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π‘æπ∏åµâπ©∫—∫

Original Article

266

∫∑§—¥¬àÕ °“√«‘®—¬π’È¡’«—µ∂ÿª√– ß§å‡æ◊ËÕ»÷°…“°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√ ·≈–„∫Àπâ“„πºŸâªÉ«¬Õÿ∫—µ‘‡Àµÿ∑’Ë∂Ÿ° àß

¡“√—°…“∑’Ë°≈ÿà¡ß“π∑—πµ°√√¡ ‚√ßæ¬“∫“≈ √–∫ÿ√’ √–À«à“ß‡¥◊Õπæƒ…¿“§¡ 2526-∏—π«“§¡ 2539 ®”π«π 1,075

√“¬ ‚¥¬»÷°…“¢âÕ¡Ÿ≈¬âÕπÀ≈—ß®“°∑–‡∫’¬πª√–«—µ‘ºŸâªÉ«¬ «‘‡§√“–Àå¢âÕ¡Ÿ≈‡ªìπ√âÕ¬≈– æ∫ºŸâªÉ«¬‡ªìπ‡æ»™“¬√âÕ¬≈–

86 ™à«ßÕ“¬ÿ 20-24 ªï¡’√âÕ¬≈– 25.4 ™à«ßÕ“¬ÿ 20-29 ªï¡’®”π«π‡°◊Õ∫§√÷ËßÀπ÷Ëß (√âÕ¬≈– 44.8) “‡Àµÿ à«π

¡“°‡°‘¥®“°√∂®—°√¬“π¬πµå√âÕ¬≈– 64.9 √Õß≈ß¡“‡°‘¥®“°°“√‡≈àπ°’Ã“ √âÕ¬≈– 14.9 æ∫¡’°√–¥Ÿ°À—°∑—ÈßÀ¡¥

1,860 µ”·Àπàß °√–¥Ÿ°¢“°√√‰°√≈à“ßÀ—°¡“° ÿ¥√âÕ¬≈– 53.1 √Õß≈ß¡“‡ªìπ°√–¥Ÿ°‚Àπ°·°â¡À—° √âÕ¬≈– 20 æ∫«à“ “‡Àµÿ¢Õß°√–¥Ÿ°¢“°√√‰°√≈à“ßÀ—° §◊Õ Õÿ∫—µ‘‡Àµÿ√∂®—°√¬“π¬πµå¡“° ÿ¥√âÕ¬≈– 64 √Õß≈ß¡“§◊Õ°“√

∂Ÿ°∑”√â“¬√à“ß°“¬√âÕ¬≈– 16.8 ∫√‘‡«≥¥â“πÀπâ“À—°¡“°∑’Ë ÿ¥ √âÕ¬≈– 46.5 ·µà “‡Àµÿ°√–¥Ÿ°„∫Àπâ“ à«π°≈“ß À—°§◊Õ Õÿ∫—µ‘‡Àµÿ√∂®—°√¬“π¬πµå√âÕ¬≈– 73.3 √Õß≈ß¡“‡ªìπ√∂¬πµå√âÕ¬≈– 13.2 °“√√—°…“‚¥¬√«¡‰¥â∑” open reduction ¡“° ÿ¥√âÕ¬≈– 55.1 ‚¥¬ºà“µ—¥¬÷¥°√–¥Ÿ°¥â«¬≈«¥√âÕ¬≈– 30.9 ·≈–ºà“µ—¥¬÷¥°√–¥Ÿ°¥â«¬ miniplate

√âÕ¬≈– 16.4 ®”π«π«—π∑’ËºŸâªÉ«¬æ—°√—°…“µ—«Õ¬Ÿà„π‚√ßæ¬“∫“≈‡ªìπ‡«≈“π“π 8-14 «—π¡’¡“°∑’Ë ÿ¥∂÷ß√âÕ¬≈– 34.1

§” ”§—≠: °“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“®“°Õÿ∫—µ‘‡Àµÿ, °“√∫“¥‡®Á∫¢Õß„∫Àπâ“

°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“

„π‚√ßæ¬“∫“≈ √–∫ÿ√’

¡—≈≈‘°“ ∂‘µπ‘√“¡—¬

°≈ÿà¡ß“π∑—πµ°√√¡ ‚√ßæ¬“∫“≈æ√–π—Ëß‡°≈â“ ππ∑∫ÿ√’

∫∑π”

°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“‡ªìπÕ’°

ªí≠À“Àπ÷Ëß´÷Ëß‡°‘¥®“°Õÿ∫—µ‘‡Àµÿ∫π∑âÕß∂ππ À√◊Õ‡°‘¥®“°

°“√∂Ÿ°∑”√â“¬√à“ß°“¬ µ°®“°∑’Ë ŸßÀ√◊Õ°“√‡≈àπ°’Ã“

‰æ»“≈ °—ß«≈°‘® ·≈–‡æ’¬√™—¬ ‡∏’¬√‚™µ‘⁽¹⁾ ‰¥â»÷°…“

“‡Àµÿ°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“æ∫«à“ ‡°‘¥

®“°Õÿ∫—µ‘‡Àµÿ√∂®—°√¬“π¬πµå¡“°∑’Ë ÿ¥ à«π°“√»÷°…“

Õ◊Ëπ^(2-9) æ∫«à“¡—°‡°‘¥°—∫«—¬√ÿàπ·≈–«—¬‡√‘Ë¡µâπ∑”ß“π ∑—Èßπ’È

Õ“®‡ªìπ‡æ√“–«—¬¥—ß°≈à“«¡—°„™â√∂®—°√¬“π¬πµå„π°“√

‡¥‘π∑“ß‡æ◊ËÕ§«“¡ –¥«°√«¥‡√Á« °“√√—°…“°√–¥Ÿ°¢“

°√√‰°√·≈–„∫Àπâ“·µ°À—°¡’µ—Èß·µà°“√∑” closed reduction °“√ºà“µ—¥¬÷¥°√–¥Ÿ°¥â«¬≈«¥ (open reduction with wire) ´÷Ëß¡’§à“„™â®à“¬‰¡à Ÿß À√◊Õ°“√ºà“µ—¥¬÷¥°√–¥Ÿ°¥â«¬

