面部多发性开放性骨折的治疗体会

我院自1990年以来共收治面部多发性骨折20例,经一次性清创、整复治疗,取得满意效果,现报告如下。1 一般资料 本组20例(男16例,女4例),年龄20～56岁。致伤原因:车祸致伤10例,高处坠落致伤4例,重物砸伤4例,面部被铁器撞伤2例。骨折部位:颧骨 上颌骨骨折3例,下颌骨 颧弓骨折3例,眶骨 上颌窦前壁骨折4例,上颌骨 下颌骨 鼻骨骨折2例,     

鼻内镜辅助下微创手术治疗颌面部骨折352例

2003年1月～2008年1月,我们在鼻内镜辅助下微创手术治疗颌面部骨折352例,效果满意。现分析报告如下。1临床资料1.1一般情况352例中,男210例,女142例;年龄17～65岁,平均40.2岁。颌面部骨折类型:单纯鼻骨骨折130例,鼻骨+上颌骨额突骨折101例,单纯颧骨骨折18例,颧骨+颧弓骨折13例,眶下壁骨折13例,眶外侧壁骨折8例,眶内壁骨折10例,眶下壁+眶外侧壁骨折6例,颧骨+颧弓+眶下壁骨折8例,颧骨+颧弓+眶外侧壁骨折5例,颧骨+颧弓+眶下壁+眶外侧壁骨折4例,上颌骨骨折10例,下颌骨骨折24例,鼻眶筛骨骨折2例。1.2手术方法(1)鼻骨骨折或鼻骨+上颌骨额突骨折:局部黏膜表面加浸润麻醉,鼻内镜辅助下行微创手术,使用德国Storz鼻内镜系统及手术器械,英国Diego外科动力系统。对鼻中隔偏曲者,先矫正偏曲部位,再在鼻内镜辅助下放置鼻骨复位器行鼻骨复位。(2)颧骨、颧弓、眼眶、鼻眶筛骨和上颌骨骨折:全麻成功后,在发际内2～3cm处行半冠状切口,暴露眶外壁、颧骨、颧弓骨折线,联合睑缘下切口暴露眶下壁及眶内壁骨折线,口内前庭沟做龈颊切口暴露上颌骨前壁、外侧壁骨折线,在鼻内镜辅助下从多个角度检查...     

非手术治疗上颌骨骨折46例

上颌骨位于面部中份,与鼻骨、颧骨和其他颅面骨相连,上颌骨骨折是颌面部常见的骨折之一[1]。武警浙江总队医院口腔科于2004-01至2013-12采用非手术治疗上颌骨骨折46例,疗效较好。1．1一般资料46例中,男39例,女7例;年龄18～67岁,平均（39．6±10．2）岁。车祸致伤29例,摔伤9例,打击伤6例,其他原因2例。骨折Left分型及合并伤情况见表1。     

口腔颌面部骨折36例临床治疗分析

目的:总结颌面部骨折原因、骨折类型以及临床诊疗方法。方法:回顾性分析2007-12～2011-12收治口腔颌面部骨折36例的临床资料,包括包括年龄、性别、致伤原因、损伤部位、类型、治疗方式等。结果:36例患者中交通事故伤为主要致伤原因占50.0%,69.4%的颌面部骨折患者发生在20～45岁。下颌骨骨折为主要受伤类型,占77.8%。32例病例进行开放复位内固定治疗,占88.9%,4例患者采取闭合复位联合单颌固定或颌间牵引治疗,术后绝大多数患者取得了满意的面形和功能疗效。结论:颌面部骨折好发于青壮年男性,交通事故伤为主要致伤原因,下颌骨骨折为主要受伤类型,开放复位内固定的治疗方式为主,可以达到精确、稳定复位,减少患者的痛苦,疗效可靠。     

