Derdyn C, Persing J A, Broaddus W C, Delashaw J B, Jane J, Levine P A, Torner J
Department of Plastic Surgery, University of Virginia Health Sciences Center, Charlottesville.
Plast Reconstr Surg. 1990 Aug;86(2):238-45; discussion 246-7.
Following the retrospective analysis of approximately 4000 head-injury patients, 49 were identified with a combination of displaced facial fractures and significant cerebral trauma. The purpose of this study was to define clinical and radiographic features in these patients that are associated with a poor prognosis, which in turn might influence the timing of facial fracture repair. The presence of an upper-level facial fracture, low Glasgow coma score, intracranial hemorrhage, displacement of normally midline cerebral structures, and multisystem trauma was associated with a statistically significant poorer prognosis. Additionally, in demographically similar groups of patients (age, sex, concomitant injury) preselected for intracranial pressures of less than 15 mmHg at the time of surgery, no significant difference in survival was appreciated in patients who underwent early (0 to 3 days), middle (4 to 7 days), or late (greater than 7 days) surgical repair. Early surgical repair of facial fractures in these circumstances does not appear to have a negative impact on recovery.
在对约4000例头部受伤患者进行回顾性分析后，发现49例患者存在面部骨折移位和严重脑外伤的组合。本研究的目的是确定这些患者中与预后不良相关的临床和影像学特征，而这反过来可能会影响面部骨折修复的时机。高位面部骨折、低格拉斯哥昏迷评分、颅内出血、正常位于中线的脑结构移位以及多系统创伤的存在与统计学上显著较差的预后相关。此外，在手术时预先选择颅内压低于15 mmHg的人口统计学相似的患者组（年龄、性别、伴随损伤）中，早期（0至3天）、中期（4至7天）或晚期（大于7天）进行手术修复的患者在生存率方面没有显著差异。在这些情况下，早期对面部骨折进行手术修复似乎不会对恢复产生负面影响。
