70例女性第6~8肋软骨组织量及钙化特点分析

Analysis of tissue volume and calcification of the 6th to 8th costal cartilage in 70 women

目的研究女性第6、7、8肋软骨组织量大小、钙化特点,以及钙化与年龄及侧别的相关性,为临床应用提供参考。方法从湘雅二医院放射科影像存储中心以抽签法随机选取2015年8月至2018年1月行胸部CT三维重建的70例肋软骨无疾患及外伤的女性患者,年龄15~56岁,根据年龄分为15~20岁、21~26岁、27~32岁、33~38岁、39~44岁、45~50岁和51~56岁7个组,每组10例。对70例女性肋软骨行双源CT三维重建,对重建后的图像行最大密度投影(MIP)和容积重建(VR)处理,通过VR图像,测量双侧第6、7、8肋软骨的长度、宽度和厚度;在VR和MIP图像上观察、统计和分析肋软骨的钙化率、钙化程度、钙化类型、钙化灶位置,钙化与年龄及侧别的相关性。数据应用SPSS 20.0进行统计分析,并采用相应的统计学方法进行比较,包括独立样本t检验、卡方检验、logistic回归分析、方差分析。结果(1)左侧第6、7、8肋软骨长度依次为(98.7±12.7)mm、(132.8±13.8)mm、(81.5±11.6)mm,宽度(12.6±1.5)mm、(11.0±1.4)mm、(7.4±1.1)mm,厚度(8.1±0.5)mm、(7.7±0.6)mm、(6.6±0.6)mm;右侧第6、7、8肋软骨长度依次为(95.8±11.3)mm、(133.1±12.0)mm、(81.7±12.3)mm,宽度(12.2±1.4)mm、(11.1±1.5)mm、(7.4±1.1)mm,厚度(8.2±0.6)mm、(7.7±0.5)mm、(6.5±0.6)mm。同一序数肋软骨左右两侧长、宽、厚度两两比较差异无统计学意义(P>0.05)。单侧不同序数肋软骨之间长、宽、厚度两两比较,差异有统计学意义(P<0.01)。(2)左侧与右侧第6、7、8肋软骨总钙化率分别为61.9%(130/210)和60.0%(126/210),两者比较差异无统计学意义(χ^2=0.160,P=0.689);左、右侧总体钙化类型、总体钙化位置及总体钙化程度计数的比较差异均无统计学意义(P>0.05)。第6、7、8肋软骨左侧和右侧钙化率的比较差异无统计学意义(P>0.05);第6、7、8肋软骨各自总体钙化类型计数的比较差异有统计学意义(χ2=61.541,P<0.001)。(3)钙化率与年龄变化的关系:通过卡方检验和logistic回归方程结果示,肋软骨序数增大,钙化率降低;年龄段越大钙化率越高。第6、7、8肋软骨钙化程度与年龄变化关系经方差检验,通过回归方程得出:年龄越大第6、7、8肋软骨的钙化程度越高。结论术前利用双源CT对肋软骨进行三维重建和图像后处理,能较精准地测量软骨组织量、明确钙化特点,指导临床合理地选择满足术式要求的肋软骨;在鼻整形、外耳再造术的不同年龄女性患者中,肋软骨的钙化率随年龄增加,但并不与其呈正相关;随着年龄增长钙化程度加重,对于钙化程度严重的病例可选用人工材料,避免手术的盲目性。

Objective To study the tissue size,calcification characteristics and the correlation between calcification and age and lateral side of 6,7 and 8 costal cartilage in women,so as to provide reference for clinical application.Methods From the radiology storage center of Second Xiangya Hospital,70 cases of female costal cartilage were treated with dual-source CT three-dimensional reconstruction.The reconstructed images were treated with maximum intensity projection(MIP)and volume reconstruction(VR).The length,width and thickness of bilateral 6,7 and 8 costal cartilage were measured by VR images,and the correlation between calcification rate,calcification degree,calcification type,calcification location,calcification with age and side was observed and analyzed on VR and MIP images.The data were analyzed by SPSS 20.0 and compared by corresponding statistical method,including independent sample t test,chi-square test,logistic regression analysis and variance analysis.Results(1)The length of costal cartilage on the left was(98.7±12.7)mm,(132.8±13.8)mm,(81.5±11.6)mm,width(12.6±1.5)mm,(11.0±1.4)mm,(7.4±1.1)mm,thickness(8.1±0.5)mm,(7.7±0.6)mm,(6.6±0.6)mm.On the right side,the length of costal cartilage was(95.8±11.3)mm,(133.1±12.0)mm,(81.7±12.3)mm,width(12.2±1.4)mm,(11.11±1.5)mm,(7.4±1.1)mm,thickness(8.2±0.6)mm,(7.7±0.5)mm,(6.5±0.6)mm.There was no significant difference in the length,width and thickness of the left and right sides of the costal cartilage in the same sequence(P>0.05).There were significant differences in length,width and thickness between unilateral costal cartilage with different ordinal numbers(P<0.01).(2)The total calcification rates of left and right costal cartilage were 61.9%(130/210)and 60.0%(126/210),respectively,and there was no significant difference between the two groups(The chi-square was equal to 0.160.The P value was equal to 0.689),but there was no significant difference in left and right total calcification types,total calcification location and total calcification count(P>0.05).There was no significant difference in the total calcification type between left and right,the total calcification location and the total calcification degree count(P>0.05).There was also no significant difference between the two groups(P>0.05).There was no significant difference in the calcification rate between the left and right sides of the 6th,7th and 8th costal cartilage,but there was significant difference in the total calcification types of the 6th,7th and 8th costal cartilage(The chi-square was equal to 61.541,P value was less than 0.001).(3)The relationship between calcification rate and age was analyzed by univariate analysis and logistic regression equation.The higher the age,the higher the calcification rate.The relationship between the calcification degree and age of the 6th,7th and 8th costal cartilage was tested by variance test,and the regression equation showed that the calcification degree of the 6th,7th and 8th costal cartilage was higher with the age.Conclusions Preoperative three-dimensional reconstruction and image post-processing of costal cartilage with dual-source CT can accurately measure the amount of cartilage tissue and define the characteristics of calcification,so as to guide the clinical selection of costal cartilage that meets the requirements of operative method.In female patients of different ages undergoing rhinoplasty and external ear reconstruction,the calcification rate of costal cartilage increased with age,but there was no positive correlation.With the increase of calcification with age,artificial materials can be used for cases with severe calcification to avoid the blindness of surgery.