4种创伤评分评估颌面部骨折效果比较

Comparative study of four trauma scoring systems to evaluate maxillofacial fractures

目的:比较4种常用创伤评分评估颌面部骨折的效果,筛选出适合评价颌面部创伤严重程度的评分方法。方法:收集2008年1月—2013年12月北京大学口腔医院收治的1009例颌面部骨折患者的临床资料,骨折类型包括单纯上颌骨骨折46例,单纯下颌骨骨折536例,单纯颧骨颧弓骨折233例,复合型骨折194例。术前均采用新损伤严重度评分(NISS)、面部损伤严重度评分(FISS)、颌面部损伤严重度评分(MFISS)、颌面损伤严重度评分(MISS)进行评分。将数据导入SPSS 21.0软件包,应用非参数相关分析,计算4种评分方法与临床效应指标之间的相关系数;并以住院时间和住院费用为因变量,进行多元线性回归分析。结果:NISS对下颌骨骨折和颧骨颧弓骨折评分无统计学差异(P>0.05),FISS、MFISS、MISS对上颌骨骨折和下颌骨骨折评分无统计学差异(P>0.05)。NISS、FISS、MFISS、MISS与手术时间、麻醉费用、住院时间呈正相关,其中MFISS的相关系数最高(0.475、0.485、0.434)(P<0.05)。创伤评分和全身合并伤为住院时间和住院费用的显著影响因素,且呈正相关(P<0.05)。结论:MFISS与临床效应指标相关性最高,且显著影响住院时间和住院费用,其分值更可反映颌面部创伤的严重程度。

PURPOSE:To select a scoring system suitable for scoring of maxillofacial trauma by comparing the effects of four commonly used trauma scoring systems.METHODS:This study cohort comprised 1009 patients with maxillofacial trauma from January 2008 to December 2013 at Peking University School and Hospital of Stomatology.There were 46 cases with simple maxillary fractures,536 cases with simple mandibular fractures,233 cases with simple zygomatic arch fractures,and 194 cases with compound fractures.New Injury Severity score(NISS),Facial Injury Severity Score(FISS),Maxillofacial Injury Severity Score(MFISS),and Maxillofacial Injury Severity Score(MISS)were used to grade the injury severity of the patients before surgery.The data were imported into SPSS 21.0 software package.Correlation coefficients between the results of the four scoring systems and clinical effective indexes were calculated by non-parametric correlation analysis.Multivariate linear regression analysis was carried out with length of stay and hospitalization expenses as depen-dent variables.RESULTS:There was no significant difference between the score of mandibular fracture and zygomatic fracture by NISS.When FISS,MFISS,and MISS were applied,there was no significant difference between maxillary frac-ture scores and mandibular fracture scores(P>0.05).NISS,FISS,MFISS and MISS were positively correlated with operation time,cost of anesthesia,length of hospitalization stay,and correlation coefficients of MFISS were the highest(0.475,0.485,0.434).The difference was statistically significant(P<0.05).Trauma score and concomitant injury were positively significant influencing factors of length of hospital stay and hospitalization expenses(P<0.05).CONCLUSIONS:MFISS showed the highest correlation with clinical effective indexes,and affected the length of hospital stay and hospitalization expenses significantly.MFISS reflected the injury severity of maxillofacial trauma better.