Burm J S, Oh S J
Department of Plastic and Reconstructive Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
Plast Reconstr Surg. 1998 Aug;102(2):342-9. doi: 10.1097/00006534-199808000-00007.
The majority of nasal fractures have been managed by using closed reduction and intranasal packing. In comminuted nasal fractures, open reduction and internal fixation may be indicated for accurate reduction and rigid fixation, but it is a very aggressive procedure. We developed a new technique for comminuted nasal fractures: indirect open reduction and intranasal Kirschner wire splinting. A periosteal elevator is used to elevate the mucoperiosteum posterior to the nasal bone through intercartilaginous incision and to reduce accurately the nasal bone, at the same time detecting the fracture lines. The Kirschner wire is used to insert between the nasal bone and the mucoperiosteum and to splint rigidly the nasal bone. During the follow-up period of 5 weeks to 4 months, 23 of 27 patients (85 percent) had successful cosmetic results. Four patients had slight cosmetic deformity but did not request a late rhinoplasty. Nineteen patients had accurate reduction on a computed tomography scan. Ten patients had undercorrection of the nasal septum on a computed tomography scan, and three patients had significant septal deviation with airway obstruction. Indirect open reduction through intercartilaginous incision and intranasal Kirschner wire splinting is a reliable and useful method for the treatment of comminuted nasal fractures because it achieves accurate reduction and rigid, long intranasal support, can be done comfortably under local anesthesia, permits early nasal breathing postoperatively, has no external scar, and minimizes complications such as nasal bleeding, soft-tissue injury, infection, and recurrent displacement.
大多数鼻骨骨折采用闭合复位和鼻内填塞进行处理。对于粉碎性鼻骨骨折，切开复位内固定术可用于精确复位和坚强固定，但这是一种创伤性较大的手术。我们开发了一种治疗粉碎性鼻骨骨折的新技术：间接切开复位和鼻内克氏针内固定。通过软骨间切口，使用骨膜剥离子将鼻骨后方的黏骨膜掀起，同时准确复位鼻骨并探查骨折线。将克氏针插入鼻骨和黏骨膜之间，对鼻骨进行坚强内固定。在5周至4个月的随访期内，27例患者中有23例（85%）获得了满意的美容效果。4例患者有轻微的美容畸形，但未要求后期行鼻整形术。19例患者在计算机断层扫描上显示复位准确。10例患者在计算机断层扫描上显示鼻中隔矫正不足，3例患者有明显的鼻中隔偏曲并伴有气道阻塞。经软骨间切口间接切开复位和鼻内克氏针内固定是治疗粉碎性鼻骨骨折的一种可靠且有效的方法，因为它能实现精确复位和坚强、持久的鼻内支撑，可在局部麻醉下舒适地完成手术，术后能早期恢复鼻腔通气，无外部瘢痕，且能将鼻出血、软组织损伤、感染和反复移位等并发症降至最低。
