Odom Elizabeth B, Snyder-Warwick Alison K
St. Louis, Mo.
From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine.
Plast Reconstr Surg. 2016 Aug;138(2):282e-289e. doi: 10.1097/PRS.0000000000002385.
Mandible fractures account for 36 to 70 percent of all facial fractures. Despite their high prevalence, the literature lacks a comprehensive review of demographics, fracture patterns, timing of management, antibiotic selection, and outcomes, particularly when evaluating pediatric versus adult patients. The authors aim to determine the complication and infection rates after surgical treatment of mandibular fractures and the bacterial isolates and antibiotic sensitivities from mandible infections after open reduction and internal fixation at their institution.
Data were collected retrospectively for all mandible fractures treated at the authors' institution between 2003 and 2013. Patients were divided into pediatric (younger than 16 years) and adult (16 years or older) subgroups. Demographics, fracture location, fracture cause, comorbidities, antibiotic choice, and subsequent complications and infections were analyzed. Data were evaluated using appropriate statistical tests for each variable.
Three hundred ninety-five patients were evaluated. Demographics and fracture cause were similar to those reported in current literature. Of the 56 pediatric patients, complications occurred in 5.6 percent. Time from injury to operative intervention did not affect outcome. The complication rate was 17.5 percent and the infection rate was 9.4 percent in the adult subgroup. Time from injury to operative intervention, sex, and edentulism were not significant predictors of complication or infection. Tobacco use, number of fractures, number of fractures fixated, and surgical approach were predictors of complication and infection. Perioperative ampicillin-sulbactam had a significantly lower risk of infection.
Certain demographic and operative factors lead to significantly higher risks of complications after surgical management of mandibular fractures. Ampicillin-sulbactam provides effective antibiotic prophylaxis. Risk factor modification may improve outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.
下颌骨骨折占所有面部骨折的36%至70%。尽管其发病率很高，但文献中缺乏对人口统计学、骨折类型、治疗时机、抗生素选择和治疗结果的全面综述，尤其是在评估儿童与成人患者时。作者旨在确定下颌骨骨折手术治疗后的并发症和感染率，以及在其机构进行切开复位内固定术后下颌骨感染的细菌分离株和抗生素敏感性。
回顾性收集2003年至2013年在作者机构治疗的所有下颌骨骨折患者的数据。患者分为儿童亚组（年龄小于16岁）和成人亚组（年龄16岁及以上）。分析人口统计学、骨折部位、骨折原因、合并症、抗生素选择以及随后的并发症和感染情况。对每个变量使用适当的统计检验对数据进行评估。
共评估了395例患者。人口统计学和骨折原因与当前文献报道的相似。56例儿童患者中，并发症发生率为5.6%。受伤至手术干预的时间不影响治疗结果。成人亚组的并发症发生率为17.5%，感染率为9.4%。受伤至手术干预的时间、性别和无牙状态不是并发症或感染的显著预测因素。吸烟、骨折数量、固定的骨折数量和手术入路是并发症和感染的预测因素。围手术期使用氨苄西林舒巴坦感染风险显著较低。
某些人口统计学和手术因素导致下颌骨骨折手术治疗后并发症风险显著更高。氨苄西林舒巴坦提供有效的抗生素预防。改变风险因素可能改善治疗结果。
临床问题/证据级别：风险，IV级