·ºàπ‡À≈Á°¥“¡·≈– °√Ÿ (open reduction with plate and screw) ´÷Ëß¡’√“§“·æß·≈–µâÕßπ”‡¢â“®“°µà“ß ª√–‡∑» °“√√—°…“ºŸâªÉ«¬‡À≈à“π’È¡ÿàß‡πâπ„ÀâºŸâªÉ«¬°≈—∫ Ÿà

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·≈–∑—πµ·æ∑¬å∑’Ë„Àâ°“√√—°…“ºŸâªÉ«¬‡À≈à“π’È®÷ß®”‡ªìπ µâÕß¡’§«“¡§«“¡√Ÿâ·≈–∑—°…–„π°“√¥Ÿ·≈ºŸâªÉ«¬ ‡æ◊ËÕ

„Àâ°“√√—°…“¡’ª√– ‘∑∏‘¿“æ Ÿß ÿ¥

°“√»÷°…“π’È¡’«—µ∂ÿª√– ß§å‡æ◊ËÕ»÷°…“Õÿ∫—µ‘°“√°“√

À—°¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“ “‡Àµÿ°“√À—° §«“¡

—¡æ—π∏å¢Õß‡æ»°—∫ “‡Àµÿ°“√À—° ≈—°…≥–¢Õß°√–¥Ÿ°∑’Ë À—° °“√√—°…“™π‘¥µà“ß Ê ∑’Ë„™â µ≈Õ¥®π¿“«–·∑√°´âÕπ

·≈–®”π«π«—π∑’Ëæ—°√—°…“„π‚√ßæ¬“∫“≈

«‘∏’°“√»÷°…“

°“√«‘®—¬¬âÕπÀ≈—ß‡™‘ßæ√√≥π“π’È∑”‚¥¬»÷°…“®“°

¢âÕ¡Ÿ≈¢ÕßºŸâªÉ«¬∑’Ë‰¥â√—∫Õÿ∫—µ‘‡Àµÿ·∫∫µà“ß Ê ®π°√–¥Ÿ°

¢“°√√‰°√ ·≈–„∫Àπâ“À—° ·≈–√—°…“∑’Ë°≈ÿà¡ß“π∑—πµ°√√¡

‚√ßæ¬“∫“≈ √–∫ÿ√’ „π√–À«à“ßæƒ…¿“§¡ 2526 -

∏—π«“§¡ 2539 √«¡√–¬–‡«≈“ 13 ªï 7 ‡¥◊Õπ ®”π«π 1,075 √“¬ ∑—ÈßºŸâªÉ«¬„π·≈–ºŸâªÉ«¬πÕ° ¢âÕ¡Ÿ≈∑—ÈßÀ¡¥‰¥â

®“°∑–‡∫’¬πª√–«—µ‘ºŸâªÉ«¬∑’Ë¡’°√–¥Ÿ°¢“°√√‰°√·≈–

„∫Àπâ“·µ°À—° ¢Õß°≈ÿà¡ß“π∑—πµ°√√¡ ∑—Èßπ’È¢âÕ¡Ÿ≈∑’Ë‰¥â ª√–°Õ∫¥â«¬ ‡æ» Õ“¬ÿ “‡Àµÿ¢Õß°“√À—° ≈—°…≥–°“√À—°

«‘∏’°“√√—°…“ ¿“«–·∑√°´âÕπÀ≈—ß°“√ºà“µ—¥ √–¬–‡«≈“

∑’Ë√—°…“µ—«„π‚√ßæ¬“∫“≈ ®“°π—Èπ«‘‡§√“–Àå¢âÕ¡Ÿ≈¥â«¬

√âÕ¬≈–

º≈°“√«‘®—¬

®“°°“√»÷°…“æ∫«à“ºŸâªÉ«¬®”π«π 1,075 √“¬ ‡ªìπ

‡æ»™“¬ 925 √“¬ (86%) ¡’Õ—µ√“ à«πºŸâªÉ«¬™“¬µàÕ ºŸâªÉ«¬À≠‘ß ª√–¡“≥ 6:1 °≈ÿà¡Õ“¬ÿ∑’Ëæ∫¡“°‰¥â·°à 20- 24 ªï ¡’ 274 √“¬ (25.4%) √Õß≈ß¡“‡ªìπ°≈ÿà¡Õ“¬ÿ 25- 29 ªï 209 √“¬ (19.4%) (√Ÿª∑’Ë 1) Õ“¬ÿ‡©≈’Ë¬ 27.9 ªï æ‘ —¬ 73-2 ªï “‡Àµÿ°“√·µ°À—°¢Õß°√–¥Ÿ°¢“°√√‰°√

·≈–„∫Àπâ“§◊ÕÕÿ∫—µ‘‡Àµÿ®“°√∂®—°√¬“π¬πµå 698 √“¬

(64.9%) √Õß≈ß¡“‡°‘¥®“° “‡ÀµÿÕ◊Ëπ Ê ‰¥â·°à Õÿ∫—µ‘‡Àµÿ

®“°√∂®—°√¬“π °“√‡≈àπ°’Ã“ °“√∑”ß“π µ°®“°∑’Ë Ÿß

·≈– Õ◊Ëπ Ê ®”π«π 160 √“¬ (14.9%) (µ“√“ß∑’Ë 1)

„π‡æ»™“¬ “‡Àµÿ√Õß¢Õß°“√À—°¢Õß°√–¥Ÿ°¢“

°√√‰°√·≈–„∫Àπâ“ ‰¥â·°à °“√∂Ÿ°∑”√â“¬√à“ß°“¬ 134 √“¬

(14.5%) à«π‡æ»À≠‘ß “‡Àµÿ√Õß ‰¥â·°à Õÿ∫—µ‘‡Àµÿ®“°

√∂¬πµå 33 √“¬ (22%)

