摘要
目的回顾分析全面部陈旧性骨折所致面部畸形、功能障碍和影响疗效的多个因素，并提出全面部陈旧性骨折的临床分类。方法39例全面部陈旧性骨折患者，男性31例，女性8例；中位年龄33岁；机动车撞击伤为主要致伤原因；35例合并全身伤。伤后时间〉4周，术后复查均〉6个月。分析临床体征与骨折特点的关系，根据骨折复杂因素提出临床分类。回顾性分析治疗效果，总结关键技术，提出治疗原则。结果陈旧性骨折面部畸形率90％，其中46％存在面宽畸形，关节脱位-髁突骨折-颏（颏旁）骨折和颧弓骨折外移位是致面宽畸形的主要因素；张口受限率59％，颧骨-颧弓骨折和关节强直是致张口受限的主要原因，髁突矢状骨折伴外脱位是继发关节内强直的典型损伤类型；咬合紊乱率100％，髁突-关节＋颏-颏旁＋上颌矢状骨折可致最复杂的错猞。眼部症状率46％，鼻骨-眶-筛骨（nosal—orbital—ethmoid，NOE）骨折是主要损伤类型。全面部骨折可以分两型，Ⅰ型：颧骨复合体＋上颌骨＋下颌骨骨折；Ⅱ型：Ⅰ型＋NOE骨折。根据是否存在关节脱位-髁突骨折和颧弓骨折将全面部骨折分3个亚型，A型：不存在关节脱位-髁突骨折和颧弓骨折；B型：关节脱位-髁突骨折（Ba），颧弓骨折（Bb）；C型：关节脱位-髁突骨折和颧弓骨折同时存在。本组中，Ⅰ型占46％，Ⅱ型占54％；A亚型占41％，B亚型占41％，C亚型占18％。疗效“良”Ⅰ型24％、Ⅱ型62％，与Ⅱ型NOE骨折术后遗留鼻畸形和眼球内陷-复视有关；疗效“中”、“差”主要集中在C亚型，与软组织损伤严重度和关节强直有关。结论NOE骨折继发的鼻畸形和眼球内陷一复视、关节强直和（或）颧骨颧弓粉碎导致的张口受限、颧骨颧弓缺损或粉碎造成的面部塌陷和颌间瘢痕、髁突骨折-关节脱位＋颏（颏旁）骨折＋上颌矢状骨折产生的复杂错猞、软组织缺损-瘢痕挛缩继发的面部畸形和器官移位是决定全面部骨折复杂性和影响治疗效果的主要因素。
Objective To analyze the injury patterns in pan-facial fractures （PFF） which potentially lead to deficient treatment outcomes and then to propose a clinical classification. Methods Thirty-nine patients, 31 male and 8 female, with an average age of 33, treated from 1998 to 2007 in the Center of Maxillaofacial Trauma, Peking University School and Hospital of Stomatology, were included. Zygomatic complex, maxilla and mandible were involved in the extensive fracture concomitant with nosalorbital-ethmoid （NOE） fracture or not. All cases experienced a delay of over 4 weeks after injury. An analysis was made to display the relationship between facial architecture demolition and disfigurement and disability. Treatment results were assessed with facial appearance, opening range, occlusion and regional deformities. The associated injury patterns most frequently leading to deficient outcomes were summarized as references to scheme a clinical classification. Results Facial deformities presented in 90% of the patients and mostly related to condylar fracture/dislocation and zygomatic complex fracture. Limited mouth opening occurred in 59% of patients and were caused most frequently by displacement of zygomatic complex and joint ankylosis. Malocclusion was found in 100% of cases and there were the associated optical signs in 46%. Thirty-nine cases were divided into two types. Zygomatic, maxillary and mandibular fractures all together constituted type Ⅰ, which accounted for 46% of patients. Type Ⅰ plus NOE fracture was type Ⅱ , which accounted for 54% of patients. Furthermore, A, B and C sub-types were recognized in corresponding to involvement of condylar dislocation/fracture and zygomatic complex fracture. In treatment outcomes, a difference between type Ⅰ and type Ⅱ fractures remained with NOE fractures. The outcomes of term ＂moderate＂ and ＂worse＂ in subtype C group were attributed to severe soft tissue injuries and trauma-induced ankylosis. Conclusions NOE fracture, condylar fracture and dislocation, and zygomatic complex fracture were closely associated with deficient treatment outcomes. Correspondingly, an clinical classification was proposed for PFF.
出处
《中华口腔医学杂志》
CAS
CSCD
北大核心
2008年第4期231-235,共5页
Chinese Journal of Stomatology
关键词
骨折
骨折
连接错位
骨折
陈旧性
全面部骨折
Fractures
Fractures,malunited
Fractures,delayed
Pan-facial,fractures
