Sidebottom A J, Cornelius P, Allen P E, Cobby M, Rogers S N
Department of Orthopaedics, Frenchay Hospital, Bristol, UK.
Injury. 1996 Jun;27(5):311-3. doi: 10.1016/0020-1383(96)00018-6.
Midfacial injuries are a common reason for attendance at Accident and Emergency (A&E) departments. A&E staff find these injuries difficult to assess due to limited undergraduate training in maxillofacial examination and early tissue oedema which may mask asymmetry. Patients are therefore referred for 'facial views' radiographs and commonly three views (OM15, OM30, lateral face) are taken for screening. We reviewed prospectively 137 consecutive patients over a 5-month period to determine whether one view (OM15) was sufficient to make a diagnosis in addition to clinical examination. Eighty-three per cent of patients had an accurate diagnosis from just the one view, representing a potential saving of 55 per cent of films taken. There were no fractures missed. The sensitivity was 87.5 per cent and the specificity was 83 per cent. We would suggest the introduction of a single-view facial radiograph as a safe method of screening for midfacial fracture in A&E patients where the clinical diagnosis is uncertain and provided there is no cervical injury. This would reduce costs by reducing films taken by over 50 per cent and patients' exposure to radiation.
面中部损伤是患者前往急诊部门就诊的常见原因。由于本科阶段在颌面检查方面的培训有限，且早期组织水肿可能掩盖不对称情况，急诊工作人员发现这些损伤难以评估。因此，患者会被要求拍摄“面部视图”X光片，通常会拍摄三张视图（15°眶下-臼齿位、30°眶下-臼齿位、侧面）用于筛查。我们前瞻性地回顾了连续5个月内的137例患者，以确定除临床检查外，仅一张视图（15°眶下-臼齿位）是否足以做出诊断。83%的患者仅通过这一张视图就能得到准确诊断，这意味着有可能节省55%的X光片拍摄量。没有漏诊骨折情况。敏感性为87.5%，特异性为83%。我们建议，对于临床诊断不确定且无颈椎损伤的急诊患者，引入单视图面部X光片作为筛查面中部骨折的安全方法。这将通过减少超过50%的X光片拍摄量以及患者的辐射暴露来降低成本。
