169例面中部复合骨折临床分类治疗探讨

Classification and treatment of 169 cases of midfacial fractures

目的探讨面中部复合骨折三维立体结构上的分类法,以提高临床治疗水平。方法收集169例面中部复合骨折病例,通过螺旋CT片检查,从三维立体结构角度将骨折分为A、B、C、D、E五型:A型:面中部复合骨折处无明显移位;B型:伴有眶外壁、眶下壁明显错位骨折;C型:伴有上颌骨明显错位骨折;D型:伴有鼻骨、眶内侧壁、上颌骨额突、筛区明显移位骨折;E型:眶、上颌、颧骨、鼻骨骨体粉碎性骨折,外形破坏,骨折移位明显。总结临床治疗方法及效果。结果术后随访2个月～7年,169例患者颧面部塌陷均得到良好改善,咬合关系紊乱的患者均达到功能性咬合,通过训练后,张口度得到满意恢复,无面神经永久性损伤。A型骨折40例,无不良症状发生;B型骨折39例,有3例术后颧-眶外壁处仍稍显膨隆;C型骨折65例,有8例术后眶下神经麻痹症状未能恢复;D型骨折6例,术后眦距增宽、复视未能恢复1例,眼球内陷1例(>2cm);E型骨折19例,术后复视未能恢复2例,眼球内陷1例(>2cm),眶下神经麻痹症状未恢复5例,手术后切口感染、二次手术取出钛板钛钉1例,术后颧骨弓仍稍显膨隆5例。结论面中部复合骨折五型分类法,对指导临床治疗有一定参考价值。

Objective To discuss the clinical applications of the classification of midfacial fractures by three-dimensional representation,and to improve the clinical treatment.Methods Totally 169 cases of midfacial fractures were reviewed.Midfacial fractures can be subdivded into A,B,C,D,E subtypes through spiral CT examination and three-dimensional reconstruction examination.Results The follow-up period lasted for 2 months to 7 years.All patients＇ zygomatic depression deformities were corrected and improved.The malocclusion was harmonized.Mouth opening became normal after training.No long-term facial nerves paralysis was observed.There was no complication in 40 cases of type A midfacial fractures,3 cases of external zygomatic-orbital external wall swelling in 39 type B cases,8 cases of paralysis of suborbital nerves in 65 type C cases,1 case of eye-ball invagination（2cm） and 1 case of diplopia in 6 type D fractures.In 19 type E fractures,there was 1 case of eye-ball invagination（2cm） and 2 cases of diplopia,5 cases of paralysis of suborbital nerves,1 case of postoperative infection and 5 cases of swelling in ansa capitis.Conclusion The five-subtype classification of midfacial fractures is valuable for clinical application.