140例面中份骨折的临床分析
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摘要
目的:1)探讨面中份骨折发生的流行病学特征和相关危险因素;2)评价面中份骨折术后疗效,揭示影响预后的危险因素,为面中份骨折的诊治提供客观依据。方法:1)搜集资料完整的140例面中份骨折住院患者,对其性别、年龄、职业、受伤原因、合并伤和骨折类型进行统计学分析;2)对120例手术患者分析其手术时间、临床治疗方法和预后情况;采用logistic回归分析影响预后的危险因素。结果:调查患者平均年龄为30.82±8.98岁;其中20～岁年龄组发病人数最多(56.43%);男性较多,占86.43%:伤者职业为从事体力劳动较多(60.71%):受伤原因以交通事故最多,占52.14%;42.86%的患者伴有全身合并伤,其中颅脑损伤位居第一,占36.27%;骨折类型以上颌骨最多(58.30%)。120例手术治疗中,77.50%的患者在2周内得到手术治疗;80.83%的面中份骨折患者获得痊愈;骨折分型、全身合并伤及延迟手术治疗,是患者预后危险因素。结论:面中份骨折患者以年轻男性多发;主要为从事体力劳动者;交通事故伤在致伤原因中居于首位;颅脑损伤是其最常见的合并伤;上颌骨骨折在面中份骨折中最常见:骨折分型、有无全身合并伤及患者能否早期行手术治疗,影响到患者的预后。
Objective:To discuss epidemiological character and relative risk factors of midfacial fractures and to appraise postoperative therapy of midfacial fractures,the report is intended to reveal the risk factors of prognosis of midfacial fractures,which can offer impersonality bases for diagnosing midfacial fractures.Methods:To collect completely data of 140 patients with midfacial fracture,the data were analyzed systemic statistically in regard of gender,age,profession,injury causes associated injuries and fracture pattern. Operation time,corresponding clinical treatment and prognosis were analyzed in 120 operated cases.The report is intended to reveal the risk factors of prognosis of midfacial fractures with logistic regression analysis.Results:The finding shows the average age was 30.82±8.98 ys and the propoulion of 20～ys was the topmost(56.43%).The males were most accounting to 86.43%.There was half more of the whole(60.71%) that were engaged in physical strength working.The leading cause of midfacial fractures was traffic accidents accounting to 52.14%.The associated systemic injuries patients was accounting to 42.86%,the incidence rate of brain damage was the topmost(36.27%) among them. Maxillary fractures were the topmost(58.30%) in the clinical classification of midfacial fractures.Of 120 cases,77.50%were cured in one week.Of the whole patients,80.83% were healed.The logistic regression analysis identified that associated systemic injuries,delayed operation and fracture pattern were prognostic dangerous factors. Conclusion:The patients of midfacial fractures were found in young males commonly. The cases were engaged in physical strength working mostly.The leading cause of midfacial fractures was traffic accidents.The incidence rate of brain damage was the topmost among them.Maxillary fractures were the topmost of midfacial fractures of clinical classification.Associated systemic injuries,delayed operation and fracture pattern were dangerous factors.
