Mayer J S, Wainwright D J, Yeakley J W, Lee K F, Harris J H, Kulkarni M
Department of Radiology, University of Texas Health Science Center, Houston 77030.
J Trauma. 1988 Jul;28(7):1043-53. doi: 10.1097/00005373-198807000-00022.
Open reduction and internal fixation of facial fractures demand a detailed understanding of the three-dimensional pattern of injury. This is difficult if not impossible to obtain with present radiographic methods. The purpose of this study was to define the role of three-dimensional computerized tomography (3DCT) in surgical management of facial fractures. The two-part investigation: 1) compared the diagnostic accuracy of 3DCT with conventional CT and plain film studies; and 2) examined the clinical usefulness of 3DCT to surgeons. Twenty-four acute trauma patients suspected of having facial fractures were examined radiographically with analysis of every facial bone and specific facial regions. Particular attention was directed to the course of the fracture lines and the number, size, and displacement of fracture fragments. The surgeons were then asked to conceptualize the reported and the personally observed radiographic information and document their impressions on preprinted diagrams of the facial skeleton. They also completed questionnaires designed to indicate whether patient management would be influenced by the 3DCT. The radiographic findings were correlated with intraoperative observations. The 3DCT provided superior definition of fracture lines (especially horizontal) and the extent of comminution was better appreciated. This additional information improved the surgeons' ability to plan placement of interfragmentary wires and/or plates. Surgeons were also able to more accurately predict those patients requiring immediate bone grafting. Large, life-size 3D images of the facial skeleton made intraoperative conceptualization of the injury pattern easier. The accuracy of the 3DCT images corroborated the intraoperative findings in all cases. The following conclusions are offered: 1) The diagnosis of most mandibular fractures can be made equally well with conventional and 3DCT techniques. 2) Improved diagnosis of fracture lines and the specific patterns of comminution in midface fractures is made possible with 3DCT. 3) If open reduction and internal fixation is the mode of treatment, 3DCT is desirable because the added information makes preoperative planning more accurate and thereby facilitates surgical intervention.
面部骨折的切开复位内固定需要对面部损伤的三维模式有详细的了解。而采用目前的放射学方法，即便并非完全不可能，也很难做到这一点。本研究的目的是确定三维计算机断层扫描（3DCT）在面部骨折手术治疗中的作用。这项分为两部分的研究：1）比较3DCT与传统CT及平片检查的诊断准确性；2）检验3DCT对外科医生的临床实用性。对24例疑似面部骨折的急性创伤患者进行了放射学检查，分析了每块面部骨骼和特定面部区域。特别关注骨折线的走行以及骨折碎片的数量、大小和移位情况。然后要求外科医生构思报告的和亲自观察到的放射学信息，并在面部骨骼的预印图上记录他们的印象。他们还完成了旨在表明患者治疗是否会受到3DCT影响的问卷。将放射学检查结果与术中观察结果进行了对比。3DCT能更清晰地显示骨折线（尤其是水平骨折线），对粉碎程度的了解也更好。这些额外信息提高了外科医生规划骨折块间钢丝和/或钢板放置的能力。外科医生还能够更准确地预测哪些患者需要立即进行骨移植。面部骨骼的大型真人大小三维图像使术中对损伤模式的构思更加容易。3DCT图像的准确性在所有病例中都与术中发现相符。得出以下结论：1）大多数下颌骨骨折采用传统技术和3DCT技术诊断效果相当。2）3DCT能够更好地诊断面中部骨折的骨折线和特定粉碎模式。3）如果采用切开复位内固定作为治疗方式，3DCT是可取之选，因为其提供的额外信息使术前规划更准确，从而便于手术干预。
