伴全身多系统创伤颌面伤患者的综合救治

A retrospective study of clinical comprehensive management of maxillofacial trauma patients associated with multiple systemic injuries

目的:研究伴发身体其他部位创伤的颌面伤患者综合救治中专科确定性手术时机和适应证。方法:回顾性统计4所大型综合医院口腔科病房近20年收治的4 869例口腔颌面部创伤患者的临床资料,分析伴发身体其他部位创伤状况和专科手术时机。结果:4 869例患者中,面骨骨折3 364例,软组织伤1 505例。伴发其他部位创伤1 524例(占31.3%),其中颅脑伤570例(37.4%),肢体伤545例(35.8%),胸部伤170例(11.2%),眼创伤151例(9.9%),脊柱伤54例(3.3%),腹部伤34例(2.2%)。74%的颅脑伴发伤患者伤后4周内、76.2%的眼伴发伤患者伤后7d内进行了面骨骨折手术治疗。而肢体、脊柱、胸腹部伴发伤患者,面骨骨折手术均有不同程度延误。结论:伴发多系统创伤的颌面伤患者的救治需要多学科间的合作,在患者呼吸系统、循环系统等全身状况稳定的情况下,大部分颌面多发伤患者可以同期或早期进行专科处理。

PURPOSE： To study the definitive surgical timing and indications in clinical comprehensive management of oral and maxillofacial trauma patients associated with multiple systemic injuries.METHODS： A total of 4869 patients with oral and maxillofacial trauma treated over a 20-year period in four general hospitals were retrospectively reviewed.The clinical conditions of associated multiple systemic injuries with oral and maxillofacial trauma and the specific definitive surgical timing were analyzed.RESULTS： 3364 patients had facial fractures,1505 patients had soft tissue injuries.1524（31.3%） patients had injuries in other parts of the body,among which 570（37.4%） were cranio-cerebral injuries,545（35.8%） were orthopedic injuries,170（11.2%） were thoracic injuries,151（9.9%） were ophthalmic injuries,54（3.3%） were spinal injuries and 34（2.2%） were abdominal injuries.There were 422（74%） patients associated cranio-cerebral injuries in whom maxillofacial fractures surgery within 4 weeks after trauma,115（76.2%） patients had associated ophthalmic injuries in whom maxillofacial fractures surgery was performed within the first 7 days after trauma.The maxillofacial definitive surgical treatment in some other associated patients including orthopedic,thoracic,abdominal and spinal injuries was delayed in different times.CONCLUSION： Clinical comprehensive management in maxillofacial trauma patients associated with multiple systemic injuries needs cooperation within multiple specialties and departments.A large number of oral and maxillofacial trauma patients with multiple systemic injuries are amenable to definitive maxillofacial surgery in early time after trauma,or surgical management of other injuries of the body,if the conditions of respiratory and circulatory system were stable.