„π®”π«πºŸâªÉ«¬ 1,075 √“¬ æ∫«à“¡’°√–¥Ÿ°¢“

°√√‰°√·≈–„∫Àπâ“À—°∑—Èß ‘Èπ 1,860 µ”·Àπàß ∫√‘‡«≥

°√–¥Ÿ°¢“°√√‰°√≈à“ß¡“°∑’Ë ÿ¥∂÷ß 988 µ”·Àπàß (53.1%)

√Õß≈ß¡“‰¥â·°à °√–¥Ÿ°‚Àπ°·°â¡ 373 µ”·Àπàß (20%)

√Ÿª∑’Ë 1 ºŸâªÉ«¬®”·π°µ“¡°≈ÿà¡Õ“¬ÿ

®”π«πºŸâªÉ«¬

°≈ÿà¡Õ“¬ÿ (ªï) 350

300 250 200 150 100 50 0

9 10-14 15-19 20-24 25-29 40-34 35-39 40-44 >44

(2%) 22

(1.50%) 27

(16.30%) 176

(25.40%) 274

(12%) 129 (19.40%)

209

(8.70%) 94

(4.90%) 53

(9.30%) 101

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Journal of Health Science 2008 Vol. 17 No. 2

268

(√Ÿª∑’Ë 2) °“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√≈à“ßæ∫¡’°“√À—°

∫√‘‡«≥°√–¥Ÿ°¢“°√√‰°√≈à“ß¥â“πÀπâ“ (symphysis) ¡“°

∑’Ë ÿ¥ 460 µ”·Àπàß (46.5%) √Õß≈ß‰ª‰¥â·°à ∫√‘‡«≥

¡ÿ¡¢“°√√‰°√≈à“ß (angle of mandible) 187 µ”·Àπàß (18.9%) ·≈–∫√‘‡«≥À—«¢âÕµàÕ¢“°√√‰°√≈à“ß (mandibular condyle) 175 µ”·Àπàß (17.7%) (√Ÿª∑’Ë 3)

à«π°“√À—°¢Õß„∫Àπâ“ à«π°≈“ß æ∫«à“ ¡’°“√À—°

¢Õß°√–¥Ÿ°‚Àπ°·°â¡ (zygomatic bone) ¡“° ÿ¥ √âÕ¬

≈– 47.9 √Õß≈ß¡“‡ªìπ°“√À—°·∫∫‡≈ÕøÕ√åµ II (# LeFort ll), °“√À—°¢Õß°√–¥Ÿ°®¡Ÿ° (#nasal bone or NOE), °“√

À—°·∫∫‡≈ÕøÕ√åµ I (#LeFort l), °“√À—°·∫∫‡≈ÕøÕ√åµ III (#LeFort lll) √âÕ¬≈– 26.9, 14.5, 7.3 ·≈– 3.2 µ“¡

≈”¥—∫

“‡Àµÿ·≈–≈—°…≥–°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√

≈à“ßæ∫«à“‡°‘¥®“°Õÿ∫—µ‘‡Àµÿ®“°√∂®—°√¬“π¬πµå¡“°∑’Ë ÿ¥

∂÷ß√âÕ¬≈– 64 √Õß≈ß¡“¡’ “‡Àµÿ®“°°“√∂Ÿ°∑”√â“¬

√à“ß°“¬√âÕ¬≈– 16.8 à«π°“√À—°¢Õß°√–¥Ÿ°„∫Àπâ“

à«π°≈“ß à«π¡“°‡°‘¥®“°Õÿ∫—µ‘‡Àµÿ®“°√∂®—°√¬“π¬πµå

√âÕ¬≈– 73.3 √Õß≈ß¡“¡’ “‡Àµÿ®“°Õÿ∫—µ‘‡Àµÿ®“°

√∂¬πµå√âÕ¬≈– 13.2 (√Ÿª∑’Ë 4)

ºŸâªÉ«¬∑—ÈßÀ¡¥ 1,075 √“¬‰¥â√—∫°“√√—°…“¥â«¬«‘∏’

open reduction and internal fixation (ORIF) ¥â«¬

«‘∏’µà“ß Ê ¡“°∑’Ë ÿ¥ 592 √“¬ (55.1%), ‰¥â√—∫°“√

√—°…“‚¥¬«‘∏’ closed reduction √âÕ¬≈– 41.3 ªØ‘‡ ∏

°“√√—°…“√âÕ¬≈– 1.1 ·≈– àß‰ª√—°…“∑’ËÕ◊ËπµàÕ√âÕ¬≈– 0.8

®”·π°°“√√—°…“‚¥¬„™â open reduction ‰¥â¥—ßπ’È „™â

°“√¬÷¥¥â«¬≈«¥¡“°∑’Ë ÿ¥ 332 √“¬ (30.9), „™â miniplate 176 √“¬ (16.4%), „™â AO plate 38 √“¬ (3.5%) ·≈–

Õ◊Ëπ Ê (µ“√“ß∑’Ë 2)

¿“«–·∑√°´âÕπÀ≈—ß°“√√—°…“ æ∫«à“ ¡’Õ“°“√

µ‘¥‡™◊ÈÕÀ≈—ßºà“µ—¥ √âÕ¬≈– 1.9 °“√ ∫øíπ‰¡à¥’√âÕ¬≈– 0.7 (µ“√“ß∑’Ë 3) Õ“°“√™“√âÕ¬≈– 0.2 ·≈– °“√‰¡à‡™◊ËÕ¡

°—π¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“ §◊Õ √âÕ¬≈– 0.2 ºŸâªÉ«¬∑’Ëæ—°√—°…“„π‚√ßæ¬“∫“≈Õ¬Ÿà‡ªìπ‡«≈“ 8-14

