鼻骨骨折合并鼻中隔损伤的诊疗进展

Advances in the diagnosis and treatment of nasal bone fracture with concomitant nasal septal injury

摘要:

未经规范治疗的鼻中隔损伤是导致鼻骨骨折复位术后出现持续性鼻塞、鼻背偏斜等不良预后的关键风险因素。鼻中隔损伤的治疗效果决定患者远期鼻部外形与通气功能的恢复。鼻中隔血肿罕见，一旦发现需及早有效处理。依据骨折累及骨性鼻中隔的范围及是否延伸至软骨进行临床分型，有助于术前方案制定。早期闭合复位适用于鼻中隔轻度骨折，对严重病例效果不佳。对于影响鼻框架结构稳定性的严重鼻中隔骨折，早期行开放鼻中隔成形术能降低术后鼻塞程度和翻修率。儿童患者避免早期行开放鼻中隔成形术，留待鼻部发育成熟后二期手术进一步矫正。因此，对于鼻中隔损伤的治疗应根据损伤严重程度、患者特征制定个体化方案。早期积极处理鼻中隔损伤，是改善患者远期功能与外形、降低翻修率的有效策略。

Abstract:

Not properly treated nasal septal injury is a key risk factor for adverse outcomes such as persistent nasal obstruction and dorsal deviation after nasal bone reduction. The outcome of nasal septal injury treatment determines the long-term restoration of the patient’s nasal appearance and ventilatory function. Nasal septal hematoma is rare and requires prompt and effective management upon discovery. Clinical classification based on the extent of the fracture involving the bony septum and whether it extends to the cartilage aids in preoperative planning. Early closed reduction is suitable for mild nasal septal fractures but is ineffective for severe cases. For severe nasal septal fractures that affect the stability of the nasal framework, early open septoplasty can reduce the degree of postoperative nasal obstruction and revision rate. Pediatric patients should avoid early open septoplasty and wait for the nasal development to mature before undergoing secondary surgery for further correction. Therefore, the treatment of nasal septal injury should be individualized based on the severity of the injury and the characteristics of the patient. Early and active management of nasal septal injury is an effective strategy to improve long-term function and appearance of the patient and reduce the revision rate.