急诊鼻外伤患者鼻骨骨折的诊治分析

目的:提高急诊鼻骨骨折患者的疗效。方法:回顾性分析154例鼻外伤致鼻骨骨折患者。根据病史和体检,结合影像学检查确诊。根据伤情分类,分别行清创术,止血、抗感染、消肿治疗术,各种鼻骨骨折整复术、上颌骨额突骨折整复术、鼻窦骨折整复术和鼻中隔矫正术以及鼻中隔血肿清除术。结果:①诊断:X线鼻骨侧位片确诊123例,占确诊例数79.9%;X线检查未见明显骨折而行CT扫描确诊31例,占确诊例数20.1%。②治疗:治愈132例,占总研究例数85.7%;好转15例,占总研究例数9.75%;其他:拟Ⅱ期复位1例,占总研究例数0.65%。严重的复合伤失访2例,占总研究例数1.3%。放弃治疗4例,占总研究例数2.6%。好转病例中,10例X线拍片未见骨折,伤后12～14d鼻部CT发现鼻骨骨折和(或)上颌骨额突骨折,行闭合性鼻骨骨折整复术和(或)上颌骨额突骨折整复术,占好转病例66.7%;3例粉碎性鼻骨骨折患者行闭合性鼻骨骨折整复术,占好转病例20%;陈旧性骨折重新复位2例,占好转病例13.3%。结论:对于有明确鼻部外伤史且外鼻畸形明显患者,X线检查未见明显骨折征象时,应行CT扫描,尽早确诊、及时治疗,以期提高骨折治愈率;同时还应关注鼻腔内部结构的损伤,鼻骨整复术同时及时处理,以免遗留外形缺损和功能障碍;不同骨折类型选择不同的治疗开始时间和治疗方案对于提高治疗治愈率有帮助。

Diagnosis and management for nasal bone fractures of patients in acute nasal trauma

Objective：To improve the effectiveness of diagnosis and management for patients with acute nasal bone fractures.Method：One hundred and fifty four cases with nasal bone fractures caused by acute nasal trauma were retrospectively reviewed.Final diagnoses were made on the basis of history,sign and imaging examination. According to different traumatic conditions,the patients were treated differently with debridement,hematischesis,anti-infection and detumescence.They underwent various plasty for fractures of nasal bones,processus frontalis maxllae and nasal sinuses.They also received septal construction as well as nasal septal hematoma evacuation.Result：One hundred and twenty three patients were diagnosed by lateral projection of nasal bone,which was 79.9% of total cases.While the other 31patients were diagnosed by Computerized Tomography（CT）when there were no fracture sign under X-ray scanning.One hundred and thirty two patients（85.7%）were cured.While 15patients （9.75%）were improved.One patient would get secondary reconstruction with rate,but two patients lost to follow up,four patients quited therapy.Ten patients with no fracture sign under X-ray were diagnosed as nasal bone fracture and/or processus frontalis maxllae fracture by CT scanning at 12～14days after injury.Other three patients with comminuted nasal bone fracture underwent closed plasty;two patients with obsolete fracture were retroposited.Conclusion：CT scan was necessary for the patients with definite history of external injury and nasal deformation when there was no fracture sign under X-ray.Damage of nasal cavity should be detected and treated at the same time to avoid shape defect and functional impairment.Different starting time and treatment should be choosed according to the classification of fracture.