«—π¡’®”π«π¡“°∑’Ë ÿ¥§‘¥‡ªìπ√âÕ¬≈– 34.1 √Õß≈ß¡“‡ªìπ

‡«≈“ 1-7 «—π√âÕ¬≈– 32.2 ‡ªìπ‡«≈“ 15-21 «—π√âÕ¬≈–

14.5 ·≈–¡“°°«à“ 21 «—π √âÕ¬≈– 7.3 ®”π«πºŸâªÉ«¬∑’Ë

‰¡à ‰¥âπÕπæ—°√—°…“„π‚√ßæ¬“∫“≈À√◊ÕºŸâªÉ«¬πÕ°§‘¥

‡ªìπ√âÕ¬≈– 11.6

µ“√“ß∑’Ë 1 “‡Àµÿ¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“·µ°À—°

“‡Àµÿ ®”π«π √âÕ¬≈–

Õÿ∫—µ‘‡Àµÿ®“°√∂®—°√¬“π¬πµå 698 64.9

Õÿ∫—µ‘‡Àµÿ®“°√∂¬πµå 109 10.1

®“°°“√∂Ÿ°∑”√â“¬√à“ß°“¬ 108 10.1

Õ◊Ëπ Ê ‰¥â·°à ®“°√∂®—°√¬“π ®“°°“√‡≈àπ°’Ã“ 160 14.9

√«¡ 1,075 100

√Ÿª∑’Ë 3 µ”·Àπàß°“√À—°„π à«πµà“ß Ê ¢Õß°√–¥Ÿ°¢“°√√‰°√≈à“ß

√Ÿª∑’Ë 2 °“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√ ·≈–„∫Àπâ“

à«π¢Õß°√–¥Ÿ°∑’ËÀ—°

¢“°√√‰°√≈à“ß ‚Àπ°·°â¡ LcFortI,II,III °√–¥Ÿ°®¡Ÿ°·≈–ethmoid °√–¥Ÿ°‡∫â“øíπ

(53.10%) 988

(20%)

373 (15.60%)

292 (6.10%)

113

(5.10%) 94 1,200

1,000 800 600 400 200 0

(4)

«‘®“√≥å

°“√»÷°…“ºŸâªÉ«¬°√–¥Ÿ°¢“°√√‰°√ ·≈–„∫Àπâ“À—°

®”π«π 1,075 √“¬ æ∫«à“ à«π¡“°‡ªìπ‡æ»™“¬∑’ËÕ¬Ÿà„π

°≈ÿà¡«—¬√ÿàπ·≈–«—¬‡√‘Ë¡∑”ß“π Õ“¬ÿ√–À«à“ß 20-29 ªï ´÷Ëß

®–§≈â“¬°—∫√“¬ß“πÕ◊Ëπ„πª√–‡∑»‰∑¬^(1,2) ·≈–ª√–‡∑»

Õ◊Ëπ Ê^(3-9) “‡Àµÿ à«π¡“°‡°‘¥®“°Õÿ∫—µ‘‡Àµÿ®“°√∂

®—°√¬“π¬πµå „π™à«ß«—¬π’È‡ªìπ«—¬‡√’¬π„°≈â®∫°“√»÷°…“

·≈–«—¬‡√‘Ë¡µâπ∑”ß“π ¬—ß§÷°§–πÕßÕ¬Ÿà¡“° ª√–°Õ∫°—∫

‡æ‘Ëß‡√‘Ë¡‡¢â“ Ÿà —ß§¡ Õ“® —ß √√§å·≈–¥◊Ë¡ ÿ√“∫àÕ¬¢÷Èπ ·≈–

„™â√∂®—°√¬“π¬πµå„π°“√‡¥‘π∑“ß ‡æ√“– –¥«°√«¥‡√Á«

ª√–°Õ∫°—∫„π™à«ß‡«≈“¥—ß°≈à“«¬—ß‰¡à¡’°“√∫—ß§—∫„™â À¡«°π‘√¿—¬ ∑”„Àâ‡°‘¥Õÿ∫—µ‘‡Àµÿ∑’Ë„∫Àπâ“‰¥â¡“° ·µà°“√

»÷°…“¢Õß∏’√æß»å π§‘π∑√å∫¥’⁽¹⁰⁾ ‚√ßæ¬“∫“≈°—π∑√≈—°…≥å

®—ßÀ«—¥»√’ –‡°… ‰¡àæ∫§«“¡·µ°µà“ßÕ¬à“ß¡’π—¬ ”§—≠

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À¡«°π‘√¿—¬„π‡√◊ËÕß °√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“∑’Ë

·µ°À—° ·µàæ∫«à“ ·µ°µà“ßÕ¬à“ß¡’π—¬ ”§—≠„π¿“«–

¡Õß°√–∑∫°√–‡∑◊Õπ ‡¡◊ËÕ»÷°…“ “‡Àµÿæ∫«à“¡’∑—Èß

‡À¡◊Õπ·≈–·µ°µà“ß®“°√“¬ß“π¢ÕßºŸâÕ◊Ëπ^(3,5,11) (µ“√“ß∑’Ë 4)

