From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine; and the R Adams Cowley Shock Trauma Center, University of Maryland Medical Center.
Plast Reconstr Surg. 2018 Jul;142(1):51e-60e. doi: 10.1097/PRS.0000000000004487.
Relatively few reports have been published investigating the operative management of pediatric zygomaticomaxillary complex fractures. The purpose of this study was to assess pediatric zygomaticomaxillary complex fracture management and associated complications, and potentially describe a standard treatment paradigm for these cases.
A retrospective cohort review was performed of all patients younger than 15 years presenting to a single institution with zygomaticomaxillary complex fractures from 1990 to 2010. Patient demographics, concomitant injuries, management details, and complications were recorded. Complications were compared among patients by dentition stage, number of fixation points, and identity of fixation sites.
A total of 36 patients with 44 unique zygomaticomaxillary complex fractures met the authors' inclusion criteria. Thirty-two fractures exhibited at least 2.0 mm of diastasis along at least one buttress (73 percent), and all but one of these were managed operatively. Among operatively managed patients with deciduous dentition, two-point fixation was associated with a lower overall complication rate compared with one- and three-point fixation (0 percent versus 75 percent and 75 percent; p = 0.01). Furthermore, rigid plate-and-screw fixation at the zygomaticomaxillary buttress was not associated with an increased complication rate in operatively managed patients with deciduous dentition (40 percent versus 50 percent; p = 0.76).
The authors' results suggest that two-point fixation is an effective management strategy for repair of displaced zygomaticomaxillary complex fractures in children. In addition, rigid plate-and-screw fixation at the zygomaticomaxillary buttress in children with deciduous dentition appears to be safe and effective when performed.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
鲜有研究报道儿童颧骨-上颌复合体骨折的手术治疗。本研究旨在评估儿童颧骨-上颌复合体骨折的治疗方法及相关并发症，并为这类病例提供一种标准的治疗方案。
回顾性分析了 1990 年至 2010 年期间，在单一机构就诊的所有年龄小于 15 岁的颧骨-上颌复合体骨折患者。记录了患者的人口统计学资料、合并伤、治疗细节和并发症。根据牙列阶段、固定点数和固定部位的不同，对患者的并发症进行了比较。
共有 36 名患者的 44 个独特的颧骨-上颌复合体骨折符合纳入标准。32 个骨折至少有 2.0mm 的移位，至少有一个支柱（73%），所有这些都需要手术治疗。在接受乳牙治疗的手术患者中，两点固定与一、三点固定相比，总体并发症发生率较低（0%对 75%和 75%；p=0.01）。此外，在接受乳牙治疗的手术患者中，颧骨-上颌支柱处的刚性板钉固定与增加的并发症发生率无关（40%对 50%；p=0.76）。
作者的结果表明，两点固定是治疗儿童移位颧骨-上颌复合体骨折的有效方法。此外，在儿童的乳牙期，颧骨-上颌支柱处使用刚性板钉固定似乎是安全有效的。
临床问题/证据水平：治疗，III 级。