458例颌面部交通事故伤临床研究

目的:探讨颌面部交通事故伤的临床特点及救治方法。方法:对458例颌面部交通事故伤的伤者年龄、性别、致伤原因、部位及合并伤进行了分析。结果:颌面部交通事故伤中男性多于女性,占74.24%;20-49岁为高发年龄段,占69.43%;涉及到汽车事故伤高达81.22%,下颌骨骨折最多,其次是上颌骨和颧骨。合并伤多达58.08%。结论:颌面部交通事故伤伤情重而复杂,合并伤多,急救中因根据病情的轻重缓急而处理。     

口腔颌面部外伤536例临床分析

目的探讨颌面损伤患者的临床流行病学特点。方法对2004年7月～2011年6月本院口腔科收治的536例颌面外伤患者的病例资料进行统计分析。结果 536例口腔颌面部外伤患者,男女比例为3.74∶1,20～40岁为发病的高峰期,交通事故在致伤原因中居第一位,占50.10%;颌面部骨折中,下颌骨骨折168例,占31.34%,其次是颧骨、上颌骨骨折;颅脑损伤是颌面骨折最常见的合并伤。结论男性青壮年为颌面部损伤高发人群,交通事故是颌面部损伤的主要原因,下颌骨为骨折多发部位,颅脑损伤为颌面部损伤最严重、最常见的合并伤。     

231例面中部骨折的临床研究

目的 探讨面中部骨折的发生机制及治疗特点。方法 以我院口腔颌面外科1981－2000年资料完整的面中部骨折患者231例为研究对象，进行性别及年龄分布、致伤原因、骨折类型、合并伤、治疗方法等方面的分析研究。结果 231例中，男195例，女36例，男女之比为5．4：1。高峰年龄段为20－40岁，占63．6％（147／231）。交通伤占56．3％（130／231），为主要致伤原因。以上颌骨折最多，占全部骨折的42．2％（206／488）；在合并伤中以眼外伤的发生率最高（29．4％，68／231）；经切开复位内固定治疗125例，占54．1％（125／231）。结论 面中部骨折最常见致伤原因是交通伤；最好发人群是20－40岁男性；最好发部位是上颌骨；最常用的治疗方法是切开复位、坚固内固定。     

下颌骨髁状突骨折64例临床分析

目的通过病例收集整理分析,研究下颌骨髁状突骨折的临床特点、手术方法及治疗效果。方法收集64例（86侧）下颌骨髁状突骨折的临床资料,分析其年龄、性别、致伤原因、骨折类型、手术方法及治疗效果。结果 64例下颌骨髁状突骨折中,男性多于女性,好发年龄段20～30岁;致伤原因以交通事故伤最多;骨折类型以髁颈骨折最多;治疗方法分保守治疗及坚固内固定术,治疗效果以坚固内固定术的临床效果为好。结论下颌骨髁状突骨折以青壮年男性为多,多由交通事故伤引起,以单侧髁颈骨折最为常见,坚固内固定术是最有效的治疗方法。     

微型钛板内固定治疗髁状突骨折22例

髁状突骨折是最常见的下颌骨骨折,其发生率约占下颌骨骨折的25%。髁状突骨折常引起患者咬合关系紊乱、张口受限,严重妨碍患者咀嚼、语言等生理功能,亦可影响下颌骨发育,引起颞下颌关节疾病的发生。在髁状突骨折治疗方法的选择上至今仍存在较大争议。对于手术治疗适应症,目前学者们尚无统一标准。随着内固定材料和技术的发展,自2003年以来共手术治疗髁状突骨折22例,现总结如下:1资料与方法1.1一般资料22例(28侧),男18例,女4例;年龄18-58岁,平均33.4岁。致伤原因:车祸伤12例,高处坠伤6例,硬物击伤4例。骨折类型:单侧16例,双侧6例。高位骨折4例…     

