外伤性鼻骨骨折合并鼻中隔骨折同期和分期手术的疗效比较

董怿; 李胜胜; 马随斌; 韩慧君

doi:10.13201/j.issn.2096-7993.2025.04.009

外伤性鼻骨骨折合并鼻中隔骨折同期和分期手术的疗效比较

- 1.
  首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈科学教育部重点实验室(北京，100730)
- 2.
  和田地区人民医院耳鼻咽喉科
- 3.
  中国医学科学院基础医学研究所北京协和医学院基础学院流行病与卫生统计学系
基金项目:
北京同仁医院院基金(No：2023-YJJ-PY-003)

详细信息

通讯作者: 董怿，E-mail：drdongyi@126.com

中图分类号: R765.8

收稿日期: 2024-06-06

刊出日期: 2025-04-03

Comparison of the efficacy of simultaneous and staged surgical procedures for traumatic nasal bone fractures with septal fractures

- 1.
  Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China
- 2.
  Department of Otolaryngology, People's Hospital of Hotan District
- 3.
  Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College

More Information

Corresponding author: DONG Yi, E-mail: drdongyi@126.com

Received Date: 06 June 2024

Publish Date: 03 April 2025

摘要

摘要: 目的比较同期和分期行鼻骨整复及鼻中隔矫正术，对外伤性鼻骨骨折伴鼻中隔骨折治疗的优劣。方法收集来自和田地区人民医院耳鼻咽喉科与北京同仁医院耳鼻咽喉头颈外科的外伤性鼻骨骨折伴或不伴鼻中隔骨折患者，分为3组，A组：同期鼻骨整复和鼻中隔矫正术治疗；B组：分期鼻骨整复和鼻中隔矫正术治疗；C组：单纯鼻骨整复术治疗。记录3组术前、术后2周、术后3个月及B组二期术后2周、术后3个月的鼻外观评分及鼻塞症状的VAS评分。经统计学软件比较上述指标的差异。结果 3组手术治疗后2周较术前鼻外观评分均降低(P＜0.01)，且3组间差异均无统计学意义(P=0.43、0.71、0.58)。A组同期术后，鼻塞症状的VAS评分降低(P＜0.01)。B组一期术后与术前、一期术后3个月与术后2周比较，鼻塞VAS评分差异均无统计学意义(P=0.61、0.13)；B组二期术后较术前、二期术后3个月与一期术后3个月比较，VAS评分均降低(P＜0.01)。A组术后2周鼻塞VAS评分，低于B组一期术后(P＜0.01)。3组术后鼻腔粘连的发生率分别为0%、6.9%及4.3%。结论对于外伤性鼻骨骨折合并鼻中隔骨折的患者，全身麻醉内镜下同期进行鼻骨整复术及鼻中隔矫正术，在时效性上优于分期手术，且术后鼻腔粘连并发症的发生率更低。
- 鼻外伤 /
- 鼻骨骨折 /
- 鼻中隔骨折 /
- 手术治疗
Abstract: Objective To compare the outcomes of simultaneous versus staged nasal bone reduction and septoplasty in the treatment of traumatic nasal bone fractures with associated septal fractures. Methods Patients with traumatic nasal bone fractures, with or without septal fractures, were recruited from two hospitals and divided into three groups. Group A underwent simultaneous nasal bone reduction and septoplasty, Group B underwent staged nasal bone reduction and septoplasty, and Group C underwent nasal bone reduction only. Nasal appearance scores and nasal congestion Visual Analogue Scale (VAS) scores were measured preoperatively, at 2 weeks postoperatively, and at 3 months postoperatively. For Group B, scores were also recorded at 2 weeks and 3 months after the second-stage surgery. Differences were analyzed using statistical software. Results Two weeks post-surgery, the nasal appearance scores significantly decreased in all three groups compared to preoperative scores (P < 0.01), with no statistically significant differences between the groups (P= 0.43, 0.71, 0.58). In Group A, the VAS score for nasal congestion decreased significantly following simultaneous surgery (P < 0.01). In Group B, there were no significant differences in nasal congestion VAS scores between pre-surgery and post-first-stage, nor between three months post-first-stage and two weeks post-first-stage (P= 0.61, 0.13). However, the VAS scores significantly decreased after the second-stage surgery compared to pre-surgery, and three months post-second-stage surgery compared to three months post-first-stage surgery (P < 0.01). The VAS scores for nasal congestion at two weeks post-surgery in Group A were lower than those in Group B after the first-stage surgery (P < 0.01). The incidence rates of nasal adhesions post-surgery in Groups A, B, and C were 0%, 6.9%, and 4.3%, respectively. Conclusion For traumatic nasal bone fractures with associated septal fractures, performing simultaneous nasal bone reduction and septoplasty under general anesthesia using endoscopy is more time-efficient compared to staged surgery, and it results in a lower occurrence rate of post-surgical nasal adhesions.
- nasal trauma /
- nasal bone fracture /
- septal fracture /
- surgical treatment

