7 年间美国一家三级护理医院收治的 150 例儿童下颌骨骨折的处理。
Management of Mandible Fracture in 150 Children Across 7 Years in a US Tertiary Care Hospital.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.
Medical Student, Indiana University School of Medicine, Indianapolis.
出版信息
JAMA Facial Plast Surg. 2019 Sep 1;21(5):414-418. doi: 10.1001/jamafacial.2019.0312.
IMPORTANCE
Pediatric mandible fractures are the most common pediatric facial fracture requiring hospitalization, but data are lacking on management methods, outcomes, and complications.
OBJECTIVE
To analyze management methods, outcomes, and complications of pediatric mandible fractures at an urban academic tertiary care center.
DESIGN, SETTING, AND PARTICIPANTS: Single-institution cohort study conducted at 2 urban level 1 pediatric trauma centers including all patients aged 0 to 17 years diagnosed with mandible fractures between January 1, 2010, and December 31, 2016. Fractures were treated by multispecialty surgical teams. Data were analyzed between January 1, 2018, and March 1, 2018.
MAIN OUTCOMES AND MEASURES
Fracture distributions, mechanisms, treatment methods, complications, and follow-up.
RESULTS
Of 150 patients with 310 total mandible fractures, the mean (SD) age was 12.8 (4.6) years; 108 (72.0%) were male; 107 (71.3%) were white; and 109 (72.7%) had 2 or more mandible fractures. There were 78 condylar or subcondylar fractures (60 patients), 75 ramus or angle fractures (69 patients), 69 body fractures (62 patients), 78 symphyseal or parasymphyseal fractures (76 patients), and 10 coronoid fractures (10 patients). The most common mechanisms of injury were assault and battery, motor vehicle collisions, falls or play, and sports-related mechanisms. Thirty-eight (25%) patients were treated with observation and a soft diet. Children 12 years and older were more likely to receive open reduction internal fixation (ORIF) (P = .02). Of 112 patients treated with surgery, 63 (56.2%) were treated with maxillomandibular fixation (MMF), 24 (21.4%) received ORIF, and 20 (17.9%) received both MMF and ORIF. Nonabsorbable plating was used in all but 1 of the ORIF procedures. Five of 44 (11.4%) patients receiving ORIF or ORIF and MMF had follow-up beyond 6 months, and 8 of the 44 (18.2%) had documented plating hardware removal; hardware was in place for a mean (SD) 180 (167) days. Sixty of the 150 patients (40.0%) had some form of follow-up, a mean (SD) 90 (113) days total after initial presentation. Thirteen patients experienced complications, for a total complication rate of 8.7%.
CONCLUSIONS AND RELEVANCE
Conservative management, using MMF and a soft diet, was favored for most operative pediatric mandible fractures. Open reduction internal fixation with titanium plating was less commonly used. Outcomes were favorable despite a lack of consistent follow-up.
LEVEL OF EVIDENCE
重要性
儿童下颌骨骨折是最常见的需要住院治疗的儿童面部骨折，但关于其治疗方法、结果和并发症的数据却很缺乏。
目的
分析城市学术三级护理中心儿童下颌骨骨折的治疗方法、结果和并发症。
设计、地点和参与者：单机构队列研究，在 2 家城市 1 级儿科创伤中心进行，纳入 2010 年 1 月 1 日至 2016 年 12 月 31 日期间诊断为下颌骨骨折的年龄在 0 至 17 岁之间的所有患者。骨折由多学科手术团队进行治疗。数据于 2018 年 1 月 1 日至 2018 年 3 月 1 日进行分析。
主要结果和测量
骨折分布、机制、治疗方法、并发症和随访。
结果
150 例患者中有 310 例下颌骨骨折，平均（标准差）年龄为 12.8（4.6）岁；108 例（72.0%）为男性；107 例（71.3%）为白人；109 例（72.7%）有 2 处或 2 处以上下颌骨骨折。有 78 例髁突或髁突下骨折（60 例）、75 例下颌支或下颌角骨折（69 例）、69 例下颌体骨折（62 例）、78 例下颌联合或正中联合骨折（76 例）和 10 例喙突骨折（10 例）。最常见的损伤机制是攻击和殴打、机动车碰撞、跌倒或玩耍以及与运动有关的机制。38 例（25%）患者接受观察和软食治疗。12 岁及以上的儿童更有可能接受切开复位内固定（ORIF）（P = .02）。在接受手术治疗的 112 例患者中，63 例（56.2%）接受了下颌骨固定术（MMF），24 例（21.4%）接受了 ORIF，20 例（17.9%）接受了 MMF 和 ORIF。除了 1 例 ORIF 外，所有病例均采用不可吸收接骨板。44 例接受 ORIF 或 ORIF 加 MMF 治疗的患者中有 5 例（11.4%）进行了随访，44 例中有 8 例（18.2%）记录了接骨板硬件的移除；硬件放置的平均（标准差）时间为 180（167）天。150 例患者中有 60 例（40.0%）接受了某种形式的随访，从初次就诊到随访结束平均（标准差）为 90（113）天。13 例患者发生并发症，总并发症发生率为 8.7%。
结论和相关性
对于大多数手术治疗的儿童下颌骨骨折，采用 MMF 和软食的保守治疗是首选。钛板切开复位内固定术的应用较少。尽管缺乏一致的随访，但结果良好。
证据水平
4。
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