Baltimore, Md. From the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, and The Johns Hopkins School of Medicine.
Plast Reconstr Surg. 2009 Dec;124(6):2096-2106. doi: 10.1097/PRS.0b013e3181bf8394.
Frontobasal injury is a classic craniomaxillofacial fracture affecting the anterior cranial base. No data exist regarding the degree of frontobasal injury and associated midfacial fractures. The authors propose a classification of frontobasal and midface fractures involving the cranial base based on cadaveric experiments and comprehensive clinical experience.
An institutional review board-approved retrospective review was conducted on patients with frontobasal fractures from 1995 to 2005. Fractures were categorized by pattern, location, midfacial involvement (impure), and complications compiled. One hundred five cadaveric heads underwent blunt impact to the frontal bone and upper midface. Calvarial vault, cranial base, and midface fracture patterns were categorized.
Three frontobasal fracture patterns were identified. Isolated linear cranial base fractures constitute type I. Vertical-linear fractures of the skull vault (frontal bone) occur in combination with base fractures, representing type II (vault and base). Comminution of the frontolateral skull vault and orbital roof in association with a linear base fracture constitute type III. Two hundred ninety patients were identified with 49 complications (cerebrospinal fistula, 24; and infectious 25). Type III (n = 159) had the highest complication rate (impure, 29 percent; pure, 17 percent), followed by type II (impure, 19 percent; pure, 5 percent). There is essentially no extension of midface fractures to the cranial vault.
Frontobasal fractures have three unique and reproducible patterns based on vector, location, and force. This new classification scheme, paired with known patterns of midfacial injuries, assists in fully understanding frontofaciobasal injury and its complications. Overwhelmingly, impure type II and any type III fractures are associated with a high rate of complications and must be carefully managed.
额眶面损伤是一种经典的颅颌面骨折，影响前颅底。目前尚无额眶面损伤程度及相关面中部骨折的数据。作者根据尸体实验和综合临床经验，提出了一种基于颅底的额眶面和中面部骨折分类。
对 1995 年至 2005 年额眶面骨折患者进行机构审查委员会批准的回顾性研究。根据模式、位置、面中部受累（不纯）和并发症进行分类。105 具尸体头颅接受额骨和中面部钝性冲击。对颅盖骨、颅底和中面部骨折模式进行分类。
发现三种额眶面骨折模式。孤立的线性颅底骨折构成 I 型。颅盖骨（额骨）的垂直线性骨折与基底骨折同时发生，代表 II 型（颅盖和基底）。前外侧颅盖骨和眶顶粉碎性骨折与线性基底骨折一起构成 III 型。共发现 290 例患者有 49 例并发症（脑脊液漏 24 例；感染 25 例）。III 型（n = 159）并发症发生率最高（不纯型 29%；单纯型 17%），其次是 II 型（不纯型 19%；单纯型 5%）。面中部骨折基本不会延伸至颅盖骨。
额眶面骨折根据矢量、位置和力有三种独特且可重复的模式。这种新的分类方案与已知的面中部损伤模式相结合，有助于全面了解额眶面骨折及其并发症。绝大多数不纯 II 型和任何 III 型骨折都与高并发症发生率相关，必须谨慎处理。
