MODERN METHODS OF OSTEOSYNTHESIS IN MANDIBULAR FRACTURES: TOWARD STABLE, COMPLICATION‑SPARING FIXATION

Modern osteosynthesis for mandibular fractures has shifted from wire fixation and prolonged maxillomandibular fixation toward rigid and semi‑rigid internal fixation concepts that enable early function and lower complication rates. Contemporary strategies are grounded in AO load‑bearing and load‑sharing principles and include monocortical miniplates along Champy’s ideal osteosynthesis lines, locking plate–screw systems, three‑dimensional (3D) plates, lag screws, and bioresorbable plating systems. Evidence from comparative studies suggests that 3D plates and lag screws can reduce postoperative complications or operative time in selected fracture patterns, while locking plates improve stability in more demanding situations. Bioresorbable systems are increasingly used for linear, non‑displaced fractures, particularly where hardware removal is undesirable. This narrative review summarizes the biomechanical principles underlying modern mandibular osteosynthesis, describes key fixation systems, and discusses their indications, advantages, and limitations. A descriptive comparison of methods and an illustrative analysis of complication trends are provided to support evidence‑based selection of fixation strategies in clinical practice.下颌骨骨折（mandibular fractures）的现代骨接合术（osteosynthesis）已从钢丝固定（wire fixation）与长期颌间固定（maxillomandibular fixation），转向可实现早期功能锻炼、降低并发症发生率的刚性与半刚性内固定理念。当前主流治疗策略以AO承重与载荷分担原则（AO load‑bearing and load‑sharing principles）为依据，涵盖沿尚皮（Champy）理想骨接骨线（Champy’s ideal osteosynthesis lines）放置的单皮质微型接骨板（monocortical miniplates）、锁定接骨板-螺钉系统（locking plate–screw systems）、三维接骨板（three-dimensional (3D) plates）、拉力螺钉（lag screws）以及可吸收接骨板系统（bioresorbable plating systems）。对照研究（comparative studies）证据显示，针对特定骨折类型，三维接骨板与拉力螺钉可降低术后并发症（postoperative complications）发生率或缩短手术时长（operative time），而锁定接骨板则可在复杂病例中提升固定稳定性。可吸收接骨板系统正愈发广泛地应用于线性、无移位骨折的治疗，尤其适用于不适宜取出内固定物（hardware removal）的临床场景。本叙述性综述（narrative review）梳理了现代下颌骨骨接合术的生物力学原理（biomechanical principles），介绍了各类核心固定系统，并探讨了其适应证（indications）、优势与局限性（limitations）。本文还对各类固定方法开展描述性对比，并对并发症趋势（complication trends）进行实例分析，旨在为临床实践中基于证据选择固定策略提供支撑。