Baltimore, Md. From the Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, and the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine.
Plast Reconstr Surg. 2011 Oct;128(4):962-970. doi: 10.1097/PRS.0b013e3182268cf3.
To date, only limited case reports involving isolated bilateral zygomatic arch fractures exist. This fracture pattern is defined by the presence of bilateral zygomatic arch fractures and the absence of any other facial fractures. The purpose of this study was to systematically review a large trauma database to determine whether this fracture pattern exists and, if so, to elucidate the mechanism of injury and associated concomitant injuries.
A retrospective review of all patients admitted to the R Adams Cowley Shock Trauma center from February of 1998 to December of 2009 was conducted. International Classification of Diseases, Ninth Revision coding of computed tomographic scans was used to identify patients with zygoma fractures. The facial computed tomographic scans of all patients coded with bilateral zygoma fractures were reviewed to determine whether any had isolated bilateral zygomatic arch fractures. Medical charts were reviewed extensively.
Five patients (0.24 percent of all zygoma fractures, 3.18 percent of bilateral zygoma fractures) were found to have isolated bilateral zygomatic arch fractures. All five patients had evidence of skull impact with at least one skull fracture and one skull base fracture. Glasgow Coma Scale scores (range, 6 to 14; average, 8.2) were significantly lower (t test, two-sided, p=0.01) compared with all patients (average, 12.2) with facial trauma during the study period.
Isolated bilateral zygomatic arch fractures do exist. The authors' findings suggest skull impacts as the inciting mechanism of injury and an intimate link with skull base force transmission. The severe nature of this injury warrants a search for concomitant injuries to the head, brain, and spinal cord.
迄今为止，仅有少量孤立性双侧颧骨弓骨折的个案报告。这种骨折模式的定义为双侧颧骨弓骨折，而无其他任何面骨骨折。本研究的目的是系统地回顾一个大型创伤数据库，以确定这种骨折模式是否存在，如果存在，阐明损伤机制及相关的伴随损伤。
对 1998 年 2 月至 2009 年 12 月期间收入 R. Adams Cowley 冲击伤中心的所有患者进行回顾性研究。采用国际疾病分类，第九版计算机断层扫描编码来识别颧骨骨折患者。对所有编码为双侧颧骨骨折的患者的面部计算机断层扫描进行回顾，以确定是否存在孤立性双侧颧骨弓骨折。详细查阅了病历。
发现 5 例（占所有颧骨骨折的 0.24%，双侧颧骨骨折的 3.18%）患者存在孤立性双侧颧骨弓骨折。所有 5 例患者均有颅骨撞击的证据，至少有 1 例颅骨骨折和 1 例颅底骨折。格拉斯哥昏迷评分（范围：6 至 14；平均：8.2）明显低于（双侧 t 检验，p=0.01）研究期间所有面部创伤患者（平均：12.2）。
孤立性双侧颧骨弓骨折确实存在。作者的发现提示颅骨撞击是损伤的诱发机制，并与颅底力的传递密切相关。这种严重损伤需要寻找头部、脑部和脊髓的伴随损伤。
