Olate Sergio, Lima Sergio Monteiro, Sawazaki Renato, Moreira Roger Willian Fernandes, de Moraes Márcio
Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Brazil.
J Craniofac Surg. 2010 Jul;21(4):1213-7. doi: 10.1097/SCS.0b013e3181e1b2b7.
The aim of this research was to analyze the surgical approaches and methods of rigid fixation used to treat zygomatic complex (ZC) fractures over a 10-year period. One hundred fifty-three patients who underwent surgery to treat ZC fractures between 1999 and 2008 were retrospectively evaluated. Demographic information, signs, and symptoms of the fractures, classification, surgical approaches, and methods of internal fixation were obtained from the medical records. The data were analyzed using statistical descriptive analysis and chi test (P < 0.05). The mean age of the sample was 31 years, and males were predominant (82.3%). In 60.1% of the patients, one surgical approach was used to treat the ZC fractures, whereas 2 surgical approaches were used in 24.8% of the patients. The zygomaticomaxillary buttress was fixed in 86.9% of the patients, followed by infraorbital rim fixation and zygomaticofrontal. There was a statistical significance between fracture displacement and surgical approach for the infraorbital rim (P < 0.0001) and zygomaticofrontal suture (P < 0.0001). Considering that adequate reduction and fixation should be performed and that we try to minimize the amount of scarring, the intraoral zygomaticomaxillary buttress approach is the first choice to treat ZC fractures. In cases of displacement bigger than 5 mm, approaches to 3 of 4 points of the ZC are mandatory to reduce the fractures. The infraorbital rim and zygomaticofrontal suture approaches are indicated to treat displaced fractures.
本研究的目的是分析10年间用于治疗颧骨复合体（ZC）骨折的手术入路和坚固内固定方法。对1999年至2008年间接受手术治疗ZC骨折的153例患者进行回顾性评估。从病历中获取人口统计学信息、骨折的体征和症状、分类、手术入路及内固定方法。采用统计描述性分析和卡方检验（P<0.05）对数据进行分析。样本的平均年龄为31岁，男性占主导（82.3%）。60.1%的患者采用一种手术入路治疗ZC骨折，而24.8%的患者采用两种手术入路。86.9%的患者固定了颧上颌支柱，其次是眶下缘固定和颧额固定。眶下缘（P<0.0001）和颧额缝（P<0.0001）的骨折移位与手术入路之间存在统计学意义。考虑到应进行充分的复位和固定，并尽量减少瘢痕形成，口内颧上颌支柱入路是治疗ZC骨折的首选。对于移位大于5mm的病例，必须采用ZC四点中的三点入路来复位骨折。眶下缘和颧额缝入路适用于治疗移位骨折。
