眶底壁骨折CT轴位影像再认识

Re-recognition of orbital floor fracture in CT axial images

目的提高对眶底壁骨折早期诊断的认识。方法回顾性分析不同医疗机构17例颌面部外伤CT轴位上眶底壁骨折的影像资料。结果眼眶爆裂性骨折12例,复合型骨折5例。其中4例在首次CT轴位扫描未识别眶底壁深部骨折而遗漏诊断,经本中心阅片再建议行CT冠状面成像后显示眶底壁骨折征象。结合眼眶解剖结构与CT轴位成像的关系,提出了CT轴位上眶底壁骨折征象"悬顶"或"底陷"征。即CT轴位影像表现——上颌窦腔内上份显示无定形斑片状或类卵圆形软组织影,边缘部位嵌顿细小条形骨嵴影。结论颌面部外伤后CT轴位图像显示上颌窦腔内"悬顶"或"底陷"征是诊断眶底壁爆裂骨折的可靠征象。

Objective To enhance the cognition m the early diagnosis of orbital floor fracture. Methods To analyse the orbital floor fracture in axial CT images of 17 craniofacial trauma, which derived from different medical institutions retrospectively. Results There were 12 cases with blowout orbital fracture and 5 with compound fracture. 4 of the cases were missed in CT axial scan for the first time, because the orbital floor fracture had not been identified. We proposed to make a CT coronal image after reading the films. Then, the signs of orbital floor blowout fracture came into view after integrating the relationship between orbital anatomic structure and CT axial image. And then, presented a concept of ＂roof overhang＂ or ＂floor collapse＂ . This sign might be defined as a patchy or class oval soft tissue shadow, which displayed upper the maxillary sinus cavity, small strip of bone shadow ridge were incarcerated at the edge of the shadow. Conclusion The reliable signs to diagnosis orbital floor blowout fracture is the ＂roof overhang＂ or ＂floor collapse＂ sign in maxillary sinus cavity, which can be reliability in CT axial images.