骨炎在慢性鼻窦炎中的影像学表现及相关因素分析

发布时间：2018-08-23 09:20

【摘要】：目的：分析骨炎在慢性鼻窦炎中的CT影像学表现及发病特点，探讨性别、年龄、鼻息肉、病程等与骨炎的相关性。方法：选择130例于2009年1月至2014年1月间在我院住院拟行初次手术的慢性鼻窦炎患者（chronic rhinosinusitis, CRS），通过查阅患者CT影像以及病例资料，利用UNISIGHT TeamView软件及整体骨炎评分系统（global osteitisscore system,GOSS）、Lund-Mackay评分系统分析患者CT影像，分析骨炎的发生率及影像学特点。根据性别、年龄、鼻息肉、病程将患者分别进行分组，采用SPSS20.0统计学软件进行数据分析，对比各个研究因素内不同组间的骨炎发生率差异，研究其与骨炎发生之间的相关性。结果： 1、130例患者中骨炎发生率34.6%（45/130），2级以上有意义骨炎31.5%（41/130）。上颌窦及前组筛窦发病率最高，左侧上颌窦发病率26.9%（35/130），右侧上颌窦发病率22.3%（29/130）,左侧前组筛窦发病率24.6%（32/130）,右侧前组筛窦发病率21.5%（28/130）。骨炎患者的GOSS介于3分-36分，，平均14.07±8.5分。 2、130例患者Lund-Mackay评分介于3分-22分之间，平均7.9±4.3分。骨炎组患者Lund-Mackay评分介于3分-22分之间，平均评分10.0±5.2分；无骨炎患者中Lund-Mackay评分介于3分-19分之间，平均评分6.6±3.7分。骨炎组与无骨炎组Lund-Mackay评分有显著差异t=4.34，p＜0.001。 3、伴骨炎的慢性鼻窦炎患者的GOSS与Lund-Mackay评分之间呈正相关趋势，r=0.950，p＜0.001。 4、男性慢性鼻窦炎患者的骨炎发生率35.3%（30/85），女性慢性鼻窦炎患者的骨炎发生率33.3%（15/45），两者间无显著差异（x2=0.05，p=0.823)。 5、伴鼻息肉的慢性鼻窦炎患者骨炎的发生率为38.9%（35/90）；不伴鼻息肉的慢性鼻窦炎患者骨炎发生率为25.0%（10/40）。两者间无统计学差异，χ2=2.360，p=0.124。 6、青年组慢性鼻窦炎患者（20岁-39岁）骨炎的发生率为22.2%（6/27）；中年组慢性鼻窦炎患者（40岁-59岁）骨炎发生率为29.1%（16/55）；老年组慢性鼻窦炎患者（60岁-81岁）骨炎的发生率为47.9%（23/48）。三组间骨炎发生率有差异，χ2=6.326，p=0.042。青年组与中年组患者的骨炎发生率无显著差异（χ2=0.435，p=0.509）.青年组、中年组患者与老年组患者的骨炎发生率均有显著统计学差异（χ2=4.810，p=0.028；χ2=3.861，p=0.049）。 7、病程3月-12月的慢性鼻窦炎患者骨炎发生率13.9%（5/36），病程13月-24月的慢性鼻窦炎患者骨炎发生率25.0%（9/36），病程25月-60月的慢性鼻窦炎患者骨炎发生率45.7%（16/35），病程＞60月的慢性鼻窦炎患者骨炎发生率65.2%（15/23）。四组患者间骨炎发生率有统计学差异x2=17.725，p＜0.001。病程25月-60月组骨炎的发生率是病程3月-12月的5.22倍，95%可信区间为【1.65,16.58】；病程＞60月组骨炎的发生率是病程13月-24月组的5.625倍，95%可信区间为【1.79,17.63】。结论：慢性鼻窦炎伴有骨炎的患者在CT影像学上具有较显著特征，可以通过GOSS进行测量分析。约三分之一的慢性鼻窦炎患者存在骨炎，上颌窦及前组筛窦的骨炎发生率最高。性别、鼻息肉与骨炎的发生无明显的相关性，年龄、病程与骨炎的发生具有一定相关性。
[Abstract]:Objective: To analyze the CT imaging features and pathogenesis of osteitis in chronic sinusitis, and to explore the correlation between sex, age, nasal polyps, course of disease and osteitis.
Methods: 130 patients with chronic sinusitis (CRS) who were scheduled to undergo primary surgery in our hospital from January 2009 to January 2014 were selected. The CT images and case data of the patients were analyzed. The UNISIGHT TeamView software and the global osteitis core system (GOSS) were used to evaluate the clinical outcomes. According to sex, age, nasal polyps and course of disease, the patients were divided into groups. The data were analyzed by SPSS20.0 statistical software. The incidence of osteitis was compared among different groups in each study factor, and the correlation between osteitis and sex, age, nasal polyps and course of disease was studied.
Result:
The incidence of osteitis was 34.6% (45/130) in 1,130 patients, 31.5% (41/130) in grade 2 and above. The incidence of ethmoid sinus was the highest in maxillary sinus and anterior group, 26.9% (35/130) in left maxillary sinus, 22.3% (29/130) in right maxillary sinus, 24.6% (32/130) in left anterior group, and 21.5% (28/130) in right anterior group. OSS ranged from 3 to -36, with an average of 14.07 + 8.5.
The Lund-Mackay score of 2,130 patients ranged from 3 to 22, with an average of 7.9 (+ 4.3). The Lund-Mackay score of the osteitis group ranged from 3 to 22, with an average score of 10.0 (+ 5.2). The Lund-Mackay score of the non-osteitis group ranged from 3 to 19, with an average score of 6.6 (+ 3.7). P < 0.001.
3. There was a positive correlation between GOSS and Lund-Mackay score in chronic sinusitis patients with osteitis, r = 0.950, P < 0.001.
4. The incidence of osteitis was 35.3% (30/85) in males and 33.3% (15/45) in females. There was no significant difference between the two groups (x2 = 0.05, P = 0.823).
5. The incidence of osteitis was 38.9% (35/90) in chronic sinusitis patients with nasal polyps and 25.0% (10/40) in chronic sinusitis patients without nasal polyps.
6. The incidence of osteitis was 22.2% (6/27) in young patients (20-39 years old), 29.1% (16/55) in middle-aged patients (40-59 years old) and 47.9% (23/48) in elderly patients (60-81 years old). There was no significant difference in the incidence of osteitis between the middle-aged group and the elderly group (_2 = 0.435, P = 0.509).
7. The incidence of osteitis was 13.9% (5/36) in patients with chronic sinusitis from March to December, 25.0% (9/36) in patients with chronic sinusitis from 13 months to 24 months, 45.7% (16/35) in patients with chronic sinusitis from 25 months to 60 months, and 65.2% (15/23) in patients with chronic sinusitis over 60 months. The incidence of osteitis in 25-60 months group was 5.22 times higher than that in 3-12 months group, 95% confidence interval was [1.65, 16.58], and the incidence of osteitis in 60 months group was 5.625 times higher than that in 13-24 months group, 95% confidence interval was [1.79, 17.63].
Conclusion:
Chronic sinusitis patients with osteitis have significant CT features and can be measured and analyzed by GOSS. About one-third of chronic sinusitis patients have osteitis. The incidence of osteitis in maxillary sinus and anterior ethmoid sinus is the highest. There is no significant correlation between sex, nasal polyps and osteitis, age, course of disease and the occurrence of osteitis. There is a certain correlation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R765.41

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