226例颌面外伤临床分析及处理体会

1　临床资料　一般资料 :本组 2 2 6例 ,男 185例 ,女 41例。年龄 9～ 72岁 ,2 0～ 5 0岁人数比较多。致伤原因 :打架斗殴民事伤害占 92 6 % ,交通事故占 7 0 % ,其它意外占 0 4%。致伤部位 :颌面除软组织伤外 ,牙齿损伤占43 2 % ,下颌骨骨折 2 7% ,颌面骨多发性骨折占 2 %。鼻部伤鼻骨骨折占领 49 4% ,鼻窦骨折占 18 8% (其中筛窦骨折 5 % ,上颌窦骨折 32 2 % ) ,鼻中隔软骨骨折占 5 8%。耳部伤鼓膜穿孔 46 2 % ,耳廓裂伤 3%。眼部伤除眼睑、眼球顿挫伤多见外 ,视网膜震荡占 32 5 % ,眶内侧壁骨折2 7 5 % ,眶底骨折占 2 2 % ,眼睑全…     

The incidence and distribution of burst fractures

This study was conducted to assess occurrence and distribution of burst fractures as well as common accident mechanisms and the associated neurologic deficit. Using picture archiving and communications system, all emergency multidetector computed tomography studies over 34 months were retrieved and evaluated for burst fractures by two radiologists by consensus. Initial neurological findings were retrieved from patients’ medical records. One hundred fifty-two patients (112 male) with a total of 169 burst fractures were found. In both genders, the incidence of burst fractures peaked at the thoracolumbar junction and between levels T5 and T8. In 10% of cases, more than one burst fracture was seen, thereof 53% on noncontiguous levels. Main accident mechanisms were falls, traffic, and sports. Neurological deficit was highest in patients with burst fractures of the cervical spine, independent of accident mechanism, and lowest in thoracolumbar junction fractures. Burst fractures occur frequently in high energy traumas and are most commonly associated with falling and traffic accidents. Multiple burst fractures occur in 10% of cases, half thereof on noncontiguous levels.     

Acute facial trauma in falling accidents: MDCT analysis of 500 patients

The aim of this study is to assess multidetector computed tomography (MDCT) findings of facial trauma due to a falling accident. Using picture-archiving and communications system, we retrieved all MDCT requests for suspected facial injury during a 62-month period. Images were interpreted by two researchers. Five hundred patients met the inclusion criteria and 329 (66%) had a total of 515 fractures. Falls on stairs were seen in 109 (22%) patients and slips or trips in 391 (78%). The corresponding number of fractures was 169 (33%) and 346 (67%). Males (N = 241) had more fractures than females (N = 259), 327 vs. 188, respectively. The zygomatic complex was the most common fracture, seen in 40% of patients suffering a fracture. Twenty patients (4%) had fractures involving the sinus walls without paranasal sinus effusions. Facial fractures due to falls are common. The zygomatic complex is the most common fracture. A clear sinus sign may be less reliable than previously thought.     

The CT characteristics of orbital blowout fracture and its medicolegal expertise

To explore the CT characteristics of orbital blowout fracture, we reviewed 76 cases with orbital blowout fracture and analyzed their clinical forensic characteristics. The missed diagnosis rate of cranial CT was 26.3%, and plain X-ray was 47.4%. The orbital CT examination has advantages in diagnosing orbital blowout fracture. In 42 cases fractures were simple medial orbital wall fracture, 30 cases were inferior orbital fractures. Loss of clinical signs included local haematoma, bone continuity, and displacement of bone fragments were mostly seen in CT image. Clinical signs and symptoms included local haematoma, whilst diplopia as the most common clinical symptom. Visual acuity was rarely affected after fracture. It is concluded that orbital blowout fracture may be misdiagnosed if only cranial CT and plain X-ray are used. Diagnose the orbital blowout fracture only by craniocerebral CT and head X-ray. Orbital CT should be done if the clinical signs are suggestive of orbital blowout fracture Visual acuity was affected and diplopia may be present.     