Objective:To discuss epidemiological character and relative risk factors of midfacial fractures and to appraise postoperative therapy of midfacial fractures,the report is intended to reveal the risk factors of prognosis of midfacial fractures,which can offer impersonality bases for diagnosing midfacial fractures.Methods:To collect completely data of 140 patients with midfacial fracture,the data were analyzed systemic statistically in regard of gender,age,profession,injury causes associated injuries and fracture pattern. Operation time,corresponding clinical treatment and prognosis were analyzed in 120 operated cases.The report is intended to reveal the risk factors of prognosis of midfacial fractures with logistic regression analysis.Results:The finding shows the average age was 30.82±8.98 ys and the propoulion of 20～ys was the topmost(56.43%).The males were most accounting to 86.43%.There was half more of the whole(60.71%) that were engaged in physical strength working.The leading cause of midfacial fractures was traffic accidents accounting to 52.14%.The associated systemic injuries patients was accounting to 42.86%,the incidence rate of brain damage was the topmost(36.27%) among them. Maxillary fractures were the topmost(58.30%) in the clinical classification of midfacial fractures.Of 120 cases,77.50%were cured in one week.Of the whole patients,80.83% were healed.The logistic regression analysis identified that associated systemic injuries,delayed operation and fracture pattern were prognostic dangerous factors. Conclusion:The patients of midfacial fractures were found in young males commonly. The cases were engaged in physical strength working mostly.The leading cause of midfacial fractures was traffic accidents.The incidence rate of brain damage was the topmost among them.Maxillary fractures were the topmost of midfacial fractures of clinical classification.Associated systemic injuries,delayed operation and fracture pattern were dangerous factors.
引文
1.张益,孙勇刚主编.颌骨坚固内固定[J].北京大学医学出版社,2003,247
2.周树夏,顾晓明.现代颌面创伤救治的基本原则.中华口腔医学杂志,2001,36(2):85-87
3.杨建,石应康,李宁,等.不同等级医院交通事故伤伤员分布特征与结局的比较研究[J].中华创伤杂志,1996,12(3):143-146.
4.Sastry SM,Sastry CM,Paul BK,Bain L,Champion HR.Leading cause of facial trauma in the major trauma outcome study[J].Plast Reconstr Surg,1995,95(1):196-197
5.Haug RH,Adams JM,Conforti PJ,Likavec MJ.Cranial fractures associated with facial fractures:a review of mechanism.Type and severity of injury.J Oral Maxillofac Surg,1994,52(7):729-733
6.Haegi M.A new deal for road crash victims[J].BMJ,2002,324:1110.
7.崔言森,高佃真,吴玉堂,等.面中部复合骨折治疗的临床分析[J].口腔颌面外科杂志,2003,13(2):178-179
8.张益,孙勇刚主编.颌骨坚固内固定[J].北京大学医学出版社,2003.312-314.
9.东耀峻,李祖兵,张壁,等.颧骨骨折手术复位和固定方法的探讨[J].口腔医学纵横,2000,16(2):83-85.
10.Wolfe SA,Lovaasm M,McCafferty LR.Use of a mini-plate to provide intermaxillary fixation in the edematous patien[J]t.Craniomaxillofac Surg,1989,17(1):31-33.
11.何冬梅.张益,张震康.颧骨复合体骨折的分类研究和治疗[J].中华口腔医字杂志,2004,39(3):211-213
12.孙庚林,齐杰,李克莉.231例面中部骨折的临床研究[J].中华创伤杂志,2002,18(11):674-676
13.邹立东,张益,何冬梅,等.1084例颌骨骨折的临床回顾性研究[J].中国口腔颌面外科杂志,2003,1(3):131-134
14.薄斌,顾晓明,周树夏.1693名颌面创伤患者临床病例回顾性研究[J].华西口腔医学杂志,1998,16(1):56-58
15.袁元杏,徐卓明,黄彦清,李敏.1288例外伤骨折住院病人流行病学特征[J].中华创伤杂志,2000,16(11):688
16.李运良,吴汉江,朱兆夫。颧骨复合体骨折140例临床分析.临床口腔医学杂志,2002,18(1):24-25
17.梁利荣.竺涵光,杨为江,等.眶颧复合体骨折112例临床分析[J].口腔医学, 2004.24(4):223-224
18.何黎升.葛成,顾晓明,等.1168例颌面部交通伤伤情分析[J].中华创伤杂志,2001,17(1):42-44
19.Kopits E,Cropper M.Global road traffic projections[J].2000-2020.Monograph.2002.
