C-Arm Guided Reduction of Isolated Zygomatic Arch Fractures

利用C-Arm導引復位單獨性顴骨弓骨折

龔正良(Jenq-Liang Kung) ； 顏毓秀(Yu-Hsiu Yen) ； 高煜權(Kao Yu Chuan) ； 蒲啟明(Chi-Ming Pu) ； 劉致和(Chih-Ho Liu) ； 吳瑞星(J. H. Simon Wu) ； 呂旭彥(Shiuh-Yen Lu) ； 陳明庭(Ming-Ting Chen)

《臺灣整形外科醫學會雜誌》 23卷3期 (2014/09) Pp. 215-221

摘要

背景：骨折手術復位要能準確，最好是能在目視到骨折移位下進行。然而顴骨弓骨折復位通常是使用閉鎖復位來達成。如此，有沒有達到解剖復位，就端賴術後的X光片來證實，此將更增添術中的不確定性。目的及目標：本篇將介紹利用C臂在術中導引顴骨弓骨折的復位，以確定使骨折移位達到解剖復位。材料及方法：從2002到2012年，本院有261位顴骨骨折的病人。其中有32位是單獨性顴骨弓骨折。排除了不穩定而且需要內或外固定的骨折。因為使用C臂需要將病人脖子過度伸張，事前也需要審慎評估有無頭頸部外傷。於是我們利用Gillies復位手術，在C臂導引下徒手操作來避免骨折移位復位得不完全。結果：大部份的顴骨弓骨折移位都能達到解剖復位。大約有10%的病人無法達到解剖復位。其中只有一位在受傷後兩個星期才手術的病人，手術後復位沒有明顯改善。結論：手術中使用C臂來導引顴骨弓骨折的復位，可以更確保骨折移位達到解剖復位。

並列摘要

Background: The accurate surgical reduction of fractures is optimally performed by visualizing fracture displacement; however, the reduction of zygomatic arch fractures is typically accomplished using closed reduction. Anatomic reduction can be assured using only postoperative radiographs, thus causing intraoperative uncertainty. Aims and Objectives: This article introduces intraoperative C-arm guided reduction for assessing zygomatic arch fractures to assure the anatomic reduction of fracture displacement. Materials and Methods: Our hospital treated 261 patients for zygomatic bone fractures from 2002 to 2012; 32 of the patients exhibited isolated zygomatic arch fractures. Unstable fractures that exhibited severe comminution or torn periostea requiring internal or external fixation were excluded. Before operation, associated injuries, such as head and C-spine injuries, were meticulously evaluated and excluded. To prevent inadequate reduction of arch fracture displacement, Gillies reduction was performed using a C-arm guide and spare-hand palpation. Postoperative zygomatic bone X-rays were assessed to confirm the results of using the C-arm. Results: Most of the zygomatic arch fracture displacements attained anatomic reduction; however, approximately 10% of the arch fractures attained no anatomical reduction. Only one case demonstrated no obvious reduction after the operation, which was performed 2 weeks after injury. Conclusion: The intraoperative C-arm guided reduction of zygomatic arch fractures can assure the anatomic reduction of arch fracture displacements.

並列關鍵字

zygomatic arch fracture ； Gillies closed reduction ； intraoperative C-arm ； fluoroscopy