通过总结临床病例，探讨烧烫伤患者在合并颌面部骨折的情况下如何合理选择骨折复位时机。

选取解放军总医院第一附属医院烧伤整形科2003年6月至2016年8月收治的烧烫伤患者合并颌面部骨折病例，符合纳入标准的共48例，其中男32例，女16例，年龄17～45岁，平均(35±12)岁。下颌骨骨折36例60处，上颌骨骨折12例20处。烧伤面积34%～76%总体表面积(TBSA)。两组患者均进行烧伤治疗和颌面部骨折治疗。根据患者骨折复位手术时间分组：治疗组：休克期后感染期前(伤后1～3 d)手术；对照组：休克期后(伤后4～6 d)手术。对比两组患者术后切口感染率、内固定感染率和平均住院时间。对观察指标采用SPSS 16.0统计软件进行分析。组间比较采用t检验，χ²检验或Fisher确切概率法检验。

治疗组患者术后切口感染率7.69%、内固定感染率0、平均住院时间(30±3) d，分别低于对照组的术后切口感染率36.36%、内固定感染率18.18%、平均住院时间(47±4) d，差异均具有统计学意义(χ²＝3.430、1.976, t＝7.949, P值均小于0.05)。

烧烫伤患者合并颌面部骨折，在休克期之后感染期之前(伤后1～3 d)行切开复位内固定术，既可以降低颌面部手术感染的发生率，又能早期实现经口进食，为患者提供良好营养支持，更好促进烧伤创面愈合。

To discuss how to choose the optimal timing of the fracture in the burn patients with maxillofacial fracture through summarizing the clinical cases.

There were 48 patients of burn and scald with maxillofacial fracture from June 2003 to August 2016 in the first affiliateed hospital of PLA general hospital. Male was 32, female was 16. Age was from 17-45 years old, average age was 35±12 years old. Thirsty six patients had 60 fractures of the mandible, 12 patients had 20 fractures of the maxilla. Burn area was from 34%-76% total body surface area (TBSA). Two groups of patients were treated with burns therapy and maxillaris and facial theray. On the basis of their reduction of fracture operation time, the patients were divided into two groups. The experimental group: an operation after the shock and before the infection time(after injury 1-3 days) . The control group: an operation after the shock time(after injury 4-6 days). The SPSS16.0 was used to analyse the observational index. The t test, Chi-square test and Fisher exact test were used to compare between the two groups.

The results showed that the rate of incision infection after surgery was 7.69%, built-in retainer infection was 0, and the time of hospitalization was (30±3) days in the experimental group are all lower than the control group, that was 36.36%, 18.18% and (47±4)days, there were statistical significance(χ²=3.430, 1.976, t=7.949, P values were less than 0.05).

The burn patients with maxillofacial fracture have reduction of fracture and built-in retainer surgery after the shock and before the infection time(after injury 1-3 days), not only reduce the rate of infection but also realize taking food by mouth in early time, which can provide nutrition support and set up benign relationship, to better promote burn wound healing.