单侧颧骨复合体骨折三维CT测量方法的建立与应用

Three Dimensional CT Metrical Analysis in Treatment of Unilateral Zygomatic Complex Fractures

目的:建立单侧颧骨复合体骨折移位的CT测量方法并应用于临床。方法:收集单侧颧骨复合体骨折并需要手术治疗者15例,术前摄头颅定位CT,利用相关CT软件(e-film)对颧骨复合体在3个方向上的移位情况进行测量分析。CT数据由PACS系统刻出光盘后,利用efilm软件在个人电脑上完成测量。测量以对侧健康颧骨和其他正常骨骼为参照,计算两侧颧骨与其他骨骼标志点之间的距离差值为骨折位移数据,根据数据指导手术。术后复查CT并测量,与术前数据进行对比,评价疗效及测量效果。结果:15例单侧颧骨复合体患者的CT测量结果显示,术前位移以向后移为主(平均5.48 mm),多伴有内移(平均1.40 mm),向内或向外转位,个别病例可有向外移位或下移。术后位移基本消失或减少至<2 mm。对向后和向内位移进行手术前后配对t检验,差异显著P<0.01。15例患者术后均达到三维对称和基本对称,骨折一期愈合,功能活动好,手术效果满意。结论:CT测量可以实现对颧骨复合体空间移位的定量测量,准确性高,对颧骨复合体骨折的手术复位有指导意义,本研究建立的测量方法操作方便,简单易行。

Objective： To establish a reliable CT metrical method for quantitative diagnosis of unilateral zygomatic complex fractures and deformities. Methods： Three dimensional CT images of 15 patients with unilateral zygomatic complex fractures were measured and analyzed by computer-assisted measurement system and software of e-film before and after operation. The displacements in three dimensions of the fractured zygoma were obtained before operation. CT data were copied from PACS system and measurement was carried out on a person computer. Anthropology points of other bones including contra-lateral normal zygomatic bone were used in this study. The distance of the two point on zygomatic bone and other bone in the same side was calculated first, then the difference of the fractured side and normal side was calculated respectively. Paired t-test were used to compare the data. The ultimate evaluation consisted of two aspects： clinical therapy of the patient and practical value of the CT metrical method. Results： Displacement of zygomatic fractures was accurately diagnosed by measurement through 3D CT photographs. The main directions of the displacement of the fractured zygoma concerned were backward （mean=5.48 ram） and inward （mean=l.40 ram）. Some cases also suffered with a rotation displacement. Most cases were cured with primary intention. All patients＇ appearances were symmetry in three dimension and function of open mouth and bite were satisfied. Conclusion： 3D-CT measurement with e-film software is an accurate, reliable and feasible method in clinic for diagnosing zygomatic fractures.