Traumatic intracranial hemorrhages in patients with maxillofacial/jaw fractures
Traumatic intracranial hemorrhages in patients with maxillofacial/jaw fractures
复制标题
颌面部/颌骨骨折患者的外伤性颅内出血
DOI：
10.3893/jjaam.19.1023
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
K. Sasaki
中科院分区：
文献类型：
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作者：
T. Kanno;M. Mitsugi;Y. Furuki;Masako Fujioka;A. Katsumata;Y. Matsumoto;K. Sasaki
颌面部骨折的患者有合并创伤性颅内血肿的风险，这是发病率和死亡率的主要原因。及时识别临床体征，然后进行神经外科检查和诊断，对于提高患者生存率和恢复至关重要。为了寻找颌面部骨折模式与颅内出血风险之间的关系，本回顾性研究检查了2005年1月至2008年6月期间在日本香川县立中央医院口腔颌面外科治疗的188例颌面部骨折患者的记录。分析患者的年龄、性别、颌面部骨折的原因、类型、部位以及颅内损伤情况。17例患者（9.0%）发生颅内出血，包括脑内出血（6.4%）、蛛网膜下腔出血（4.8%）、硬膜下出血（3.7%）和硬膜外出血（0.5%）。面中部（LeFort-2/3）、颅穹窿和颅底骨折伴发颅内出血的风险更高。全面部颌面部骨折（OR 19.1）和高能量损伤（OR 50.8）增加了伴随颅内出血的风险。尽管如此，外伤性颅内血肿被发现与一个简单的骨折的脑膜瘤，一个上颌骨，两个骨折的下颌骨，甚至两个上颌牙槽骨折。4例患者（23.5%）不得不接受神经外科手术以清除颅内血肿。高能量损伤可能影响颅内血管，导致颅内不同部位出血。因此，在治疗颌面部骨折时，口腔颌面外科医生和急诊和重症监护医生应始终考虑创伤性颅内出血的临床体征，并与重症监护中心和神经外科医生密切协商。
Patients sustaining maxillofacial fractures are at risk of accompanying traumatic intracranial hematomas, which are a major cause of morbidity and mortality. Prompt recognition of the clinical signs, followed by a neurosurgical inspection and diagnosis, is crucial for improving patient survival and recovery. To look for a relationship between the pattern of maxillofacial fractures and the risk of an intracranial hemorrhage, this retrospective study examined the records of 188 patients with maxillofacial fractures treated at the Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan, between January 2005 and June 2008. The patients' age, gender, cause, type, and location of maxillofacial fracture, and the intracranial injuries, were analyzed. Intracranial hemorrhage occurred in 17 patients (9.0%) and included intracerebral (6.4%), subarachnoid (4.8%), subdural (3.7%), and epidural (0.5%) hemorrhages. Central mid-face (LeFort-2/3), cranial vault, and basal skull fractures had much higher risks of an accompanying intracranial hemorrhage. Pan-facial maxillofacial fractures (OR 19.1) and high-energy injuries (OR 50.8) increased the risk of an accompanying intracranial hemorrhage. Nevertheless, traumatic intracranial hemorrhages were seen with one simple fracture of the zygoma, one of the maxilla, two fractures of the mandible, and even two maxillary alveolar fractures. Four patients (23.5%) had to undergo neurosurgery to decompress an intracranial hematoma. High-energy injuries may affect the intracranial vessels, leading to hemorrhage in different intracranial compartments. Therefore, when treating maxillofacial fractures, oral and maxillofacial surgeons and emergency and critical care physicians should always consider the clinical signs of traumatic intracranial hemorrhage, in close consultation with critical care centers and neurosurgeons.