CT重建颌面部的影像学解剖研究

发布时间：2018-03-26 22:30

  本文选题：解剖　切入点：眶壁骨折　出处：《泰山医学院》2012年硕士论文

【摘要】：目的: 根据临床筛窦鼻内镜筛窦手术及纸样板外伤性骨折修复手术的实际需要，通过多层CT影像学解剖的研究，在影像学解剖筛窦的基础研究之上，深入探讨眼眶的解剖结构以及眶内侧壁薄弱点，以此找出眶内侧壁爆裂性骨折的原因，为临床显微外科筛窦手术及眼眶骨折修复手术提供详尽的影像学资料。 研究方法： 1采用西门子SOMATOM SENSATION64层螺旋CT扫描，扫描方式：常规头部多层螺旋CT扫描及MPR、VR重建正常头颅60例，对所随机选取的60例正常头颅进行64层CT-VR重建，根据薄层重建时层厚不同显示图像不同，依次逐渐增加层厚，当层厚越厚时，图像显示越简略。对所搜集正常头颅进行骨模式采集和VR重建，依次寻找60例头颅的薄弱点进行统计；。扫描范围：自下颌骨底端与枕骨大孔中心的连线为基线，对整个头颅的全部进行扫描，患者取仰卧位，层厚2mm层距2mm螺距1矩阵512X512。所得图像运用多层螺旋CT的后处理功能进行扫描后重建，分别取骨窗及软组织窗进行观察，并测量筛骨及筛窦的径线。 2眼眶骨折多层螺旋CT扫描及MPR、VR重建80例，按照眶内侧壁受损面积进行分类，并分析统计。扫描范围：眶上1cm到眶下1cm。所得图像运用多平面重组（MPR重建）技术行冠状面、矢状面和斜面重组，对眶壁骨折类型及受损程度进行系统分析，找出眶内侧壁薄弱点，阐述眶内压升高致眶内侧壁骨折的原理得出眶内侧壁易骨折的原因。对80例眶壁骨折患者行64层螺旋CT平扫，采用双盲法进行常规断层条件下诊断，后对所得数据进行容积再现（VR），利用64层CT的“各向同性”，进行VR重建条件下的二次诊断，对两次诊断结果进行对比并对最终诊断结果进行统计分析。 3从实验室寻找男女颅骨各一个，用手锯锯开头颅取眼眶内侧壁，剥离筛骨观察眶壁的各个链接点，对所获得的影像图片进行校正，便于寻找骨骼标准位置。 多层螺旋CT扫描及MPR重建参数：容积扫描，120kV380mA，机架旋转0.33s/圈，层厚2mm螺距1阵距512X512骨窗：窗位C450，窗宽W1500;软组织窗：窗位C40窗宽W80扫描后进行冠状位、横断位及矢状位多平面重建。 重建参数：定位像：120KV35mA 骨窗:slice0.75mm recon increment0.7mm kemel H60s sharp window Olslteo 软组织窗：slice0.75mm recon increment0.7mm kemel H30s medium smooths+window crebrum 统计学处理 采用SPSS13.0统计软件包，变量符合正态分布且方差齐性的计量资料采用单因素方差分析。P值小于0.05具有统计学意义，反之则无。 结果： 眶板薄弱点与眶壁易爆裂骨折位置关系 1薄弱点位置位于中1/3及中后2/3者33例多于位于前1/3及中前2/3者27例，差异无统计学意义（X2=1.20，P=0.273＞0.05，）。即薄弱点发生部位对本次研究无影响。 2眶壁骨折发生于前1/3或中前2/3者27例多于发生于中1/3及中后2/3者26例，但差异无统计学意义(X2=0.33,P=0.8570.05)。即骨折所累及部位无统计学意义。 常规断层诊断与VR重建诊断结果的对比 80例眼眶外伤患者在平扫诊断中确诊眶内侧壁骨折57例，占71.25%，后进行VR重建筛查确诊眼眶内侧壁骨折63例，占78.75%，其余17例为外侧壁骨折、或外侧壁与下壁合并骨折，占21.25%。常规条件诊断漏诊率为9.524%（6/63），VR诊断漏诊率远远小于常规断层图像诊断。 眼眶骨缝与骨折纹理的VR成像特点对比 研究发现，在VR成像条件下眼眶的骨缝显示为两种类型：○1较厚骨质间的骨缝，如上颌骨与颧骨构成的骨缝（图36A）,设定为Ⅰ型;○2较厚骨质与较薄骨质间的骨缝，如上颌骨与筛骨之间的骨缝（图36B）,设定为Ⅱ型。骨折分为三种类型：a爆裂性骨折，多发生于眼眶内侧壁(如图36C)；b断裂性骨折，多发生于骨折较厚的眶壁，如眶下壁（图36D）、外侧壁；c粉碎性骨折，多发生于骨质较厚处的严重创伤。粉碎性骨折易分辨，在此不作详细阐述。 筛窦径线测量结果见附表 结论： 1筛窦多层螺旋CT重建的三维图像所呈现的解剖结构更加直观，对临床手术的开展具有重要指导作用 2眶内壁骨折是由于外力钝物冲击眼眶眶内压力升高，压力超过眶内壁所承压的阈值，即发生眶内壁爆裂性骨折 364层CT重建眶壁进行的分型观察更加细致明确，在眶壁骨折的诊断中MPR、VR重建具有重要价值。 4由于筛窦变异大，眶部骨折分型多，依靠单纯的CT影像学三维图像进行手术是危险的，，易导致并发症的出现。将应用解剖数据、CT扫描后三维图像重建和鼻窦显微外科手术路标、仿真内窥镜位置结合起来，所获数据更加准确，有利于手术。
[Abstract]:Objective:
According to the actual needs of the surgical repair of nasal endoscopic sinus surgery and clinical ethmoidal lamina papyracea fracture, anatomy study by multi-slice CT images, studying the anatomy of ethmoid sinus in the image above, in-depth study of anatomical structure and the medial orbital orbital weakness, in order to find out the medial orbital wall burst fracture, and provide detailed the imaging data for clinical microsurgical surgery and orbital ethmoid fracture repair surgery.
Research methods:
