| Purpose: zygomatic complex fracture(ZCF)is the most likely happened maxillofacial region fracture;some previous reports suggest that the incidenceof ZCF could be above 30% of all kinds of maxillofacial fracture [1].However,facial deformity or dysfunction frequently happens due to the improper treatment to ZCF,which has bad impact to the patients' life.In order to improve the diagnosis and treatment,many researchers put forward many different kinds of classification methods but none of them is widely accepted by the doctors as a convenient,easy treating and therapeutic evaluation standard.What's more,the scientific and practical classification methods are very helpful for the diagnosis and treatment of ZCF.Although there are complex and multitudinous classification methods,all of them seem to ignore an important anatomical structure named as maxillary sinus which is around zygomatic complex.Maxillary sinus lies in the middle of maxilla,whose upper lateral wall is the inner part of zygomatic;and the maxillary sinus' back lateral wall connects the zygomatic by Zygomaticalveolar crest;its upper wall and part of zygoma jointly constitutes inferior orbital and part of lateral wall.Therefore,the translocation of Zygomatic complex protrusion to any given direction will cause the morphological change of maxillary sinus.In clinical practice,we have observed most of ZCFs are concerned with maxillary sinus fracture.The three dimensionalmorphological changes of maxillary sinus could reflect the ZCF's shift direction and degree.This study is to establish a new method to classify zygomatic complex fracture based on morphological change of maxillary sinus.Further more,we want to apply the classification method to the new therapy and to investigate the new classification method based on the maxillary sinus measurement.Finally,we want to study whether the morphological recovery of the maxillary sinus can be regarded as a new evaluation criterion to the postoperative result.Method:The objects of this study are 86 patientsin hospitalization from May 2011 to December 2015 who are injured in zygomatic complex in Huangdao Area of The Affiliated Hospital of Qingdao University.They are investigated according to their sexuality,age,occupation,injury causeand Zingg classification,and theirepidemiology character is also investigated.Moreover,we reviewed the 3D CT of the 86 patients,and we reclassify all patients according to the CT information regarding the shift of maxillary sinus wall fracture.We pick 17 patients with Bhemi-ZCF to direct operation reduction and to evaluate the postoperative effect with the help of measurementbased on the landmarks of maxillary sinus.Then the t-test is applied with the SPSS16.0.Results:1.86 patients' age ranges from 13 to 71 years old;the average is 37.47 years old,and their age mainly lies in the interval of 20-50 years old.The ratio of male to female is 5.1:1 respectively;The primary injury factor is traffic accident and the proportion is 55.8%.Occupational injury,sport injury,fighting injury and fall injury take the proportion of 14.0%,10.4%,12.8% and 7.0%,respectively.ZCF jointly injury take the proportion of 59.3%,the most common type is craniocerebral injury,which is accounted for35.4%;andmandibular fracture,limbs injury,thoracoabdominal injuries and spine injury take the proportion of21.5%?23.5%?15.7%?3.9%respectively.And there are 21 hemi-ZCF patients,accounted for 24.4% in all patients.Zingg classification shows that A1,A2,A3,B and C type fracture is 6,2,3,52 and 23 respectively.2.The classification result based on the morphology change of maxillary sinus is that,A type fracture has no changes in the morphology of maxillary sinus;among them,there were 6 cases of A1: fracture has no impact to maxillary sinus.5 cases are A2 fracture which has some impact to the maxillary sinus wall without translocation.B type is thecases that maxillary sinus' posterior-lateral and anteriorwall break and shift.Among them,B1 is 12 cases whose distal fracture shift to anterior and inner direction;B2 is 25 cases whose distal fracture shift to posterior and inner direction;B3 is 15 cases whose distal fractureshift to outer and anterior direction;B4 is 11 cases whosedistal fracture shift to lateral-posterior direction.C type fracture is 12 cases whose maxillary sinus break up in all directions and shift complicatedly.3.Among the new classification methods,the Bhemi-ZCF reset therapy for the 17 patientswith the application of the measurement based on the maxillary sinus' mark points is satisfied.Conclusion:1.The new classification method based on the morphology changes of maxillary sinuscould cover all types of ZCF,which has guiding significance to the clinical practice.Choosing the measurement based on the maxillary sinus' mark points pre-operation and post-operation could guide the hemi-B type ZCF reduction in new classification methods and could be used as the evaluation criterion for the post-operation curative effect. |
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