高能量创伤与低能量创伤中的面部骨折及相关损伤：并非所有情况都相同。
Facial fractures and associated injuries in high- versus low-energy trauma: all are not created equal.
作者信息
Hilaire Cameron St, Johnson Arianne, Loseth Caitlin, Alipour Hamid, Faunce Nick, Kaminski Stephen, Sharma Rohit
机构信息
Santa Barbara Cottage Hospital, Santa Barbara, California USA.
出版信息
Maxillofac Plast Reconstr Surg. 2020 Jun 24;42(1):22. doi: 10.1186/s40902-020-00264-5. eCollection 2020 Dec.
INTRODUCTION
Facial fractures (FFs) occur after high- and low-energy trauma; differences in associated injuries and outcomes have not been well articulated.
OBJECTIVE
To compare the epidemiology, management, and outcomes of patients suffering FFs from high-energy and low-energy mechanisms.
METHODS
We conducted a 6-year retrospective local trauma registry analysis of adults aged 18-55 years old that suffered a FF treated at the Santa Barbara Cottage Hospital. Fracture patterns, concomitant injuries, procedures, and outcomes were compared between patients that suffered a high-energy mechanism (HEM: motor vehicle crash, bicycle crash, auto versus pedestrian, falls from height > 20 feet) and those that suffered a low-energy mechanism (LEM: assault, ground-level falls) of injury.
RESULTS
FFs occurred in 123 patients, 25 from an HEM and 98 from an LEM. Rates of Le Fort (HEM 12% vs. LEM 3%, = 0.10), mandible (HEM 20% vs. LEM 38%, = 0.11), midface (HEM 84% vs. LEM 67%, = 0.14), and upper face (HEM 24% vs. LEM 13%, = 0.217) fractures did not significantly differ between the HEM and LEM groups, nor did facial operative rates (HEM 28% vs. LEM 40%, = 0.36). FFs after an HEM event were associated with increased Injury Severity Scores (HEM 16.8 vs. LEM 7.5, <0.001), ICU admittance (HEM 60% vs. LEM 13.3%, <0.001), intracranial hemorrhage (ICH) (HEM 52% vs. LEM 15%, <0.001), cervical spine fractures (HEM 12% vs. LEM 0%, = 0.008), truncal/lower extremity injuries (HEM 60% vs. LEM 6%, <0.001), neurosurgical procedures for the management of ICH (HEM 54% vs. LEM 36%, = 0.003), and decreased Glasgow Coma Score on arrival (HEM 11.7 vs. LEM 14.2, <0.001).
CONCLUSION
FFs after HEM events were associated with severe and multifocal injuries. FFs after LEM events were associated with ICH, concussions, and cervical spine fractures. Mechanism-based screening strategies will allow for the appropriate detection and management of injuries that occur concomitant to FFs.
TYPE OF STUDY
Retrospective cohort study.
LEVEL OF EVIDENCE
Level III.
引言
面部骨折（FFs）可发生于高能和低能创伤后；相关损伤和预后的差异尚未得到充分阐明。
目的
比较因高能和低能机制导致面部骨折患者的流行病学、治疗及预后情况。
方法
我们对在圣巴巴拉小屋医院接受治疗的18至55岁成年面部骨折患者进行了为期6年的回顾性本地创伤登记分析。比较了因高能机制（HEM：机动车碰撞、自行车碰撞、汽车与行人碰撞、从高于20英尺处坠落）和低能机制（LEM：袭击、平地跌倒）受伤的患者的骨折类型、伴随损伤、治疗方法及预后。
结果
123例患者发生面部骨折，其中25例由高能机制导致，98例由低能机制导致。Le Fort骨折发生率（HEM组12% vs. LEM组3%，P = 0.10）、下颌骨骨折发生率（HEM组20% vs. LEM组38%，P = 0.11）、中面部骨折发生率（HEM组84% vs. LEM组67%，P = 0.14）和上面部骨折发生率（HEM组24% vs. LEM组13%，P = 0.217）在HEM组和LEM组之间无显著差异，面部手术率也无显著差异（HEM组28% vs. LEM组40%，P = 0.36）。高能机制事件后的面部骨折与损伤严重程度评分增加相关（HEM组16.8 vs. LEM组7.5，P <0.001）、入住重症监护病房（ICU）（HEM组60% vs. LEM组13.3%，P <0.001）、颅内出血（ICH）（HEM组52% vs. LEM组15%，P <0.001）、颈椎骨折（HEM组12% vs. LEM组0%，P = 0.008）、躯干/下肢损伤（HEM组60% vs. LEM组6%，P <0.001）、因ICH进行的神经外科手术（HEM组54% vs. LEM组36%，P = 0.003）以及入院时格拉斯哥昏迷评分降低相关（HEM组11.7 vs. LEM组14.2，P <0.001）。
结论
高能机制事件后的面部骨折与严重和多灶性损伤相关。低能机制事件后的面部骨折与ICH、脑震荡和颈椎骨折相关。基于机制的筛查策略将有助于对面部骨折伴随发生的损伤进行适当的检测和管理。
研究类型
回顾性队列研究。
证据水平
三级。
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