Manson P N, Markowitz B, Mirvis S, Dunham M, Yaremchuk M
Division of Plastic Surgery, Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems.
Plast Reconstr Surg. 1990 Feb;85(2):202-12; discussion 213-4.
Facial fractures have formerly been classified solely by anatomic location. CT scans now identify the exact fracture pattern in a specific area. Fracture patterns are classified as low, middle, or high energy, defined solely by the pattern of segmentation and displacement in the CT scan. Exposure and fixation relate directly to the fracture pattern for each anatomic area of the face, including frontal bone, frontal sinus, zygoma, nose, nasoethmoidal-orbital region, midface, and mandible. Fractures with little comminution and displacement were accompanied by subtle symptoms and required simple treatment; middle-energy injuries were treated by standard surgical approaches and rigid fixation. Highly comminuted fractures were accompanied by dramatic instability and marked alterations in facial architecture; only multiple surgical approaches to fully visualize the "buttress" system provided alignment and fixation. Classification of facial fractures by (1) anatomic location and (2) pattern of comminution and displacement define refined guidelines for exposure and fixation.
面部骨折以前仅根据解剖位置进行分类。如今，CT扫描能够确定特定区域内确切的骨折类型。骨折类型分为低能量、中能量或高能量，这完全由CT扫描中的分割和移位模式来定义。对于面部的每个解剖区域，包括额骨、额窦、颧骨、鼻子、鼻筛眶区域、中面部和下颌骨，暴露和固定直接与骨折类型相关。粉碎和移位较少的骨折伴有轻微症状，只需简单治疗；中能量损伤采用标准手术方法和坚固固定进行治疗。高度粉碎性骨折伴有明显的不稳定和面部结构的显著改变；只有采用多种手术方法以充分观察“支柱”系统，才能实现对位和固定。根据（1）解剖位置和（2）粉碎和移位模式对面部骨折进行分类，为暴露和固定制定了精细的指导原则。
