Bellamy Justin L, Mundinger Gerhard S, Reddy Sashank K, Flores José M, Rodriguez Eduardo D, Dorafshar Amir H
Johns Hopkins School of Medicine, Baltimore, MD 21201, USA.
J Oral Maxillofac Surg. 2013 Sep;71(9):1556-62. doi: 10.1016/j.joms.2013.04.007. Epub 2013 Jul 15.
To investigate whether complex midface fractures have a greater association with death and intracranial injury than simple midface fractures.
A retrospective chart review was performed for patients with blunt-mechanism midface fractures who had presented to an urban trauma center from 1998 to 2010. The survival and intracranial injury status was evaluated for patients with simple and complex midface fractures, including Le Fort, naso-orbitoethmoid, and/or zygomaticomaxillary fractures. Intracranial injury included hemorrhage and brainstem injury. Patients with upper face fractures were excluded to minimize confounding. Adjusted relative risk estimates were obtained using multivariate regression analysis.
Of 3,291 patients with midface fractures, 213 (6.3%) died and 693 (21.3%) had an intracranial injury. The cumulative mortality reached 11.6% in patients with complex midface fractures and 5.1% in those with simple midface fractures (P < .001). Patients with complex midface fractures were 57% more likely to die (relative risk = 1.57; P < .005). Specifically, Le Fort II fractures independently conferred a 94% increased risk of death (relative risk = 1.94; P < .01), but Le Fort I and III fractures were not significantly associated with death. Among patients presenting without neurologic impairment, those with Le Fort II and III fractures remained 2.88-fold (P < .01) and 2.54-fold (P < .001) more likely to have an underlying intracranial injury, respectively.
Le Fort II fractures are associated with increased mortality. Furthermore, Le Fort II and III fractures are associated with serious intracranial injury, even in the absence of alterations in consciousness. These patients should be monitored with heightened vigilance and followed up closely during hospitalization, regardless of the presenting clinical findings.
探讨复杂面中部骨折与单纯面中部骨折相比，是否与死亡及颅内损伤有更强的相关性。
对1998年至2010年在一家城市创伤中心就诊的钝器所致面中部骨折患者进行回顾性病历审查。评估单纯面中部骨折和复杂面中部骨折患者的生存情况及颅内损伤状况，复杂面中部骨折包括Le Fort骨折、鼻眶筛骨折和/或颧上颌骨折。颅内损伤包括出血和脑干损伤。排除上颌骨骨折患者以尽量减少混杂因素。采用多因素回归分析获得校正后的相对风险估计值。
3291例面中部骨折患者中，213例（6.3%）死亡，693例（21.3%）有颅内损伤。复杂面中部骨折患者的累积死亡率为11.6%，单纯面中部骨折患者为5.1%（P <.001）。复杂面中部骨折患者死亡的可能性高57%（相对风险=1.57；P <.005）。具体而言，Le Fort II型骨折独立使死亡风险增加94%（相对风险=1.94；P <.01），但Le Fort I型和III型骨折与死亡无显著相关性。在无神经功能障碍的患者中，Le Fort II型和III型骨折患者发生潜在颅内损伤的可能性分别高2.88倍（P <.01）和2.54倍（P <.001）。
Le Fort II型骨折与死亡率增加相关。此外，Le Fort II型和III型骨折与严重颅内损伤相关，即使意识无改变。无论目前的临床表现如何，这些患者在住院期间都应加强监测并密切随访。
