 3 months after surgery, the VAS scores of the two groups were lower than those before surgery, and those of the observation group were lower than those of the control group [(2.03±0.86) points vs. (2.49±0.71) points, (0.22±0.05) points vs. (0.29±0.07) points] ( t=3.031 and 5.980, both P<0.05). At 1 month and 3 months after surgery, the masticatory function scores of the two groups were higher than those before surgery, and those of the observation group were higher than those of the control group [(5.76±1.13) points vs. (5.02±1.07) points, (8.65±0.67) points vs. (8.23±0.59) points] ( t=3.494 and 3.457, both P<0.05). At 1 month and 3 months after surgery, the mouth opening and mandibular anterior-to-posterior motion of the two groups were higher than those before surgery, and those of the observation group were higher than those of the control group (all P<0.05). In the observation group, there were 29 cases of first stage healing, 23 cases of second stage healing, and 2 cases of third stage healing; in the control group, there were 22 cases of first stage healing, 21 cases of second stage healing, and 11 cases of third stage healing; there was a statistically significant difference between the two groups ( Z=3.971, P=0.046). Conclusion:Implantable titanium nail intermaxillary traction combined with titanium plate internal fixation helps to improve the pain, mastication, and limitation of mouth opening in patients with mandibular angle fracture, and promote the fracture healing and recovery.