1 Emory University School of Medicine, Atlanta, GA.
2 Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 550 Peachtree Rd, Atlanta, GA 30308.
AJR Am J Roentgenol. 2016 Nov;207(5):1070-1076. doi: 10.2214/AJR.15.15901. Epub 2016 Aug 24.
The objective of the present study is to examine the concordance of facial fracture classifications in patients with trauma who underwent surgery and to assess the epidemiologic findings associated with facial trauma.
Patients with trauma who underwent facial CT examination and inpatient operative intervention during a 1-year period were retrospectively analyzed. Patient demographic characteristics, the mechanism of injury, the radiology report, the surgical diagnosis, and clinical indications were reviewed. Fractures were documented according to bone type and were classified into the following subtypes: LeFort 1, LeFort 2, LeFort 3, naso-orbital-ethmoidal, zygomaticomaxillary complex (ZMC), orbital, and mandibular. Concordance between the radiology and surgery reports was assessed.
A total of 115,000 visits to the emergency department resulted in 9000 trauma activations and 3326 facial CT examinations. One hundred fifty-six patients (4.7%) underwent facial surgical intervention, and 133 cases met criteria for inclusion in the study. The mean injury severity score was 10.2 (range, 1-75). The three most frequently noted injury mechanisms were as follows: assault (77 cases [57.9%]), a traffic accident (21 cases [15.8%]), and a fall (20 cases [15%]). The three most frequently noted facial bone fractures were as follows: mandible (100 cases [75.2%]), maxilla (53 cases [39.8%]), and orbit (53 cases [39.8%]). The five descriptors most frequently found in the radiology and surgery reports were the mandibular angle (25 cases), the orbital floor (25 cases), the mandibular parasymphysis (22 cases), the mandibular body (21 cases), and ZMC fractures (19 cases). A classification was not specified in 31 of the radiologic impressions (22.5%), with 28 of 31 radiologists expecting the surgeon to read the full report. The descriptors used in the radiology and surgery reports matched in 73 cases (54.9%) and differed in 51 cases (38.3%). No classifications were used by one or both specialties in nine cases (6.8%).
For 38.3% of patients needing facial surgery, descriptors used in the radiologic and surgery reports differed. Speaking a common language can potentially improve communication between the radiology and surgery services and can help expedite management of cases requiring surgery.
本研究旨在检查接受手术治疗的创伤患者的面部骨折分类是否一致，并评估与面部创伤相关的流行病学发现。
回顾性分析了在 1 年内接受面部 CT 检查和住院手术干预的创伤患者。回顾患者的人口统计学特征、损伤机制、放射学报告、手术诊断和临床指征。根据骨类型记录骨折，并分为以下亚型：LeFort 1、LeFort 2、LeFort 3、鼻眶筛-额骨、颧骨上颌复合体（ZMC）、眼眶和下颌骨。评估放射学报告和手术报告之间的一致性。
急诊就诊 115000 次，创伤激活 9000 次，行面部 CT 检查 3326 次。156 例患者（4.7%）接受了面部手术干预，133 例符合纳入研究标准。平均损伤严重程度评分 10.2（范围 1-75）。最常见的三种损伤机制如下：袭击（77 例[57.9%]）、交通事故（21 例[15.8%]）和跌倒（20 例[15%]）。最常见的三种面部骨折如下：下颌骨（100 例[75.2%]）、上颌骨（53 例[39.8%]）和眼眶（53 例[39.8%]）。放射学和手术报告中最常出现的五个描述符如下：下颌角（25 例）、眶底（25 例）、下颌体正中联合（22 例）、下颌体（21 例）和 ZMC 骨折（19 例）。31 份放射学印象中未指定分类（22.5%），其中 28 份报告期望外科医生阅读完整报告。放射学和手术报告中使用的描述符在 73 例（54.9%）中匹配，在 51 例（38.3%）中不同。9 例（6.8%）报告中未使用分类。
对于需要面部手术的 38.3%的患者，放射学和手术报告中使用的描述符不同。使用共同语言可以提高放射科和外科服务之间的沟通，有助于加快需要手术的病例的管理。
