Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon, 14584, Republic of Korea.
J Otolaryngol Head Neck Surg. 2019 Jul 30;48(1):36. doi: 10.1186/s40463-019-0359-2.
The goal of treatment for zygomaticomaxillary (ZM) complex (ZMC) fractures is to achieve stability and restore aesthetic appearance through three-dimensional reduction and rigid fixation. The purpose of this study was to evaluate the stability and aesthetic appearance outcomes of one-point fixation using a three-dimensional photogrammetric analysis.
From March 2014 to December 2014, 34 patients with ZMC fractures were treated by one-point fixation in the ZM buttress using unsintered hydroxyapatite (u-HA)/poly-L-lactide (PLLA) plates. Differences in soft tissue inter-malar height between the fractured side and unfractured sides were evaluated using photogrammetric analysis with a three-dimensional camera (Morphius®) at the preoperative and 1 week, 1 and 3 months after surgery. The differences in bony inter-malar height between the fractured and unfractured sides were evaluated using computer tomography at the pre-operative and 6 months after surgery. The paired t-test was used to compare differences in malar height.
Six months after surgery, 34 patients achieved satisfactory bony stability and symmetric malar appearances. Comparisons of differences in soft-tissue inter-malar height revealed statistically significant differences between the pre-operative period and 1 week and 1 month after surgery (p < .01). There was no statistically significant difference between 1 and 3 months after surgery. Comparison of differences in bony inter-malar height revealed a statistically significant difference between before and 6 months after surgery (p < .01).
When we conducted a three-dimensional photogrammetric analysis, although it has restricted surgical indications, one-point fixation of the ZM buttress using an u-HA / PLLA plate yielded reliable, satisfactory, and safe clinical results in patients with ZMC fractures.
CLINICAL QUESTION / LEVEL OF EVIDENCE: Therapeutic, III.
颧骨复合体（ZMC）骨折的治疗目标是通过三维复位和坚固固定实现稳定性并恢复美学外观。本研究的目的是通过三维摄影分析评估单点固定的稳定性和美学效果。
2014 年 3 月至 2014 年 12 月，我们使用未烧结羟基磷灰石（u-HA）/聚 L-乳酸（PLLA）板对 34 例 ZMC 骨折患者进行 ZM 支柱的单点固定治疗。使用三维相机（Morphius®）对术前、术后 1 周、1 个月和 3 个月的软组织眶颧间距差值进行摄影分析，并对术前和术后 6 个月的骨眶颧间距差值进行计算机断层扫描。采用配对 t 检验比较眶颧间距差值。
术后 6 个月，34 例患者获得满意的骨性稳定性和对称的颧骨外观。软组织眶颧间距差值的比较显示，术前与术后 1 周和 1 个月差异有统计学意义（p<.01）。术后 1 个月与 3 个月差异无统计学意义。骨眶颧间距差值的比较显示，术前与术后 6 个月差异有统计学意义（p<.01）。
当我们进行三维摄影分析时，尽管单点固定的手术适应证受到限制，但使用 u-HA / PLLA 板固定 ZM 支柱可在 ZMC 骨折患者中获得可靠、满意和安全的临床效果。
临床问题/证据水平：治疗，III 级。
