多层螺旋CT后处理技术在鼻骨骨折的应用价值

发布时间：2018-04-21 22:44

  本文选题：鼻骨骨折 + 体层摄影术　； 参考：《山东大学》2012年硕士论文

【摘要】：目的 鼻骨骨折在颌面部外伤中多见,以往鼻骨骨折的诊断主要依赖X线平片或常规CT检查,X线平片能检出多数鼻骨骨折,但由于普通X线平片检查受投照体位、部位重叠以及密度分辨率较差等的影响,有时鼻骨骨折容易漏诊；常规CT的轴位或冠状位检查时,常难以使双侧结构对称,受到患者外伤的限制常难以做冠状位扫描,另外受到层厚的限制,易将正常结构误诊为骨折或将细微骨折漏诊,延误患者的治疗或对司法鉴定带来困惑。本文利用多层螺旋CT (MSCT)各向同性扫描的特征,探讨多层螺旋CT后处理技术在鼻骨骨折的临床应用价值。 方法 对115例鼻外伤患者的多层螺旋CT原始图像进行MPR和VR后处理,将鼻骨骨折分为单纯Ⅰ型(线性骨折无移位或成角),单纯Ⅱ型(线性骨折伴移位),粉碎型骨折(单侧或双侧鼻骨碎成三块及以上,即两条或两条以上贯通性骨折线),复合型骨折(鼻骨骨折合并周围骨骨折),骨缝分离型(骨缝大于2mm或缝隙骨两端错位),将单纯的鼻泪管和上颌骨额突骨折也纳入统计范围,是考虑鼻外伤多有或伴有上颌骨额突等骨折。另外收集83例无鼻部外伤患者(主要是进行副鼻窦CT检查)分别采用骨和软组织算法进行MPR和VR后处理以观察正常鼻骨骨缝、鼻骨的骨性孔道和鼻骨的形态,同时对骨和软组织算法的VR逼真程度进行对比。 结果 鼻骨骨折患者91例。单纯Ⅰ型9例；单纯Ⅱ型6例；粉碎型骨折5例；复合型骨折57例,其中合并眶骨骨折32例、鼻中隔骨折9例、鼻泪管骨折8例和上颌骨额突骨折44例；骨缝分离型23例,其中额颌缝分离1例,鼻颌缝分离22例；单纯上颌骨额突骨折11例；骨折累及鼻骨孔2例,骨折累及上颌骨额突根部血管神经孔3例；眼肌损伤1例,球后出血1例。骨算法VR在颌面部骨缝及骨孔显示方面优于软组织算法,二者对鼻中间缝、鼻额缝、鼻颌缝、鼻骨孔显示为优的百分率分别47.0%vs0%；91.6%vs9.6%；72.3%vs12.0%；84.3%vs3.6%。鼻骨常见类型35例,表现为鼻骨尖部平直；鼻骨下缘变异48例,分为四种类型：单侧鼻骨的倒V字型、双侧鼻骨的M型缺口、裂隙样、锯齿样,分别为16例、29例、2例、1例。 结论 MPR图像结合骨算法的VR图像在显示鼻骨正常结构、变异及鼻骨多发骨折中具有重要价值,特别有益于区分鼻骨孔、骨缝、鼻骨变异与无明显移位的线性骨折,使诊断更加准确、完善,为治疗提供了更好的依据。
[Abstract]:Purpose Nasal fracture is more common in maxillofacial trauma. In the past, the diagnosis of nasal fracture mainly depended on X-ray plain film or conventional CT examination. Because of the influence of overlap of position and poor density resolution, it is easy to miss diagnosis of nasal bone fracture, and it is difficult to make bilateral structure symmetrical in axial or coronal examination of conventional CT, so it is difficult to do coronal scan because of the limitation of patients' trauma. In addition, due to the limitation of layer thickness, the normal structure is easily misdiagnosed as fracture or fine fracture is missed, which delays the treatment of patients or brings confusion to judicial identification. Based on the isotropic features of multislice spiral CT (MSCT), the clinical value of multislice spiral CT post-processing in nasal fracture was discussed. Method MPR and VR postprocessing were performed on the original images of multislice spiral CT in 115 patients with nasal trauma. The nasal bone fracture was divided into simple type 鈪，

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