° “ √ À— ° ¢ Õ ß ° √ – ¥Ÿ ° ¢ “ ° √ √ ‰ ° √ · ≈ – „ ∫ À πâ “ „ π

µ“√“ß∑’Ë 2 °“√√—°…“°√–¥Ÿ°¢“°√√‰°√ ·≈–„∫Àπâ“·µ°À—°¥â«¬

«‘∏’µà“ß Ê

°“√√—°…“ ®”π«π √âÕ¬≈–

Closed reduction 444 41.3

Open reduction with wire 332 30.9

ORIF with AO plate 38 3.5

ORIF with miniplate 176 16.4

ORIF with AO plate and wire 17 1.6

ORIF with miniplate and wire 26 2.4 ORIF with AO, miniplate and wire 3 0.3

Observe 18 1.7

ªØ‘‡ ∏°“√√—°…“ 12 1.1

Refer µàÕ 9 0.8

√«¡ 1,075 100

µ“√“ß∑’Ë 3 ¿“«–·∑√°´âÕπÀ≈—ß°“√ºà“µ—¥

¿“«–·∑√°´âÕπ ®”π«π √âÕ¬≈–

°“√µ‘¥‡™◊ÈÕ 20 1.9

°“√‰¡à‡™◊ËÕ¡°—π¢Õß°√–¥Ÿ° 2 0.2

¢“°√√‰°√·≈–„∫Àπâ“

Õ“°“√™“ 2 0.2

°“√ ∫øíπ‰¡à¥’ 8 0.7

Õ◊Ëπ Ê 12 1.1

‰¡à¡’ 1,031 95.9

√«¡ 1,075 100

√Ÿª∑’Ë 4 “‡Àµÿ·≈–°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√≈à“ß·≈–°√–¥Ÿ°„∫Àπâ“ à«π°≈“ß

700 600 500 400 300 200 100 0

(9.2%) 91 (6.8%)

53 (64%)

628 (73.3%) 571

(9.8%) 96

(13.2%) 103

(16.8%) 165

(6.5%) 51

“‡Àµÿ¢Õß°√–¥Ÿ°À—°

Õÿ∫—µ‘‡Àµÿ®—°√¬“π¬πµå Õÿ∫—µ‘‡Àµÿ√∂¬πµå ∂Ÿ°∑”√â“¬√à“ß°“¬ Õ◊Ëπ Ê

¢“°√√‰°√≈à“ßÀ—°

°√–¥Ÿ°„∫Àπâ“ à«π°≈“ßÀ—°

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270

ª√–‡∑»Õ—ß°ƒ…^(11,12) ¡’ “‡Àµÿ‡°‘¥®“°°“√∂Ÿ°∑”√â“¬

√à“ß°“¬¡“° ÿ¥ √Õß≈ß¡“‡ªìπÕÿ∫—µ‘‡Àµÿ∫π∑âÕß∂ππ

‡π◊ËÕß®“°µ—Èß·µà æ.». 2526 „πª√–‡∑»Õ—ß°ƒ…‰¥â‡√‘Ë¡„™â

°ÆÀ¡“¬∫—ß§—∫„™â‡¢Á¡¢—¥π‘√¿—¬·≈–°“√§«∫§ÿ¡°“√¥◊Ë¡

·Õ≈°ÕŒÕ≈å„ π ºŸâ „™â‡§√◊ËÕß¢—∫¢’Ë ∑”„Àâ®”π«πºŸâªÉ«¬

°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“·µ°À—°≈¥≈ßÕ¬à“ß¡’π—¬

”§—≠

≈—°…≥–¢Õß°√–¥Ÿ°¢“°√√‰°√∑’ËÀ—°„π 1,860 µ”·Àπàßæ∫°√–¥Ÿ°¢“°√√‰°√≈à“ßÀ—°¡“°∑’Ë ÿ¥∂÷ß 988 µ”·Àπàß (53.1%) √Õß≈ß¡“‡ªìπ°√–¥Ÿ°‚Àπ°·°â¡ 373 µ”·Àπàß (20%) ‡™àπ‡¥’¬«°—∫√“¬ß“πº≈°“√»÷°…“¢Õß K. Balakrishnan ®“°ª√–‡∑»Õ‘π‡¥’¬⁽³⁾ ·≈– Taher⁽⁴⁾

®“°ª√–‡∑»§Ÿ‡«µ ´÷Ëßæ∫¢“°√√‰°√≈à“ß à«πÀπâ“À—°

(symphysis) ¡“°∑’Ë ÿ¥ §◊Õ√âÕ¬≈– 46.5 „°≈â‡§’¬ß

°—∫√“¬ß“π¢Õß ‰æ»“≈ °—ß«≈°‘®·≈–‡æ’¬√™—¬ ‡∏’¬√‚™µ‘

®“°®—ßÀ«—¥™≈∫ÿ√’⁽¹⁾ √«¡∑—Èß ¡√ ∫ÿ≥‡°…¡ ·≈–«‘®‘µ√

∏√“ππ∑å ®“°®—ßÀ«—¥¢Õπ·°àπ⁽²⁾ ·µàµà“ß®“°√“¬ß“π¢Õß ª√–‡∑»Õ‘π‡¥’¬^{( 3)} ´÷Ëßæ∫«à“À—°∫√‘‡«≥ body ¡“° ÿ¥

√âÕ¬≈– 30.2 ·≈–√“¬ß“π®“°ª√–‡∑» «’‡¥π⁽¹³⁾ æ∫«à“

À—°∫√‘‡«≥À—«¢âÕµàÕ¢“°√√‰°√≈à“ß (mandibular condyle) Ÿß ÿ¥√âÕ¬≈– 43 ¥—ß√Ÿª∑’Ë 5 ´÷ËßºŸâ»÷°…“ —ππ‘…∞“π «à“

Õÿ∫—µ‘‡Àµÿ à«π¡“°‡°‘¥®“°√∂®—°√¬“π¬πµå ‡ ’¬À≈—°æ≈‘°

§«Ë”∑”„Àâ„∫Àπâ“ à«π∑’Ë¬◊Ëπ°«à“ à«πÕ◊Ëπ Ê §◊Õ§“ß·≈–

‚Àπ°·°â¡°√–·∑°æ◊Èπ À“°§“ß°√–·∑°°—∫æ◊Èπ®–∑”„Àâ

¢Õß°√–¥Ÿ°¢“°√√‰°√≈à“ß à«πÀπâ“À—° ·µà∂â“‡Õ“¥â“π

¢â“ß¢ÕßÀπâ“≈ß °√–¥Ÿ°‚Àπ°·°â¡ (zygomatic bone)

