蝶窦骨折的模式与后遗症

Patterns and sequelae of sphenoid sinus fractures.

作者信息

Craig John, Goyal Parul

机构信息

Department of Otolaryngology, State University of New York, Upstate Medical University, Syracuse, New York, USA.

出版信息

Am J Rhinol Allergy. 2015 May-Jun;29(3):211-4. doi: 10.2500/ajra.2015.29.4160.

DOI:10.2500/ajra.2015.29.4160

PMID:25975253

Abstract

BACKGROUND

The sphenoid sinus is one of the most commonly fractured regions of the skull base after blunt head trauma. These fractures may be associated with complications such as blunt carotid artery injury (BCAI) and cerebrospinal fluid (CSF) leak. Association of these sequelae with sphenoid sinus fractures has yet to be analyzed thoroughly in the literature.

OBJECTIVE

Analyze patterns of traumatic sphenoid sinus fractures and assess relationships between fracture patterns and incidence of BCAI and traumatic nasal CSF leaks.

METHODS

A retrospective review of 123 patients sustaining sphenoid sinus fractures was performed. Patient medical records and radiographic images were reviewed. Fractures were classified based on the sinus walls involved. Logistic and linear regressions were used to analyze associations between injury mechanisms, fracture subsites, and sequelae.

RESULTS

The most commonly fractured sphenoid sinus subsites included the carotid canal, sphenoid roof, and lateral wall (60%, 49% and 48%, respectively). CSF leaks occurred in 9% of sphenoid sinus fractures, whereas BCAI occurred in 1.6%. On logistic regression, sphenoid roof fractures were significantly associated with CSF leaks (odds ratio [OR] = 12.4, p = 0.002). No fracture subsite was associated with BCAI. The positive predictive value (PPV) of sphenoid roof fractures for the presence of CSF leaks was 17%, whereas the negative predictive value (NPV) was 98%. The PPV of carotid canal fractures for BCAI was 3%, whereas the NPV was 100%. There was no association between the number of fractured sinus walls and the incidence of BCAI or CSF leak. Penetrating injuries were significantly associated with CSF leak (OR = 24.7, p = 0.01), but no other injury mechanisms were associated with BCAI or CSF leak.

CONCLUSION

Nasal CSF leak was the most common sequela of sphenoid sinus fractures, whereas BCAI was extremely uncommon. Analysis of fracture patterns can be useful in determining the need for additional evaluation.

摘要

背景

蝶窦是钝性头部外伤后颅底最常发生骨折的区域之一。这些骨折可能与诸如钝性颈动脉损伤（BCAI）和脑脊液（CSF）漏等并发症相关。这些后遗症与蝶窦骨折之间的关联在文献中尚未得到充分分析。

目的

分析外伤性蝶窦骨折的类型，并评估骨折类型与BCAI发生率和外伤性鼻脑脊液漏之间的关系。

方法

对123例发生蝶窦骨折的患者进行回顾性研究。查阅患者的病历和影像学资料。根据受累的窦壁对骨折进行分类。采用逻辑回归和线性回归分析损伤机制、骨折亚部位与后遗症之间的关联。

结果

蝶窦最常发生骨折的亚部位包括颈动脉管、蝶窦顶和外侧壁（分别为60%、49%和48%）。9%的蝶窦骨折发生脑脊液漏，而BCAI发生率为1.6%。逻辑回归分析显示，蝶窦顶骨折与脑脊液漏显著相关（比值比[OR]=12.4，p=0.002）。没有骨折亚部位与BCAI相关。蝶窦顶骨折存在脑脊液漏的阳性预测值（PPV）为17%，而阴性预测值（NPV）为98%。颈动脉管骨折对BCAI的PPV为3%，而NPV为100%。骨折窦壁的数量与BCAI或脑脊液漏的发生率之间没有关联。穿透性损伤与脑脊液漏显著相关（OR=24.7，p=0.01），但没有其他损伤机制与BCAI或脑脊液漏相关。