颞骨骨折及其并发症的临床研究

为探讨颞骨骨折及其并发症的特点及救治方法，作者对1989年1月－1999年11月收治的48例颞骨骨折临床资料进行了回顾性分析。结果显示，48例颞骨骨折患者中交通事故所致的占66．7％，存活43例（89．6％），死亡5例（10．4％）；中、内耳或颅脑损伤占77．1％，听力下降或耳鸣占48％；纵行骨折的脑脊液耳漏占36．7％，面瘫占3％；横行骨折的面瘫占37．5％，脑脊液耳漏则占25％。研究结果表明，交通事故伤是造成颞骨骨折的首要高危因素，其严重并发症为颅脑损伤，合并多脏器伤常是致死性并发症；其常用并发症为听力下降或耳鸣等中、内耳损伤；纵行骨折以脑脊液耳漏多见，横行骨折易造成面瘫。     

交通事故致特重型颅脑损伤患者的救治分析

目的探讨交通事故致特重型颅脑损伤(GCS 3~5分)患者的伤情特点及提高救治水平的方法。方法对我院自2001年6月~2008年5月采用综合治疗的资料完整的76例由交通事故导致的特重型颅脑损伤患者进行分析,其中高速公路组24例,普通公路组52例,并对高速公路和普通公路发生的特重型颅脑损伤患者进行对比分析。结果高速公路组24例,死亡12例,死亡率为50%;生存者按格拉斯哥预后评分(GOS),恢复良好3例(12.5%),中残2例(8.3%),重残4例(16.7%),植物生存3例(12.5%)。普通公路组52例,死亡39例,死亡率为75%;恢复良好6例(11.6%),中残4例(7.7%),重残2例(3.8%),植物生存1例(1.9%)。结论高速公路伤员多为男性青壮年,送院时间较长,多发伤比例高,休克发生率高,GCS评分3分患者极难生存。但只要积极救治,高速公路伤员也可以取得与普通公路相似的疗效。     

颞骨骨折及其中、内耳损伤48例回顾性研究

目的　探讨颞骨骨折及中、内耳损伤的特点及救治。　方法　对 1989年 1月～ 1999年 11月收治的 48例颞骨骨折的临床资料进行回顾性分析。　结果　 (1) 4 8例颞骨骨折占同期颅-颅面骨折的 17% ,其中交通事故所致的颞骨骨折 32例 (6 7% ) ;(2 )本组合并中、内耳和 (或 )颅脑损伤 37例 (77% ) ,2 3例 (4 8% )出现听力下降或耳鸣 ;(3)纵行骨折致脑脊液耳漏 12例 (36 % )、面瘫1例 (3% ) ;横行骨折致面瘫 3例 (37% ) ,脑脊液耳漏 2例 (2 5 % ) ;(4 )早期急救手术占 96 % ,其中颅脑手术占所有急救手术的 46 % ,Ⅱ期手术占 17% ,存活 43例 (90 % ) ,死亡 5例 (10 % )。　结论　(1)交通伤是造成颞骨骨折的首要高危因素 ;(2 )骨折易并发中、内耳或颅脑损伤 ,其中听力下降或耳鸣是常见的耳并发症 ;(3)纵行骨折的脑脊液耳漏多见 ,横行骨折易造成面瘫 ;(4 )早期救治应该着重抢救生命 ,保证呼吸道通畅 ,维持循环系统功能。     

复合髋臼骨折手术中后方入路的特点和选择

目的探讨后方入路(Kocher-Langenbeck,K-L)在治疗复合髋臼骨折中的特点和选择指征。方法自1994年10月～2010年1月,通过后方入路手术治疗59例复合髋臼骨折,对患者手术过程、术后复位情况和并发症进行随访评价。结果平均手术时间105分钟,平均出血量480m l,平均输血2U;解剖复位31例,良好复位17例,复位差11例;发生异位骨化11例。结论在复合髋臼骨折中,后柱+后壁、横断+后壁、部分T型和前方伴后方横形骨折,甚至少量双柱骨折可经后方入路完成复位和固定,手术创伤小,复位情况良好,并发症发生率低。     

Visual expertise in detecting and diagnosing skeletal fractures

Objective

Failure to identify fractures is the most common error in accident and emergency departments. Therefore, the current research aimed to understand more about the processes underlying perceptual expertise when interpreting skeletal radiographs.

