颞骨与面部骨折并存：模式、结局及缓冲效应假说。

文献信息

中文摘要

目的： 探讨颞骨骨折（TBFs）合并面部骨折（FBFs）患者的损伤模式、临床特征及结局。并在缓冲效应假说的背景下评估这些发现。
方法： 对一家三级医疗中心经影像学确诊的TBFs患者进行回顾性队列分析。根据是否合并FBFs对患者进行分组。比较就诊时和随访时的特征，包括创伤机制、评估发现和TBF并发症。在控制年龄、性别和创伤机制后，进行多因素logistic回归分析。
结果： 2011年2月至2023年11月期间，219例TBF患者中有61例合并FBFs。机动车碰撞是TBF/FBF组最常见的创伤机制（50.82%），而跌倒则在单纯TBF组中占主导（43.67%）。合并FBFs与鼓室积血发生率降低（OR=0.338，p=0.001）以及随访评估时主观听力损失发生率降低（OR=0.284，p=0.001）相关。具体而言，TBF/FBF队列中的下颌骨骨折与颅内出血（ICH）风险降低相关（OR=0.127，p=0.005）。其他TBF并发症未见差异。
结论： 合并FBFs的TBF患者遭受了更严重的初始创伤，但鼓室积血和听力损失的发生率较低。TBF/FBF队列中的下颌骨骨折与较低的ICH发生率独立相关。这些发现与缓冲效应假说相符；然而，无法推断因果关系。需要进一步的前瞻性和生物力学研究来阐明这些关系。
证据等级： 4。

英文摘要

OBJECTIVES: To investigate injury patterns, clinical features and outcomes in patients with concomitant temporal bone fractures (TBFs) and facial bone fractures (FBFs). To evaluate these findings in the context of the cushion effect hypothesis.
METHODS: Retrospective cohort analysis of patients with radiographically confirmed TBFs at a tertiary care medical center. Patients were grouped by presence or absence of concomitant FBFs. Characteristics including trauma mechanism, findings on evaluation, and TBF complications were compared at presentation and follow-up. Multivariate logistic regression analysis was performed controlling for age, gender, and trauma mechanism.
RESULTS: Of 219 TBF patients from February 2011 to November 2023, 61 had concomitant FBFs. Motor vehicle collision was the most common trauma mechanism in the TBF/FBF group (50.82%) and fall was predominant in the TBF alone group (43.67%). Concomitant FBFs were associated with a reduced rate of hemotympanum (OR = 0.338, p = 0.001) and subjective hearing loss on follow-up evaluation (OR = 0.284, p = 0.001). Specifically, mandibular fractures in the TBF/FBF cohort were associated with a decreased risk of intracranial hemorrhage (ICH) (OR = 0.127, p = 0.005). No differences were observed for other TBF complications.
CONCLUSION: TBF patients presenting with concomitant FBFs sustained more severe initial trauma, but had lower rates of hemotympanum and hearing loss. Mandibular fractures in the TBF/FBF cohort were independently associated with lower rates of ICH. These findings are compatible with the cushion effect hypothesis; however, causality cannot be inferred. Further prospective and biomechanical studies are warranted to clarify these relationships.
LEVEL OF EVIDENCE: 4.