MSCT曲面重组在鼻骨线性骨折法医鉴定中的应用价值

发布时间：2018-06-18 03:05

  本文选题：鼻骨线性骨折 + MSCT　； 参考：《青岛大学》2016年硕士论文

【摘要】：目的:鼻骨骨折作为运动受伤、冲突受伤、车祸受伤、摔倒面部着地受伤等外伤的常见受伤部位,多带有纠纷性质,线性骨折的判定对于轻微伤、轻伤的鉴别有指导意义,其定性诊断对于治疗及事故的鉴定有指导意义,而鼻骨骨折受解剖机构及检查方法的影响漏诊率误诊率较高,随着影像检查技术及后处理技术的发展鼻骨骨折诊断正确率明显的提高,本文重点讨论多层螺旋CT鼻骨曲面重组(MSCT CPR)技术在鼻骨线性骨折的法医鉴定中的应用价值。材料与方法:收集青岛大学附属医院2013年1月1日至2014年12月31日因颅面部外伤需要法医学鉴定进行CT检查的患者。本组资料共计98例,其中男性72例,女性26例,年龄15~70Y,平均年龄43岁,设备采用荷兰Philips256层i CT机,对比使用MSCT CPR技术、MSCT轴位平扫、多平面重组(MPR)对2013年1月1日至2014年12月31日因头面部外伤入院进行法医学鉴定的患者进行检查,收集临床资料,分析检查结果,检验多层螺旋CT曲面重组(MSCT CPR)对鼻骨骨折的诊断特异性。结果:98例患者,CT轴位平扫诊断结果鼻骨正常29例,诊断鼻骨可疑线性骨折69例,阳性率为70.4%MSCT CPR诊断结果鼻骨正常20例,鼻骨可疑线性骨折78例,真实阳性率为79.6%。其中CT轴位平扫与MSCT CPR均诊断为鼻骨正常者15例,两者均诊断为线性骨折者64例,CT轴位平扫诊断为鼻骨正常而MSCT CPR诊断为线性骨折者14例,CT轴位平扫诊断为鼻骨骨折而MSCT CPR诊断为鼻骨正常者5例。结论:CT曲面重组图像能有效的分辨骨折与鼻骨正常解剖结构,结合常规CT检查,能够降低鼻骨线性骨折误诊及漏诊率,提高鼻骨轻微伤的法医学鉴定的参考价值。目前,针对鼻骨进行曲面重组的研究临床实践相对较少,若结合常规CT检查,尤其是HRCT检查,对鼻骨骨折诊断价值更高。
[Abstract]:Objective: as the common injury sites of sports injury, conflict injury, traffic accident injury, falling face injury and so on, the nasal bone fracture has the dispute nature, the judgment of the linear fracture has the guiding significance for the differential diagnosis of the slight injury and the slight injury. The qualitative diagnosis is of guiding significance for the treatment and identification of accidents, while the misdiagnosis rate of nasal fracture is higher due to the influence of anatomical organization and examination methods. With the development of imaging and post-processing techniques, the diagnostic accuracy of nasal fracture has been improved significantly. This paper focuses on the application of MSCT CPR in the forensic identification of nasal bone linear fracture. Materials and methods: from January 1, 2013 to December 31, 2014, the patients with craniofacial trauma who needed forensic medical examination were collected from the affiliated Hospital of Qingdao University. A total of 98 cases, including 72 males and 26 females, with an average age of 43 years, were enrolled in this study. The equipment was performed with Philips256 slice I CT in the Netherlands. MSCT CPR technique was used to contrast the axial plain scan of MSCT. From January 1, 2013 to December 31, 2014, patients admitted to hospital for head and facial trauma were examined by MPRs. The clinical data were collected and the results were analyzed. To examine the specificity of MSCT CPR in diagnosis of nasal fracture. Results 29 cases of nasal bone were normal by axial plain CT scan, 69 cases were diagnosed suspected linear fracture of nasal bone. The positive rate was 70.4 MSCT CPR in 20 cases of normal nasal bone and 78 cases of suspected linear fracture of nasal bone. The true positive rate was 79.6%. Ct axial plain scan and MSCT CPR were all diagnosed as normal nasal bone in 15 cases. In both cases, 64 cases of linear fracture were diagnosed by CT axial plain scan, 14 cases by MSCT CPR were diagnosed as linear fracture, and 5 cases were diagnosed as normal nasal bone by MSCT CPR. Conclusion the curved surface recombination image of CT can effectively distinguish fracture from normal anatomical structure of nasal bone, combined with routine CT examination, it can reduce the misdiagnosis rate and missed diagnosis rate of linear fracture of nasal bone, and improve the reference value of forensic medical identification of slight injury of nasal bone. At present, the clinical practice of curved surface reconstruction of nasal bone is relatively few. If combined with conventional CT examination, especially HRCT, it is more valuable for the diagnosis of nasal bone fracture.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：D919.4
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本文编号：2033747