20.张益,顾晓明.我国口腔颌面创伤外科的现状与展望[J].中华口腔医学杂志,2001,36(2):88-90
21.Oji C.Maxillofacial injuries.Plast Surg Reconste.1996,(4):868 - 886
22.梁河清.林岩松,毕绍臣,等.交通事故致面中部骨折113例临床分析[J].第一军医大学学报,1994,14(1):71-72
23.Mackay M.Engineering in accidents:vehicle design and injuries[J].Injury,1994,25(9):615-621
24.史文进.颌面部创伤院内死亡病例分析[J].第三军医大学学报,1995,17(1):79-80
25.薄斌,顾晓明,周树夏,等.交通伤颌面骨折临床病例回顾性研究[J].口腔颌面外科杂志,1998,8(1):9-11
26.Haug RH,Adams JM,Conforti PJ,et al.Cranial fractures associated with facial fractures:a review of mechanism.Type and severity of injury[J].J Oral Maxillofac Surg,1994,52(7):729-733
27.Schultz RC.Facial injuries from automobile accidents:A study of 400 consecutive cases.Plast Reconstr Surg,1967,40(5):415
28.Salem JE,Lilly GE,Cutcher JL,Steiner M.An alysis of X23 mandibular fractures[J].Oral Surg Oral Med Oral Pathol,1968,26(3):390-395
29.Ellis E,Moos KF,El-Attar A.Ten years of mandibular fractures:An analysis of 2137cases[J].Oral Surg Oral Med Oral Pathol,1985,59(2):120-129
30.王文崔,王贤淑.临床颌骨外科学[M].北京:北京医科大学中国协和医科大学联合出版社,1994:179
31.Manson PN.Some thoughts on the classification and treatment of LeFort fractures.Ann Plast Surg,1986,17:3562363.
32.张益,顾晓明,蔡业军,等.对上颌骨骨折LeFort分类的改良补充方案[J].中华口腔医学杂志,2005,40(2):134-136
33.Knight JS,North JE The classification of malar fractures:an analysis of displacement as a guide to treatment[J].Br J Plast Surg,1961,13:325 - 339
34.Manson PN,Markowtz B,Mirvis S,et al.Toward CT based facial fracture treatment [J].Plast Reconstr Surg,1990,85(2):202-212
35.Zingg M,Laedrach K,Chen J,et al.J Raveh Classifi- cation and treatment of zygomatic fractures:a review of 1025 cases[J].Oral Maxillofac Surg,1992,50(8):778-790
36.Markowitz BL,Manson PN.Panfacial fracture Organization of treatment[J].Clin Plast Surg,1989,16(1):105-114
37.Gruss JS,MacKinnon SE.Complex maxillary fractures role of buttress reconstruction and immediate bone grafts[J].Plast Reconstr Surg,1986,78(1):9-22
38.田卫东,李声伟,潘剑,等.面中部骨折手术治疗及坚固内固定技术的应用[J].华西口腔医学杂志,1999,17(2):139
39.梁志刚,郑苍尚.眶-上颌骨-颧骨联合骨折86例临床报道[J].临床口腔医学杂志,2005,21(5):299
40.张益,孙勇刚.颌骨坚固内固定术[M].北京:北京大学医学出版社,2003:310
41.Gruss JS,Van Wyck L,Phillips JH,et al.The importance of the zygomatic arch in complex midfacial fracture repair and correction of post traumatic orbitzygomaic deformities[J].Plast Reconstr Surg,1990,85(6):878
42.张益.颌骨骨折治疗与研究的近代发展及国内现状[J].口腔颌面外科杂志,1999,9(3):155.
43.Morgan RF,Manson PN,Shack RB,et al.Management of nasoethmoid - orbital fractures[J].Ann Surg,1982,48:447 - 450.
44.Zide BM,McCarthy JG.The medial canthus revisited-an anatomical basis for canthopexy[J].Ann Plast Surg,1983,11:1 - 9.
45.刘宝林,顾晓明.口腔医学实用技术[M].口腔颌面外科学,第1版,沈阳:辽宁科学技术出版社,1999.178-181.
