Choi Jun Ho, Oh Hyun Myung, Hwang Jae Ha, Kim Kwang Seog, Lee Sam Yong
Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.
Arch Craniofac Surg. 2022 Jun;23(3):119-124. doi: 10.7181/acfs.2022.00661. Epub 2022 Jun 20.
Many severe nasal bone fractures present with septal fractures, causing postoperative septal deviation and negatively affecting the patients' quality of life. However, when a septal fracture is absent, it is difficult to predict whether surgical correction can help minimize nasal septal deviation postoperatively. This study determined whether performing closed reduction on even mildly displaced nasal bone fracture could deter the outcome of septal deviation.
We retrospectively reviewed the data of 116 patients aged 21-72 years who presented at the outpatient clinic and emergency room with fractures of nasal bones only without any involvement of the septum from January 2014 to December 2020. Patients were classified into three fracture type groups: A (unilateral), B (bilateral), and C (comminuted with depression). The degree of septal deviation was calculated by measuring the angle between the apex of the most prominent point and the crista galli in the coronal view on computed tomography images. The difference between the angles of the initial septal deviation and that of the follow-up was calculated and expressed as delta (Δ).
Closed reduction tended to decrease the postoperative septal deviation in all fracture types, but the values were significantly meaningful only in type A and B fractures. In the surgical group, with type A as the baseline, type B showed a significantly larger Δ value, but type C was not significantly different, although type C showed a smaller Δ value. In the conservative group, with type A as the baseline, the other fracture types presented significantly lower Δ values.
For all fracture types, closed reduction significantly decreased the extent to which the nasal septum likely deviated. Therefore, when a patient is reluctant to undergo closed reduction, physicians should address the possible outcomes and prognosis of untreated nasal bone fractures.
许多严重的鼻骨骨折伴有鼻中隔骨折，导致术后鼻中隔偏曲，对患者的生活质量产生负面影响。然而，当不存在鼻中隔骨折时，很难预测手术矫正是否有助于将术后鼻中隔偏曲降至最低。本研究确定了即使是轻度移位的鼻骨骨折进行闭合复位是否会影响鼻中隔偏曲的结果。
我们回顾性分析了2014年1月至2020年12月在门诊和急诊室就诊的116例21 - 72岁患者的数据，这些患者仅鼻骨骨折，鼻中隔未受累。患者被分为三个骨折类型组：A组（单侧）、B组（双侧）和C组（粉碎性伴凹陷）。通过在计算机断层扫描图像的冠状面上测量最突出点的顶点与鸡冠之间的角度来计算鼻中隔偏曲的程度。计算初始鼻中隔偏曲角度与随访角度之间的差异，并表示为差值（Δ）。
闭合复位在所有骨折类型中都倾向于减少术后鼻中隔偏曲，但仅在A组和B组骨折中，该值具有显著意义。在手术组中，以A组为基线，B组的Δ值显著更大，但C组无显著差异，尽管C组的Δ值较小。在保守组中，以A组为基线，其他骨折类型的Δ值显著更低。
对于所有骨折类型，闭合复位显著降低了鼻中隔可能偏曲的程度。因此，当患者不愿接受闭合复位时，医生应告知其未治疗的鼻骨骨折可能的后果和预后。