°Á®–À—°

µ“√“ß∑’Ë 4 ‡ª√’¬∫‡∑’¬∫ “‡Àµÿ°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–

„∫Àπâ“ √–À«à“ß°“√»÷°…“π’È°—∫°“√»÷°…“Õ◊Ëπ

Õÿ∫—µ‘‡Àµÿ∫π ∂Ÿ°∑”√â“¬ ªï∑’Ë

∑âÕß∂ππ (%) (%) æ‘¡æå

√–∫ÿ√’ 75 10.1 2551

µ√’·«π¥√—¡ (Õ‘π‡¥’¬)⁽³⁾ 40.3 24.6 2529

°√’´⁽⁵⁾ 57 9 2533

Õ—ß°ƒ…^(11,12) 17.3 50.1 2534

√Ÿª∑’Ë 5 ‡ª√’¬∫‡∑’¬∫°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√≈à“ß„πµ”·Àπàßµà“ß Ê

(6)

à«π°“√À—°¢Õß°√–¥Ÿ°„∫Àπâ“ à«π°≈“ßæ∫«à“¡’

°√–¥Ÿ°‚Àπ°·°â¡¡“°∑’Ë ÿ¥√âÕ¬≈– 47.9 √Õß≈ß¡“

‡ªìπ°“√À—°·∫∫‡≈ÕøÕ√åµ II √âÕ¬≈– 26.9, °“√À—°·∫∫

‡≈ÕøÕ√åµ II ·≈– °“√À—°·∫∫‡≈ÕøÕ√åµ III ¡—°æ∫„π Õÿ∫—µ‘‡Àµÿ∑’Ë¡’°“√∫“¥‡®Á∫Õ¬à“ß√ÿπ·√ß (severe injury) ´÷Ëß

¡—°¡’°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√ à«πÕ◊Ëπ√à«¡¥â«¬

Mark⁽¹⁴⁾ °≈à“««à“°“√À—°¢Õß°√–¥Ÿ°„∫Àπâ“ à«π°≈“ß

¡—°‡ªìπº≈®“°·√ß°√–·∑°∑’Ë√ÿπ·√ß·≈–¡’§«“¡‡√Á« Ÿß

·≈–„πÕÿ∫—µ‘‡Àµÿ®“°√∂¬πµåæ∫«à“ºŸâ¢—∫¢’Ë¡—°‡Õ“„∫Àπâ“

à«π°≈“ß°√–·∑°°—∫æ«ß¡“≈—¬⁽¹⁵⁾

°“√√—°…“°“√À—°¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“

„π™à«ß 20 ªï ∑’Ëºà“π¡“¡’°“√‡ª≈’Ë¬π·ª≈ß¡“‡ªìπ≈”¥—∫

‚¥¬π” internal rigid fixation ¡“„™â ‡™àπ dynamic compression plate À√◊Õ AO plate ´÷Ëß¡’¢π“¥„À≠à ·≈–

°“√¥—¥·ºàπ‡À≈Á°¥“¡ (plate) „Àâ·π∫°—∫°√–¥Ÿ°¢“

°√√‰°√∑’Ë¡’ à«π‚§âß·≈– à«π‡«â“∑”‰¥â§àÕπ¢â“ß≈”∫“° µàÕ

¡“®÷ß„™â miniplate ´÷Ëß∫“ß°«à“·≈–‡ªìπ monocortical screw ∑”„Àâ “¡“√∂‡¢â“∑”ºà“µ—¥„π™àÕßª“°‰¥â –¥«°

¿“¬À≈—ß°“√ºà“µ—¥ºŸâªÉ«¬ “¡“√∂Õâ“ª“°·≈–‡§’È¬«Õ“À“√

‰¥â‡√Á«°«à“‡¥‘¡ ‚¥¬‰¡àµâÕß¡—¥øíπ‡æ◊ËÕ¬÷¥¢“°√√‰°√∫π≈à“ß (maxillomandibular fixation or MMF) ‰«âπ“π 4-6 —ª¥“Àå ®÷ß¡’ºŸâπ”¡“„™âÕ¬à“ß·æ√àÀ≈“¬¡“°¢÷Èπ

°“√»÷°…“«‘®—¬π’Èæ∫«à“‰¥â√—°…“ºŸâªÉ«¬∑—ÈßÀ¡¥ 1,075

√“¬‚¥¬∑” open reduction √âÕ¬≈– 54.9 °“√ºà“µ—¥

¬÷¥°√–¥Ÿ°‚¥¬„™â≈«¥√âÕ¬≈– 30.8 °“√ºà“µ—¥„™â·ºàπ

‡À≈Á°¥“¡„π°“√¬÷¥°√–¥Ÿ°∑ÿ°™π‘¥√«¡°—π (AO plate and miniplate) √âÕ¬≈– 24.1 ‚¥¬®–·µ°µà“ß®“°‰æ»“≈ °—ß«≈

°‘®·≈–‡æ’¬√™—¬ ‡∏’¬√‚™µ‘⁽¹⁾ ´÷Ëß„Àâ°“√√—°…“‚¥¬°“√∑”