Materials and methods

Thirty participants, consisting of ten novices, ten intermediates, and ten experts were presented with ten clinical cases of normal and abnormal skeletal radiographs of varying difficulty (obvious or subtle) while wearing eye tracking equipment.

Results

Experts were significantly more accurate, more confident, and faster in their diagnoses than intermediates or novices and this performance advantage was more pronounced for the subtle cases. Experts were also faster to fixate the site of the fracture and spent more relative time fixating the fracture than intermediates or novices and this was again most pronounced for subtle cases. Finally, a multiple linear regression analysis found that time to fixate the fracture was inversely related to diagnostic accuracy and explained 34 % of the variance in this variable.

Conclusions

The results suggest that the performance advantage of expert radiologists is underpinned by superior pattern recognition skills, as evidenced by a quicker time to first fixate the pathology, and less time spent searching the image.     

道路交通伤中特重型颅脑损伤的救治新策略

目的探讨道路交通伤中特重型颅脑损伤患者的伤情特点及救治新策略。方法对我院自2005年5月—2011年5月采用综合治疗资料完整的86例由交通事故导致的特重型颅脑损伤患者进行分析,其中高速公路组29例,普通公路组57例,并对高速公路和普通公路发生的特重型颅脑损伤患者进行对比分析。结果高速公路组29例,死亡13例,死亡率为44.8%;生存者按格拉斯哥预后评分(GOS),恢复良好4例(13.8%),中残3例(10.3%),重残5例(17.2%),植物生存4例(13.8%)。普通公路组57例,死亡40例,死亡率为70.2%;恢复良好7例(12.3%),中残5例(8.8%),重残3例(5.2%),植物生存2例(3.5%)。结论高速公路伤员多为男性青壮年,送院时间较长,多发伤比例高,休克发生率高,评分3分患者极难生存。但院前急救为特重型颅脑损伤患者抢救赢得了时间,对于提高生存率与生存质量,改善预后具有重大意义。     

Avulsion fracture of the lateral ankle ligament complex in severe inversion injury: incidence and clinical outcome

BACKGROUND: Avulsion fracture of the lateral ankle ligaments is often undetected on early radiographs. The epidemiology and treatment of such avulsion fractures have received much less attention than the epidemiology and treatment of rupture of these ligaments. HYPOTHESIS: The clinical characteristics of avulsion fracture are different from those of ligament rupture. Unlike nonoperative treatment of lateral ligament rupture, nonoperative treatment of avulsion fracture does not yield satisfactory results. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 169 consecutive patients with severe inversion injury were classified into a ligament rupture group or avulsion fracture group on the basis of physical examination findings and anterior talofibular ligament and calcaneofibular ligament radiographic views. Age, sex, activity level, and the mechanism of injury were analyzed. Patients in both groups were treated by casting. Follow-up examination of 152 patients included clinical assessment and functional evaluation based on the Karlsson system. RESULTS: Avulsion fracture was diagnosed in 44 (26%) of the 169 patients and was most common among children and patients over 40 years of age. Sedentary level activity and low-energy injury were more common in the avulsion fracture group than in the ligament rupture group (77% vs 37%, respectively, P = .001; 68% vs 43%, respectively, P =.004). Nonoperative treatment of avulsion fracture (mean Karlsson score, 89.1 points) yielded satisfactory results that were comparable with those of nonoperative treatment of ligament rupture (mean Karlsson score, 88.4 points) (P = .123). Osseous union was achieved in 65% of the patients with avulsion fracture. CONCLUSION: Avulsion fracture of the lateral ankle ligaments in cases of severe inversion injury is more common than previously believed. Because of the high incidence and difficulty of detection in children, a high level of suspicion is necessary in order to obtain an accurate diagnosis of avulsion fracture in cases of severe inversion injury and to achieve adequate stability.