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图 1 鼻骨骨折合并中隔骨折患者手术前后冠状位CT同一层面鼻中隔形态

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图 2 鼻骨骨折合并中隔骨折轴位CT像

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表 1 患者信息及受伤情况例(%)

特征	A组(n=33)	B组(n=29)	C组(n=70)
年龄
16~18岁	6(18.2)	0(0.0)	0(0.0)
19~30岁	11(33.3)	15(51.7)	27(38.6)
31~45岁	12(36.4)	11(37.9)	26(37.1)
≥46岁	4(12.1)	3(10.3)	17(24.3)
性别
女	3(9.0)	3(10.3)	22(31.4)
男	30(90.9)	26(89.7)	48(68.6)
受伤原因
运动损伤或自己撞伤/摔伤	16(48.5)	6(20.7)	19(27.1)
交通事故	4(12.1)	8(27.6)	15(21.4)
打架斗殴	13(39.4)	15(51.7)	36(51.4)
受伤至第一次手术时间
≤7 d	3(9.1)	1(3.4)	4(5.7)
8~14 d	26(78.8)	27(93.1)	64(91.4)
15~21 d	4(12.1)	1(3.4)	2(2.9)
平均时间/d	8.3±1.7	9.5±2.0	10.2±2.6
骨折部位
单侧鼻骨及鼻中隔	3(9.1)	7(24.1)	0(0)
双侧鼻骨及鼻中隔	30(90.9)	22(75.9)	0(0)
单侧鼻骨	0(0)	0(0)	8(11.4)
双侧鼻骨	0(0)	0(0)	62(88.6)

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表 2 各组术前术后鼻外观及鼻塞VAS评分比较 M(P₂₅，P₇₅)

组别	鼻外观评分	P	鼻塞症状VAS评分	P
A组
术后2周与术前比较	-5(-6，-4)	＜0.01	-3(-4，-2)	＜0.01
术后3个月与术前比较	-5(-5，-4)	＜0.01	-4(-5，-3)	＜0.01
术后3个月与术后2周比较	0(0，0)	0.38	0(-2，0)	0.56
B组
一期术后2周与术前比较	-4(-5，-4)	＜0.01	0(0，0)	0.61
一期术后3个月与术后2周比较	0(0，0)	0.35	0(-1，0)	0.13
二期术后2周与一期术后3个月比较	0(-1，0)	0.21	-3(-5，-2)	＜0.01
二期术后3个月与二期术后2周比较	0(-1，0)	0.56	0(-1，0)	0.12
二期术后3个月与术前比较	-5(-6，-3)	＜0.01	-4(-6，-3)	＜0.01
C组
术后2周与术前比较	-4(-5，-2)	＜0.01	0(-1，0)	0.14
术后3个月与术前比较	-4(-5，-2)	＜0.01	0(-2，0)	0.55
术后3个月与术后2周比较	0(0，0)	0.40	0(0，0)	0.39

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表 3 各组间术前术后鼻外观及鼻塞VAS评分比较 M(P₂₅，P₇₅)

组别	鼻外观评分		鼻塞症状VAS评分
组别	术后2周	术后3个月	术后2周	术后3个月
A组	-5(-6，-4)	-5(-5，-4)	-3(-4，-2)¹⁾²⁾	-4(-5，-3)³⁾
B组	-4(-5，-4)	-5(-6，-3)	0(0，0)	-4(-6，-3)³⁾
C组	-4(-5，-2)	-4(-5，-2)	0(-1，0)	0(-2，0)
与C组术后2周比较，¹⁾P＜0.05；与B组术后2周比较，²⁾P＜0.01；与C组术后3个月比较，³⁾P＜0.01。

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