closed reduction ¡“°°«à“§◊Õ √âÕ¬≈– 63.3 ‚¥¬‰æ»“≈

°—ß«≈°‘® ·≈–‡æ’¬√™—¬ ‡∏’¬√‚™µ‘⁽¹⁾ ‰¥â„ à plate ‡æ◊ËÕ

√—°…“°√–¥Ÿ°¢“°√√‰°√≈à“ßÀ—° ‡æ’¬ß√âÕ¬≈– 19.9 º≈

°“√»÷°…“„πª√–‡∑»Õ‘π‡¥’¬⁽³⁾ „π™à«ßªï 2525-2526 æ∫

«à“°“√∑” closed reduction ‡æ◊ËÕ√—°…“°√–¥Ÿ°¢“°√√‰°√

≈à“ßÀ—°¡’®”π«π√âÕ¬≈– 89 ·≈–‡æ◊ËÕ√—°…“°√–¥Ÿ°¢“

°√√‰°√∫πÀ—°¡’®”π«π√âÕ¬≈– 96.8 à«π Kahnberg

KE⁽¹⁶⁾ ‰¥â√—°…“‚¥¬∑” closed reduction „π°“√À—°

·∫∫‡≈ÕøÕ√åµ√âÕ¬≈– 57 ·≈– open reduction ‡æ’¬ß

√âÕ¬≈– 19 à«π Zachariades⁽⁵⁾ ‰¥â»÷°…“„π™à«ß‡«≈“

25 ªïæ∫«à“√—°…“‚¥¬„™â closed reduction √âÕ¬≈– 56

·≈– open reduction √âÕ¬≈– 37

Zachariades⁽¹⁷⁾ ‰¥â»÷°…“ºŸâªÉ«¬„πªï 2528-2533 æ∫«à“∑” ORIF with wire πâÕ¬≈ß·µà„ à plate ¡“°¢÷Èπ Mark⁽¹⁴⁾ °≈à“««à“ªí®®ÿ∫—π·æ∑¬åºŸâºà“µ—¥∫“ß∑à“ππ‘¬¡„™â open reduction with plate ‡ªìπª√°µ‘„π°“√√—°…“

°“√°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“·µ°À—° „π°“√»÷°…“

π’È ‰¥â∑” open reduction ‚¥¬„™â∑—Èß·ºàπ‡À≈Á°¥“¡·≈–

≈«¥ À√◊Õ„™â∑—Èß 2 ™π‘¥√à«¡°—π ∑—Èßπ’È‡ÀÁπ«à“°“√√—°…“

°√–¥Ÿ°¢“°√√‰°√≈à“ßÀ—°‚¥¬°“√∑” closed reduction

¥â«¬°“√¡—¥øíπ‡æ◊ËÕ¬÷¥¢“°√√‰°√∫π≈à“ß‰«âµâÕß∑” MMF

‰«âπ“π 6 —ª¥“Àå ®–∑”„ÀâºŸâªÉ«¬‰¡à “¡“√∂Õâ“ª“°‰¥â

ORIF with plate ∑”„ÀâºŸâªÉ«¬Õâ“ª“°‰¥â “¡“√∂°‘π Õ“À“√µ“¡ª√°µ‘ ·≈–°≈—∫§◊π Ÿà ¿“æª√°µ‘‰¥â„π‡√Á««—π

·µà°“√√—°…“°“√À—°¢Õß°√–¥Ÿ°¥â“π¢â“ß¢Õß„∫Àπâ“ à«π

°≈“ß ‡™àπ °“√À—°¢Õß°√–¥Ÿ°‚Àπ°·°â¡„π∫“ß°√≥’°“√

„™â≈«¥°Á “¡“√∂®—¥°√–¥Ÿ°„Àâ‡¢â“∑’Ë‰¥â¥’ Zachariades⁽¹⁷⁾

‡ÀÁπ«à“°“√„™â≈«¥°Á¡’§«“¡·¢Áß·√ß‡æ’¬ßæÕ∑’Ë®–¬÷¥

°√–¥Ÿ°‚Àπ°·°â¡‰«â ‰¥â¥’‚¥¬¡‘µâÕß„™â plate ‡π◊ËÕß®“°

‡ªìπ∫√‘‡«≥∑’Ë‰¡à‰¥â√—∫·√ß à«π°“√À—°·∫∫‡≈ÕøÕ√åµ Õ“®

æ∫«à“¡’≈—°…≥–‡ªìπ comminuted fracture ´÷Ëß∑”„Àâ

°“√„ à plate ∑”‰¥â¬“°≈”∫“° µâÕß‡ªî¥·º≈ºà“µ—¥°«â“ß

¡“°·≈–Õ“®∑”„Àâ‡°‘¥°“√µ“¬¢Õß°√–¥Ÿ°‰¥âßà“¬ ¥—ßπ—Èπ

°“√∑” closed reduction with suspension πà“®–

‡æ’¬ßæÕ ‡π◊ËÕß®“°°“√À—°·∫∫‡≈ÕøÕ√åµ®–√—°…“‚¥¬∑”

MMF ‰«â‡æ’¬ß 3-4 —ª¥“Àå à«π°“√À—°¢Õß°√–¥Ÿ°¢“

°√√‰°√·≈–„∫Àπâ“™π‘¥´—∫´âÕπ °“√√—°…“‚¥¬ ORIF with plate ®–®—¥‚§√ß√à“ß¢Õß„∫Àπâ“„Àâ§ß√Ÿª‰¥â¥’°«à“ ·µà

∑—È ß π’È ‰¡à§«√„™â plate „πºŸâªÉ«¬‡¥Á°‡π◊ËÕß®“°Õ“®∑”

Õ—πµ√“¬µàÕÀπàÕøíπ·∑â¢ÕßºŸâªÉ«¬‰¥â ¥—ßπ—Èπ°“√‡≈◊Õ°«‘∏’

√—°…“·∫∫„¥®÷ß¢÷Èπ°—∫≈—°…≥–°“√À—°¢Õß°√–¥Ÿ°√à«¡

(7)

272

¥â«¬°—∫Õß§åª√–°Õ∫Õ◊Ëπ Ê

¿“«–·∑√°´âÕπ¿“¬À≈—ß°“√ºà“µ—¥æ∫«à“¡’°“√µ‘¥

‡™◊ÈÕ√âÕ¬≈– 1.9 °“√‰¡à‡™◊ËÕ¡°—π¢Õß°√–¥Ÿ°¢“°√√‰°√

·≈–„∫Àπâ“ (malunion ·≈– non-union) √âÕ¬≈– 0.2

‚¥¬æ∫„πºŸâªÉ«¬∑’Ë∂Ÿ°¬‘ß Zachariades⁽¹⁷⁾ æ∫«à“„π°“√∑”

rigid fixation ¡’°“√µ‘¥‡™◊ÈÕÀ≈—ßºà“µ—¥√âÕ¬≈– 3.8 ¢Õß µ”·Àπàß∑’ËÀ—°‚¥¬æ∫„π°“√À—°¢Õß¢“°√√‰°√≈à“ß√âÕ¬≈–