The SIEMENS SOMATOM SENSATION64 1 slice spiral CT scan, scan head: conventional multislice spiral CT scanning and MPR VR reconstruction, 60 cases of normal brain, 64 slice CT-VR reconstruction of normal skull 60 cases randomly selected, according to the reconstruction of thin layer thickness of different display different images, gradually increase the layer thickness, when the thickness of the more thick, more simple image display. The collected normal cranial bone pattern acquisition and VR reconstruction, in order to find the weak points of 60 cases of skull were analyzed.; scan range: from the mandibular foramen magnum and the bottom end of the center line as a baseline, the head of all patients were scanned in supine position thickness of 2mm layer from the 2mm pitch 1 matrix 512X512. image obtained using multi-slice spiral CT postprocessing function scans were taken after the reconstruction, bone and soft tissue windows were observed, and measuring the diameter of ethmoid and ethmoid sinus.
2 orbital fracture multi-slice spiral CT scanning and MPR VR reconstruction in 80 cases, in accordance with the classification of medial orbital wall damaged area, and statistical analysis. The scanning range: 1cm to 1cm. orbital orbital images obtained using multiplanar reconstruction (MPR reconstruction) technique for coronal, sagittal and oblique reformation, of orbital fracture the type and extent of damage are analyzed, and find out the medial orbital wall weakness, this orbital pressure caused by the principle of the medial orbital wall fracture that the medial orbital wall fracture of the reason. In 80 cases of orbital fracture underwent 64 slice spiral CT scan, by double blind method under the condition of conventional fault diagnosis, after the data of volume rendering (VR), using 64 layer CT "isotropic" two diagnosis VR reconstruction under the conditions of the two diagnostic results were compared and the final diagnosis results were statistically analyzed.
3 from the laboratory for men and women of a skull, beginning with sawn from the cranial orbital medial wall, orbital ethmoid stripping observation point on each link, the images obtained were corrected, easy to find bones position.
Multi slice spiral CT scan and MPR reconstruction parameters: volume scan, 120kV380mA, rack rotation 0.33s/ circle, thickness 2mm pitch 1 array from 512X512 bone window: window C450, window width W1500; soft tissue window: window position C40 window width, W80 scan, coronal, transversal and sagittal multiplanar reconstruction.
Reconstruction parameters: location image: 120KV35mA
Bone window: slice0.75mm Recon increment0.7mm kemel H60s sharp window Olslteo
Soft tissue window: slice0.75mm Recon increment0.7mm kemel H30s medium smooths+window crebrum
Statistical treatment
The SPSS13.0 statistical software package was used. Variables with normal distribution and homogeneity of variance were analyzed by one-way ANOVA. The.P value was less than 0.05, which was statistically significant, whereas on the contrary, there was no statistical significance.
Result锛

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