Matsumoto Shokei, Akashi Taku, Hayashida Kei, Sekine Kazuhiko, Orita Tomohiko, Funabiki Tomohiro, Kitano Mitsuhide
Department of Emergency Medicine, Saiseikai Central Hospital, Kanagawa, Japan.
Ann Plast Surg. 2018 Jun;80(6):664-668. doi: 10.1097/SAP.0000000000001405.
Transcatheter arterial embolization (TAE) has gained importance in the management of maxillofacial fractures with life-threating hemorrhage (MFH). However, clinical evidence supporting the use of TAE has not been clearly established in the literature. Therefore, we evaluated the effectiveness of TAE for MFH, based on data obtained from the Japan Trauma Data Bank.
Patients were identified from Japan Trauma Data Bank entries for the years 2004 to 2014. Inclusion criteria for MFH were defined using the Abbreviated Injury Scale code (Maxilla fracture, LeFort III; blood loss. > 20%). On the basis of the treatment strategy, patients were categorized into either the TAE group or the non-TAE group. A comparative analysis of the demographics, injury characteristics, and outcomes was performed.
From among 198,744 documented cases of trauma, a total 118 patients were eligible for the study; 26 of these patients (22.0%) underwent TAE. The Glasgow Coma Scale score was significantly lower in the TAE group than in the non-TAE group (P = 0.019); the other variables did not significantly differ between the groups. Overall, the in-hospital mortality rate was 39.8%, and the median hospital length of stay was 21.0 days (0.0-53.5 days). The in-hospital mortality was significantly lower in the TAE group than in the non-TAE group (23.1% vs 44.6%; odds ratio [OR], 0.37; 95% confidence interval [CI], 0.14-1.02; p = 0.048). However, patients in the TAE group had a longer median hospital length of stay (39.5 [7.3-53.5] vs 14.0 [0.0-55.3] days, p = 0.072). In the logistic regression model, the use of TAE was extracted as the independent predictor for better outcomes after adjusting for potential confounders (OR, 0.32; 95% CI, 0.66-0.88; P = 0.032). Hypotension, a high Injury Severity Score, aged 60 years or older, and a low Glasgow Coma Scale score were also independently associated with mortality, with an OR of 5.48, 3.99, 3.30, and 2.89, respectively.
Cases of MFH are rare, but they are associated with a high mortality. Transcatheter arterial embolization use appears to lead to successful outcomes in such cases. Further studies are required to confirm the efficacy of TAE and evaluate its indications and complications.
经导管动脉栓塞术（TAE）在伴有危及生命出血的颌面骨折（MFH）治疗中已变得愈发重要。然而，文献中尚未明确确立支持使用TAE的临床证据。因此，我们基于从日本创伤数据库获得的数据，评估了TAE治疗MFH的有效性。
从日本创伤数据库2004年至2014年的记录中识别患者。使用简明损伤定级代码（上颌骨骨折，勒福Ⅲ型；失血>20%）定义MFH的纳入标准。根据治疗策略，将患者分为TAE组或非TAE组。对人口统计学、损伤特征和结局进行了比较分析。
在198,744例有记录的创伤病例中，共有118例患者符合研究条件；其中26例患者（22.0%）接受了TAE。TAE组的格拉斯哥昏迷量表评分显著低于非TAE组（P = 0.019）；两组间的其他变量无显著差异。总体而言，住院死亡率为39.8%，中位住院时间为21.0天（0.0 - 53.5天）。TAE组的住院死亡率显著低于非TAE组（23.1%对44.6%；优势比[OR]，0.37；95%置信区间[CI]，0.14 - 1. [02]；P = 0.048）。然而，TAE组患者的中位住院时间更长（39.5 [7.3 - 53.5]天对14.0 [0.0 - 55.3]天，P = 0.072）。在逻辑回归模型中，在对潜在混杂因素进行调整后，TAE的使用被确定为预后较好的独立预测因素（OR，0.32；95% CI，0.66 - 0.88；P = 0.032）。低血压、高损伤严重度评分、60岁及以上年龄以及低格拉斯哥昏迷量表评分也与死亡率独立相关，OR分别为5.48、3.99、3.30和2.89。
MFH病例罕见，但死亡率高。在这类病例中，使用经导管动脉栓塞术似乎能取得成功的治疗效果。需要进一步研究以证实TAE的疗效并评估其适应证和并发症。