46.Robinson TJ,Stranc MF.The anatomy of the medial canthal ligament[J].Plast Surg,1970,23:1 - 7.
47.Stranc MF.Primary treatment of naso - ethmoid injuries with increased intercanthal distance[J].Br J Plast Surg,1970,23:8 - 25.
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2.周树夏,顾晓明.现代颌面创伤救治的基本原则.中华口腔医学杂志,2001,36(2):85-87
3.杨建,石应康,李宁,等.不同等级医院交通事故伤伤员分布特征与结局的比较研究[J].中华创伤杂志,1996,12(3):143-146.
4.Sastry SM,Sastry CM,Paul BK,Bain L,Champion HR.Leading cause of facial trauma in the major trauma outcome study[J].Plast Reconstr Surg,1995,95(1):196-197
5.Haug RH,Adams JM,Conforti PJ,Likavec MJ.Cranial fractures associated with facial fractures:a review of mechanism.Type and severity of injury.J Oral Maxillofac Surg,1994,52(7):729-733
6.Haegi M.A new deal for road crash victims[J].BMJ,2002,324:1110.
7.崔言森,高佃真,吴玉堂,等.面中部复合骨折治疗的临床分析[J].口腔颌面外科杂志,2003,13(2):178-179
8.张益,孙勇刚主编.颌骨坚固内固定[J].北京大学医学出版社,2003.312-314.
9.东耀峻,李祖兵,张壁,等.颧骨骨折手术复位和固定方法的探讨[J].口腔医学纵横,2000,16(2):83-85.
10.Wolfe SA,Lovaasm M,McCafferty LR.Use of a mini-plate to provide intermaxillary fixation in the edematous patien[J]t.Craniomaxillofac Surg,1989,17(1):31-33.
11.何冬梅.张益,张震康.颧骨复合体骨折的分类研究和治疗[J].中华口腔医字杂志,2004,39(3):211-213
12.孙庚林,齐杰,李克莉.231例面中部骨折的临床研究[J].中华创伤杂志,2002,18(11):674-676
13.邹立东,张益,何冬梅,等.1084例颌骨骨折的临床回顾性研究[J].中国口腔颌面外科杂志,2003,1(3):131-134
14.薄斌,顾晓明,周树夏.1693名颌面创伤患者临床病例回顾性研究[J].华西口腔医学杂志,1998,16(1):56-58
15.袁元杏,徐卓明,黄彦清,李敏.1288例外伤骨折住院病人流行病学特征[J].中华创伤杂志,2000,16(11):688
16.李运良,吴汉江,朱兆夫。颧骨复合体骨折140例临床分析.临床口腔医学杂志,2002,18(1):24-25
17.梁利荣.竺涵光,杨为江,等.眶颧复合体骨折112例临床分析[J].口腔医学, 2004.24(4):223-224
18.何黎升.葛成,顾晓明,等.1168例颌面部交通伤伤情分析[J].中华创伤杂志,2001,17(1):42-44
19.Kopits E,Cropper M.Global road traffic projections[J].2000-2020.Monograph.2002.
