茎突X线平片与CT扫描三维成像的临床评价

Clinical evaluation of the styloid process by plain radiographs and three-dimensional computed tomography

目的:评价茎突X线平片与螺旋CT三维重建成像(3-DCT)技术在诊断茎突综合征(SPS)的准确性。方法:对113例疑似病例(144侧茎突)记录X线正位平片的茎突长度值并进行咽部指诊,依据茎突X线平片和咽部指诊结果比较临床和影像学检查结果的一致性。对其中23例进行3-DCT检查。记录X线平片和3-DCT两种方法测量同一个体的茎突长度数值,比较两种影像学测量茎突长度的差异和一致性。根据指诊可否触及茎突分组比较茎突前倾角和内倾角的差别。结果:113例中78例被诊断为SPS,茎突X线平片与咽部指诊结果的一致性较好(Kappa指数:0.58)。30侧茎突的X线平片与3-DCT测量茎突长度的差值平均数(1.59±1.32)mm,两法测量茎突长度的差异具有统计学意义(P<0.01),两种影像学检查茎突长度数值之间呈正相关,相关系数为0.982 4,P<0.01。咽部指诊阳性和阴性茎突内倾平均角分别为(25.60±2.56)°和(15.42±2.79)°(P<0.01)。咽部指诊阳性和阴性茎突前倾平均角分别为(16.86±4.83)°和(12.71±3.39)°(P<0.01)。8例咽部指诊单侧阳性的茎突长度正常者,经3-DCT显示茎突角度异常而证实临床诊断。4例术前未满意触及的单侧过长茎突者,经3-DCT显示茎突末端向内向前明显偏斜而采用口内进路手术。结论:茎突X线平片经济、简便、实用,足以为大多数病例的临床诊断提供客观依据。茎突3-DCT可弥补茎突X线平片不足,对部分病例选择手术进路具有重要的参考价值。

Objective： To investigate the relation between radiological and clinical diagnosis for Eagle＇s syndrome and to evaluate the value of plain radiograph （ PR ） and three-dimensional CT reconstructional image （ 3- DCT ） of styloid process （ SP ）. Method：The length of the 144 SPs from the PR was recorded and the palpation of the SP in tonsillar fossa was carried out in 113 patients with suspectlve Eagle＇s syndrome. Twenty-three of 113 pa tients also underwent 3-DCT, so that the length and angulation of the 30 SPs were measured. Result：Seventy-eight of 113 patients（ 31 men and 47 women ）were diagnosed as having Eagle＇s syndrome. The age ranged from 32 to 68 years （average age： Forty-two years）. A good agreement between the PR and the palpation was determinated, Kappa coefficient was 0. 58. The difference value of the length of 30 SPs between the PR and the 3-DCT was （1.59±1.32）mm, and there were statistically significant difference of the length（ t= 6. 64, P 〈0.01） on the length of SP between the PR and the 3 DCT. Positive correlation between the PR and the 3 DCT was found to be statistically significant （ r= 0. 9824 ±95% confidence interval： 0. 963 1, 0. 991 7）, The mean of medial angle of SPs was （25.60±2.56）°in patients with positive palpation and （15. 42± 2.79）° in those with negative palpation, respectively（ P 〈0.01） and the mean of anterior angle of SPs was （16.86 ± 4.83）°in patients with positive palpa tion and （12.71 ± 3.39）°in those with negative palpation, respectively（ P 〈20.01）. The abnormal medial and ante rior angles of unilateral SP without more than 30mm long was also objectively diagnostic of SPS in 8 patients with positive palpation. Four patients, whose elongated SP is too tenuous to be palpated preoperatively, underwent intraoral styloidectomy because of the fact that 3-DCT showed the tip of SPs medial and anterior deflexion. Conclution ：Despite magnifying image, the PR of SP is enough to diagnose Eagle＇s syndrome for the majority of cases. 3- DCT allows precise measurement of the length and the angulation of SPs, it is the best for the complementary pur pose to the PR and to the selection of surgical approach in some cases.