Results of treatment of patients with midfacial fractures

A. Khudyk, S. Grigorov
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Abstract

Background. Fractures of the bones of the facial skeleton, in particular the midface area, are one of the most frequent reasons for patients to apply to maxillofacial inpatient care, not only in Ukraine but also abroad. Along with more modern treatment technologies (osteosynthesis using titanium miniplates and minigrid for fixation bone fragments), methods of repositioning of fragments with subsequent tamponade of the maxillary sinus with iodoform tampon and without tamponade and fixation of fragments are used. A certain group of patients is treated conservatively, which is associated with their reluctance to undergo surgery, minimal displacement of fragments or minimal cosmetic and functional impairments. The purpose of the study. Comparative evaluation of the results of treatment of patients with fractures of the midface area by repositioning the fragments of the zygomatic-orbital complex without fixating the fragments and their subsequent fixation by tamponade of the maxillary sinus with iodoform tampon. Object and methods of research. The comparison was made of the results of treatment of 70 patients with fractures of the midface area, among which 13 patients were treated by the method of repositioning fragments of the zygomatic-orbital complex (ZOC) without fixation and without maxillary sinus tamponade, 29 patients underwent repositioning of ZOC fragments with subsequent fixation of fragments with iodoform tampon – the tamponade of the maxillary sinus was performed on the affected side. For comparison, the results of conservative treatment of 28 patients with fractures of the midface area were used. Results. It was found that the reliable (χ2=11.43; p<0.05) majority of patients (64%) sought treatment within 0-3 days after injury. 83-89% of patients who underwent repositioning of the fragments had fresh small-fragment fractures. The reliable (χ2=11.43; p<0.05) majority of them simultaneously had 3-4 sites of bone fractures of the midfacearea, hemosinus of varying degrees and paresthesia in the infraorbital area. In the majority of patients who underwent repositioning of bone fragments with and without tamponade (85% and 93%, respectively), the final displacements ranged from 3.1 to 6 mm. In patients treated conservatively, in most cases (93%) the displacements were greater than 3.1 mm, which remained after treatment. Conclusion. In the majority of patients treated with the studied methods, in the long term, the displacement of bone fragments remained, which had functional and cosmetic consequences. In all studied groups, a certain cosmetic effect was achieved over time, as evidenced by a reliable (χ2=160.9; p=0.00000) decrease in the indicator by the visual analogue scale .
面中骨折患者的治疗效果
背景。面部骨骼的骨折,特别是面中区域的骨折,是患者申请颌面住院治疗的最常见原因之一,不仅在乌克兰,而且在国外。随着更现代的治疗技术(使用微型钛板和微型网格固定骨碎片),使用碘形卫生棉条将碎片重新定位并随后填塞上颌窦和不填塞并固定碎片的方法。某一组患者接受保守治疗,这与他们不愿接受手术、最小的碎片移位或最小的美容和功能损伤有关。研究的目的。颧眶复合体碎片复位不固定与碘仿棉条填塞上颌窦内固定治疗面中区骨折的效果比较。研究对象和方法。对70例面中区骨折患者的治疗结果进行比较,其中13例采用颧眶复合体(ZOC)碎片复位不固定和上颌窦不填塞的方法,29例采用ZOC碎片复位后用碘形棉条固定碎片-患侧上颌窦填塞。采用保守治疗的方法对28例面中区骨折患者进行比较。结果表明,该指标的可靠度(χ2=11.43;P <0.05)大多数患者(64%)在伤后0 ~ 3天内就诊。83-89%接受碎片复位的患者有新的小碎片骨折。信度(χ2=11.43;P <0.05)多数同时出现面中3 ~ 4处骨折、不同程度血窦及眶下区感觉异常。在大多数接受有或没有填塞的骨碎片重新定位的患者中(分别为85%和93%),最终移位范围为3.1至6mm。在保守治疗的患者中,大多数(93%)患者的移位大于3.1 mm,治疗后仍然存在。在大多数用研究方法治疗的患者中,长期来看,骨碎片的移位仍然存在,这对功能和美容都有影响。在所有研究组中,随着时间的推移,取得了一定的美容效果,可靠的(χ2=160.9;P =0.00000),该指标通过视觉模拟量表下降。
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