面骨骨折521例临床回顾性分析

贺佳妮， 胡 枫， 韩思源， 郭家妍， 李 怒， 冷 冰， 左 娜， 刘海燕

作者单位：110001 辽宁 沈阳，中国医科大学附属第一医院 整形外科

面骨骨折521例临床回顾性分析

贺佳妮， 胡 枫， 韩思源， 郭家妍， 李 怒， 冷 冰， 左 娜， 刘海燕

作者单位：110001 辽宁 沈阳，中国医科大学附属第一医院 整形外科

颌面部骨折； 面骨骨折； 坚固内固定

1 临床资料

本组患者共521例。男性409例，女性112例；年龄8～67岁，平均32岁。致伤原因：打伤62例，交通事故253例，坠落伤206例；骨折部位：上颌窦前壁460处，颧骨颧弓358处，眶壁238处，鼻骨117处，下颌骨84处，髁状突19处。合并其他骨折，如肋骨、四肢等219例，伴脑脊液漏56例，眼球破裂伤11例。

2 手术方法

2.1 术前准备 所有患者术前行颌面部三维CT重建检查明确诊断，确定骨折位置及移位方向和角度。治疗时机依据患者伤情而定，大部分患者于伤后1～2周进行手术，合并脑脊液漏的患者在停止脑脊液自耳鼻流出后10～14 d进行手术，对于合并颅脑或重要脏器损伤的患者待病情平稳后考虑手术。

2.3 手术过程 除11例髁状突高位骨折行颌垫辅助颌间牵引治疗外，其余各部位均经局部小切口(如口腔前庭、眶外缘、下睑缘、颧骨颧弓表面、耳屏前切口等)行面骨骨折切开复位坚固内固定术，术中仔细对比双侧颧骨突度，合并眶壁骨折且存在复视或眼球活动受限等症状时联合眼科行眶壁修补术。

3 结果

4 讨论

图1 手术切开复位坚固内固定治疗面骨骨折手术前后对比 a.术前 b.术后6个月 c.术前正位三维CT重建 d.术后6个月正位三维CT重建 e.术前侧位三维CT重建 f.术后6个月侧位三维CT重建

Fig 1 Comparison between preview and postview of facial fracture treated with open reduction and internal fixation. a. preview. b. postview at 6 months. c. frontal preview of three-dimensional reconstruction. d. frontal postview of three-dimensional reconstruction at 6 months.e. lateral preview of three-dimensional reconstruction. f. lateral postview of three-dimensional reconstruction at 6 months.

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Clinical retrospective analysis of facial fracture on 521 cases

HEJia-ni,HUFeng,HANSi-yuan,etal.

(DepartmentofPlasticSurgery,TheFirstAffiliatedHospitalofChinaMedicalUniversity,Shenyang110001,China)

Objective To summarize the clinical experience of causes of injury, prone position and rigid internal fixation method on patients of facial fracture. Methods Retrospective summary was performed on data from 521 cases of facial fracture patients, including the cause of injury, gender, age, prone position and treatment method.The major treatment method on fracture were open reduction and rigid fixation. Results In all patients, 11 patients with condylar fracture treated with jaw pad between auxiliary jaw traction treatment. Others treated with fractures open reduction and sturdy fixation through small incision, 12 patients with postoperative side zygomatic degree was lower than those of the contralateral slightly, others were stisfied with the results. Conclusion Facial bone fractures are more common in males, occurs in young adults, most are caused by traffic accidents and the prone position is maxillary sinus. Orbital fracture are often complicated with zygoma fracture. For condylar intracapsular fractures and fractures in children, the best treatment method is conservative treatment, and open reduction and internal fixation were used for the rest.

Maxillofacial fracture; Bone fracture; Rigid internal fixation

贺佳妮(1983-)，女，辽宁营口人，主治医师，硕士.

韩思源，110001，中国医科大学附属第一医院 整形外科，电子信箱：hansiyuan2013@163.com

10.3969/j.issn.1673-7040.2015.07.006

R782.2

A

1673-7040(2015)07-0400-03

2015-05-13)