6.1 ¡’°“√‰¡à‡™◊ËÕ¡°—π¢Õß°√–¥Ÿ°¢“°√√‰°√·≈–„∫Àπâ“

(delayed union ·≈– malunion) √«¡°—π √âÕ¬≈– 5.6

·≈–æ∫¿“«–·∑√°´âÕπÀ≈—ßºà“µ—¥®“°°“√„™â ORIF with wire Ÿß°«à“‚¥¬µ‘¥‡™◊ÈÕ∂÷ß√âÕ¬≈– 9.4

°“√√—°…“°√–¥Ÿ°¢“°√√‰°√ ·≈–„∫Àπâ“·µ°À—°

æ—≤π“‰ªÕ¬à“ß√«¥‡√Á«·≈–„™â‡∑§‚π‚≈¬’∑’Ë Ÿß¢÷Èπ ‡™àπ °“√

„™â titanium plate À√◊Õ miniplate ·≈– °√Ÿ´÷Ëß¡’

§ÿ≥ ¡∫—µ‘‡ªìπosteointregration °“√®–‡≈◊Õ°„™â°“√

√—°…“„¥ Ê §«√§”π÷ß∂÷ßªí®®—¬·«¥≈âÕ¡·≈–Õß§åª√–°Õ∫

À≈“¬ª√–°“√ °“√«‘®—¬π’ÈÕ“®™à«¬„Àâ¢âÕ¡Ÿ≈∑’Ë„™â‡ªìπ

·π«∑“ß„π°“√‡µ√’¬¡§«“¡æ√âÕ¡¢Õß∫ÿ§≈“°√∑“ß°“√

·æ∑¬å ∑’Ë®–„Àâ°“√√—°…“ºŸâªÉ«¬‡À≈à“π’ÈÕ¬à“ß¡’ª√– ‘∑∏‘¿“æ

‡æ◊ËÕ„ÀâºŸâªÉ«¬ “¡“√∂Õâ“ª“°·≈–‡§’È¬«Õ“À“√‰¥â‡™àπ‡¥‘¡

‚¥¬¬—ß§ß√—°…“‚§√ß √â“ß¢Õß„∫Àπâ“„Àâ‡À¡◊Õπ‡¥‘¡„Àâ

¡“°∑’Ë ÿ¥‡∑à“∑’Ë®–∑”‰¥â ®“°°“√»÷°…“§√—Èßπ’Èæ∫«à“„π À≈“¬ Ê °√≥’°“√∑” closed reduction °Á¬—ß‡ªìπ«‘∏’

√—°…“∑’Ë „Àâº≈¥’·≈–‰¡à¬ÿàß¬“° „πºŸâªÉ«¬∫“ß√“¬´÷Ëß

°√–¥Ÿ°À—°À≈“¬µ”·Àπàß‰¥â√—°…“‚¥¬„™â∑—Èß plate ·≈–

wire µ“¡§«“¡®”‡ªìπ ‡π◊ËÕß®“°·ºàπ‚≈À–¡’√“§“·æß

∂â“ “¡“√∂¬÷¥°√–¥Ÿ°¥â«¬≈«¥‰¥âº≈¥’‡™àπ‡¥’¬«°—∫ ·ºàπ

‚≈À– °Á®–æ‘®“√≥“„™â≈«¥°àÕπ Õ¬à“ß‰√°Áµ“¡°“√√—°…“

¢÷Èπ°—∫°“√µ—¥ ‘π„® ·≈–ª√– ∫°“√≥å¢ÕßºŸâ√—°…“¥â«¬

·¡â‡∑§‚π‚≈¬’®–æ—≤π“‰ªÕ¬à“ß‰¡àÀ¬ÿ¥¬—Èß ºŸâ√—°…“°Á§«√

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10. ∏’√æß»å π§‘π∑√å∫¥’, ÿ∑’ «ß§å≈–§√. °“√»÷°…“°“√∫“¥‡®Á∫„π ºŸâªÉ«¬Õÿ∫—µ‘‡Àµÿ√∂®—°√¬“π¬πµå∑’Ë «¡·≈–‰¡à «¡À¡«°π‘√¿—¬

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(8)

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Abstract Maxillo-facial Fracture in Saraburi Hospital Mallika Satitniramai

Dental Department, Pranangklao Hospital, Nonthaburi Journal of Health Science 2008; 17:266-73.

The purpose of this retrospective study was to determine the fracture of the mandible and facial bone. The study was based on the records of 1,075 cases who were treated at the Dental Depart- ment, Saraburi hospital between May 1983 and December 1996. The study group was 86 percent male and 44.8 percent of the patients were 20-29 years old. The majority of the patients (64.9%) were in motorcycle accidents and 14.9 percent were in sports accidents 10.1 percent. There were 1,860 facial bone fractures in this study and 53.1 percent affected in the mandible and 20 percent zygoma. Of the total number of mandibular fracture 46.5 percent were at the symphysis. Regarding mandibular fractures, 64 percent of them were caused by motorcycle accidents and 16.8 percent by assaults. Whereas 73.3 percent of the fractures of the middle face were caused by motorcycle accidents and 13.2 percent by car accidents. From the beginning more than half (55.1%) of all the cases were treated by using open reduction,open reduction with wire 30.9 percent and open reduction with miniplate 16.4 percent. The majority of the cases (34.1%) stayed at the hospital for 8-14 days.

Key words: maxillofacial injury, maxillo - facial trauma, retrospective study

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