20.张益,顾晓明.我国口腔颌面创伤外科的现状与展望[J].中华口腔医学杂志,2001,36(2):88-90
21.Oji C.Maxillofacial injuries.Plast Surg Reconste.1996,(4):868 - 886
22.梁河清.林岩松,毕绍臣,等.交通事故致面中部骨折113例临床分析[J].第一军医大学学报,1994,14(1):71-72
23.Mackay M.Engineering in accidents:vehicle design and injuries[J].Injury,1994,25(9):615-621
24.史文进.颌面部创伤院内死亡病例分析[J].第三军医大学学报,1995,17(1):79-80
25.薄斌,顾晓明,周树夏,等.交通伤颌面骨折临床病例回顾性研究[J].口腔颌面外科杂志,1998,8(1):9-11
26.Haug RH,Adams JM,Conforti PJ,et al.Cranial fractures associated with facial fractures:a review of mechanism.Type and severity of injury[J].J Oral Maxillofac Surg,1994,52(7):729-733
27.Schultz RC.Facial injuries from automobile accidents:A study of 400 consecutive cases.Plast Reconstr Surg,1967,40(5):415
28.Salem JE,Lilly GE,Cutcher JL,Steiner M.An alysis of X23 mandibular fractures[J].Oral Surg Oral Med Oral Pathol,1968,26(3):390-395
29.Ellis E,Moos KF,El-Attar A.Ten years of mandibular fractures:An analysis of 2137cases[J].Oral Surg Oral Med Oral Pathol,1985,59(2):120-129
30.王文崔,王贤淑.临床颌骨外科学[M].北京:北京医科大学中国协和医科大学联合出版社,1994:179
31.Manson PN.Some thoughts on the classification and treatment of LeFort fractures.Ann Plast Surg,1986,17:3562363.
32.张益,顾晓明,蔡业军,等.对上颌骨骨折LeFort分类的改良补充方案[J].中华口腔医学杂志,2005,40(2):134-136
33.Knight JS,North JE The classification of malar fractures:an analysis of displacement as a guide to treatment[J].Br J Plast Surg,1961,13:325 - 339
34.Manson PN,Markowtz B,Mirvis S,et al.Toward CT based facial fracture treatment [J].Plast Reconstr Surg,1990,85(2):202-212
35.Zingg M,Laedrach K,Chen J,et al.J Raveh Classifi- cation and treatment of zygomatic fractures:a review of 1025 cases[J].Oral Maxillofac Surg,1992,50(8):778-790
36.Markowitz BL,Manson PN.Panfacial fracture Organization of treatment[J].Clin Plast Surg,1989,16(1):105-114
37.Gruss JS,MacKinnon SE.Complex maxillary fractures role of buttress reconstruction and immediate bone grafts[J].Plast Reconstr Surg,1986,78(1):9-22
38.田卫东,李声伟,潘剑,等.面中部骨折手术治疗及坚固内固定技术的应用[J].华西口腔医学杂志,1999,17(2):139
39.梁志刚,郑苍尚.眶-上颌骨-颧骨联合骨折86例临床报道[J].临床口腔医学杂志,2005,21(5):299
40.张益,孙勇刚.颌骨坚固内固定术[M].北京:北京大学医学出版社,2003:310
41.Gruss JS,Van Wyck L,Phillips JH,et al.The importance of the zygomatic arch in complex midfacial fracture repair and correction of post traumatic orbitzygomaic deformities[J].Plast Reconstr Surg,1990,85(6):878
42.张益.颌骨骨折治疗与研究的近代发展及国内现状[J].口腔颌面外科杂志,1999,9(3):155.
43.Morgan RF,Manson PN,Shack RB,et al.Management of nasoethmoid - orbital fractures[J].Ann Surg,1982,48:447 - 450.
44.Zide BM,McCarthy JG.The medial canthus revisited-an anatomical basis for canthopexy[J].Ann Plast Surg,1983,11:1 - 9.
45.刘宝林,顾晓明.口腔医学实用技术[M].口腔颌面外科学,第1版,沈阳:辽宁科学技术出版社,1999.178-181.
46.Robinson TJ,Stranc MF.The anatomy of the medial canthal ligament[J].Plast Surg,1970,23:1 - 7.
47.Stranc MF.Primary treatment of naso - ethmoid injuries with increased intercanthal distance[J].Br J Plast Surg,1970,23:8 - 25.
[1]周树夏,刘彦普.进一步提高面中部骨折的治疗质量[J].中华口腔医学杂志,2004.39(1):3-4.
[2]上野正,伊藤秀夫.最新口腔外科,第3版[M].东京:医药出版株式会社,1986.529-592.
[3]林影.上颌骨骨折的小型钛板内固定技术[J].中华口腔医学杂志,2000,35(2):85.
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