Madhusudan G, Sharma Ramesh Kumar, Khandelwal N, Tewari M K
Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Plast Reconstr Surg. 2006 Jun;117(7):2382-8. doi: 10.1097/01.prs.0000218794.28670.07.
High-velocity accidents cause significant injury to the cranial and facial skeleton. Frontobasal fractures include fractures of the upper third of the face and anterior skull base. The pattern and classifications of these fractures are poorly understood at present. The authors have attempted a new comprehensive classification based on detailed clinicoradiographic evaluation.
A prospective study was undertaken in a tertiary care hospital in 1 calendar year (July of 2000 to June of 2001). All 63 patients with frontobasal fractures had detailed clinical and radiographic evaluation with plain radiographs and high-resolution computed tomographic scan. The fractures were classified as frontal, basal, and combined. Areas were separated as central (designated type 1) and lateral (designated type 2) to differentiate the pattern in the sagittal plane according to the site of impact. Combined fractures involving both central and lateral areas were designated type 3. These could be further classified into unilateral or bilateral or pure or impure, depending on the absence or presence of midfacial fractures.
The fractures were subdivided into nine types considering the whole lateral and anteroposterior extents of the frontobasal region. The most common was the combined frontobasal type (30.16 percent). We found the pure type in 38.1 percent (24 of 63) and the impure type in 61.9 percent (39 of 63) of patients. Cerebrospinal fluid leaks occurred more commonly in impure types of frontobasal fracture. Blunt trauma leading to closed frontobasal fracture was seen in 35 patients. Penetrating trauma with open fractures was found in 28 patients and cerebrospinal fluid leak through the wound was seen in six of them.
The new comprehensive classification clearly defines the anatomical areas within the frontobasal region, the nature of injury, and its association with midfacial injuries, and is helpful in planning the approach to their exposure in surgery.
高速事故会对颅面骨骼造成严重损伤。额底骨折包括面部上三分之一和前颅底的骨折。目前对这些骨折的模式和分类了解甚少。作者基于详细的临床影像学评估尝试了一种新的综合分类方法。
在一家三级护理医院进行了为期1个日历年（2000年7月至2001年6月）的前瞻性研究。所有63例额底骨折患者均通过平片和高分辨率计算机断层扫描进行了详细的临床和影像学评估。骨折分为额部、底部和复合型。根据撞击部位，将区域分为中央（指定为1型）和外侧（指定为2型），以区分矢状面的模式。涉及中央和外侧区域的复合型骨折指定为3型。根据是否存在面中部骨折，这些骨折可进一步分为单侧或双侧、单纯或非单纯型。
考虑到额底区域的整个外侧和前后范围，骨折被细分为九种类型。最常见的是额底复合型（30.16%）。我们发现38.1%（63例中的24例）为单纯型，61.9%（63例中的39例）为非单纯型患者。脑脊液漏在非单纯型额底骨折中更常见。35例患者因钝性创伤导致闭合性额底骨折。28例患者为开放性骨折的穿透性创伤，其中6例可见脑脊液通过伤口漏出。
新的综合分类明确界定了额底区域内的解剖区域、损伤性质及其与面中部损伤的关联，有助于规划手术中暴露这些区域的方法。
