Yang Lijuan, Liu Chunming, Hua Wenmei, Liu Weidong, Wang Xiguang, Wang Kai, Zhang Zhanle, Li Meifang, Duan Hainan
Department of Stomatology, Langfang Fourth Peoples' Hospital, Bazhou Hebei 065700, PR China.
Department of Plastic Surgery, General Hospital of Chinese PLA, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Oct;27(10):1181-4.
To explore the procedure and effectiveness of sequential reduction and fixation for zygomatic complex fractures.
Between March 2004 and February 2012, 32 patients with zygomatic complex fractures were treated. There were 28 males and 4 females with a median age of 29 years (range, 17-55 years). Fractures were caused by traffic accident in 29 cases and by tumble in 3 cases. The time between injury and admission was 1-12 days (mean, 3 days) in 28 fresh fractures and 22-60 days (mean, 40 days) in 4 old fractures. All patients were diagnosed by clinical symptom and CT scan. Coronal scalp incision, lower eyelid aesthetic incision, and intraoral incision were used to expose the zygomatic bone segments. The sequence of fractures reduction and fixation was horizontal first, and then longitudinal. In horizontal orientation, reduction and simultaneous fixation started from the root of the zygoma, to zygomatic arch, body of the zygoma, and inferior orbital rim in turn. Longitudinally, fracture reduction of zygomatico-frontal suture and orbital posterolateral walls was done first, followed by fracture reduction of zygomaticomaxillary buttress.
Primary healing of incision was obtained in all 32 cases, without complications of maxillary sinus fistula and infection. Eighteen patients were followed up 6 months to 6 years with a median time of 32 months. All the patients gained satisfactory results with normal zygomatic contour and symmetric midface. All patients restored normal mouth opening. No eye and vision damage occurred. Frontal disappearance and brow ptosis were observed in 2 cases. Hair loss (2-3 mm) was seen at the site of coronal scalp incision, without scar hyperplasia; there was no obvious scar at lower eyelid. CT and X-ray films showed bony healing at 6 months after operation.
Sequential reduction and fixation is accord with the mechanical characters of complicated zygomatic fractures. It is very easy to achieve anatomic reduction of the bone segments and facial symmetry.
探讨颧骨复合体骨折序贯复位固定的方法及疗效。
2004年3月至2012年2月，收治32例颧骨复合体骨折患者。其中男性28例，女性4例，中位年龄29岁（范围17 - 55岁）。骨折原因：交通事故29例，摔伤3例。28例新鲜骨折伤后至入院时间为1 - 12天（平均3天），4例陈旧性骨折为22 - 60天（平均40天）。所有患者均经临床症状及CT扫描确诊。采用冠状头皮切口、下睑美容切口及口内切口暴露颧骨骨段。骨折复位固定顺序为先行水平方向复位固定，再行垂直方向复位固定。水平方向上，复位及同步固定依次从颧根开始，至颧弓、颧骨体、眶下缘。垂直方向上，先进行颧额缝及眶后外侧壁骨折复位，再进行颧上颌支柱骨折复位。
32例患者切口均一期愈合，无上颌窦瘘及感染等并发症。18例患者随访6个月至6年，中位随访时间32个月。所有患者颧部外形正常，面部对称，效果满意。所有患者张口度恢复正常。无眼部及视力损害发生。2例患者出现额纹消失及眉下垂。冠状头皮切口处有2 - 3mm脱发，无瘢痕增生；下睑无明显瘢痕。术后6个月CT及X线片显示骨折骨性愈合。
序贯复位固定符合复杂颧骨骨折的力学特点，易于实现骨段的解剖复位及面部对称。
