Radiographic evaluation of percutaneous transfacial wiring versus open internal fixation for surgical treatment of unstable zygomatic bone fractures

Introduction
The fixation of unstable zygomaticomaxillary complex (ZMC) fractures can be achieved by open reduction with rigid internal fixation (ORIF) and/or by closed reduction with percutaneous transfacial Kirschner wire fixation (CRWF). The aim of this study was to tomographically assess the symmetry and the protrusion of the cheekbone with unstable ZMC fractures that had been treated by ORIF vs. CRWF.
Materials and methods
Sixty patients exhibiting a surgically unstable tetrapodal ZMC fracture were included in this multicenter retrospective study. The coordinates of 5 landmarks representing the zygomatic protrusion were comparatively studied on the healthy and on the broken side using preoperative and postoperative tridimensional computed tomography (CT) scans or cone beam CT.
Results
No significant difference was found in the zygomatic protrusion irrespective of the surgical technique that was used. The zygomatico-maxillary ansa was found to be the most complicated area to reduce, particularly in the frontal plane with both the CRWF and the ORIF technique (p1 = 0.001 and p2 = 0.0009, respectively). There was no difference in terms of the level of complications, while the mean duration of the surgery was significantly less for the CRWF group.
Conclusion
With good postoperative radiographic outcomes, the CRWF can be proposed as an alternative or in association with the ORIF technique for fixation of tetrapodal fractures of the ZMC.

引言
不稳定颧骨上颌复合体（zygomaticomaxillary complex, ZMC）骨折的固定可通过切开复位内固定术（open reduction with rigid internal fixation, ORIF）和/或经皮经面克氏针固定联合闭合复位（closed reduction with percutaneous transfacial Kirschner wire fixation, CRWF）实现。本研究旨在通过影像学手段，对比评估分别采用ORIF与CRWF治疗的不稳定ZMC骨折患者的颧骨对称性与突出度。
材料与方法
本多中心回顾性研究纳入了60例经手术证实的四足型ZMC不稳定骨折患者。研究人员于术前及术后分别获取三维计算机断层扫描（computed tomography, CT）或锥形束CT（cone beam CT）影像，对比分析健侧与患侧5个代表颧骨突出度的标志点坐标。
结果
无论采用何种手术方式，颧骨突出度均未出现显著差异。颧上颌襻（zygomatico-maxillary ansa）被证实为最难复位的区域，尤其在额状面层面，采用CRWF与ORIF技术时该区域的复位难度均存在统计学差异（分别对应p₁=0.001与p₂=0.0009）。两组患者的并发症发生率无显著差异，但CRWF组的平均手术时长显著更短。
结论
在术后影像学结果良好的前提下，CRWF可作为ZMC四足型骨折固定的替代方案，或与ORIF技术联合应用。