Pau Candace Y, Barrera Jose E, Kwon Jaehwan, Most Sam P
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
Craniomaxillofac Trauma Reconstr. 2010 Sep;3(3):167-76. doi: 10.1055/s-0030-1263082.
Zygomatic-maxillary (ZMC) complex fractures are a common consequence of facial trauma. In this retrospective study, we present a novel method of ZMC fracture pattern analysis, utilizing three-dimensional visualization of computed tomography (CT) images to record displacement of the malar eminence in a three-dimensional coordinate plane. The pattern of fracture was then correlated with treatment outcome. Facial CT scans were obtained from 29 patients with unilateral ZMC fractures and 30 subjects without fractures and analyzed. Briefly, displacement of the malar eminence (ME) on the fractured side was measured in medial-lateral (x), superior-inferior (y), and anterior-posterior (z) dimensions, as well as Euclidean distance, by comparison to ME location on the unfractured side. Baseline natural variance in asymmetry was accounted for by comparing ME location on the left and right sides in subjects without fractures. Patients who required open reduction and internal fixation (ORIF) to repair the ZMC fracture alone had significantly greater cumulative ME displacements than patients who did not require ORIF (p = 0.02). Additionally, patients with a high fracture score of 3, 4, or 5 (assigned based on severity displacement in each dimension) had significantly higher rates of ORIF than patients with a low fracture score of 0, 1, or 2 (p = 0.05). Severe displacement in one or more dimensions was associated with higher rates of ORIF than seen in patients with only neutral or mild displacements in all dimensions (p = 0.05). Severe x displacement was most strongly correlated with surgical intervention (p = 0.02). Overall, orbital floor repair was less strongly associated with most displacement measures than ZMC repair alone; however, patients requiring orbital floor repair had greater Euclidean ME displacements than patients who did not require orbital floor repair (p = 0.02). Fracture severity, as determined by multiple parameters in this novel evaluation system, is associated with higher rates of ORIF in patients with unilateral ZMC fractures. Determination of ZMC fracture pattern may thus be informative when considering treatment options.
颧上颌复合体（ZMC）骨折是面部创伤的常见后果。在这项回顾性研究中，我们提出了一种ZMC骨折模式分析的新方法，利用计算机断层扫描（CT）图像的三维可视化技术，在三维坐标平面上记录颧骨突出部的移位情况。然后将骨折模式与治疗结果进行关联分析。我们获取了29例单侧ZMC骨折患者和30例无骨折受试者的面部CT扫描图像并进行分析。简要地说，通过与未骨折侧颧骨突出部（ME）的位置相比较，测量骨折侧ME在内侧-外侧（x）、上下（y）和前后（z）维度上的移位情况以及欧几里得距离。通过比较无骨折受试者左右两侧ME的位置，计算出不对称性的基线自然差异。单纯ZMC骨折需要切开复位内固定（ORIF）治疗的患者，其ME累积移位明显大于不需要ORIF治疗的患者（p = 0.02）。此外，骨折评分为3、4或5分（根据各维度的严重移位情况确定）的患者，其ORIF发生率显著高于骨折评分为0、1或2分的患者（p = 0.05）。一个或多个维度的严重移位与ORIF发生率较高相关，高于所有维度仅为中性或轻度移位的患者（p = 0.05）。严重的x轴移位与手术干预的相关性最强（p = 0.02）。总体而言，与单纯ZMC修复相比，眶底修复与大多数移位测量指标的相关性较弱；然而，需要眶底修复的患者其ME的欧几里得移位大于不需要眶底修复的患者（p = 0.02）。在这个新的评估系统中，由多个参数确定的骨折严重程度与单侧ZMC骨折患者较高的ORIF发生率相关。因此，在考虑治疗方案时，确定ZMC骨折模式可能具有指导意义。
