全景片诊断髁突骨折的应用价值

The value of panoramic films in diagnosis of condylar fractures

目的:评价全景片对髁突骨折的诊断价值,探讨全景片易出现漏诊的髁突骨折的特点。方法:对163例220侧由CT确诊为髁突骨折病例的全景片进行读片,根据CT进行分类,统计各类髁突骨折全景片的检查结果。按骨折类型是否为囊内骨折进行分组,比较两组资料在全景片上的检出率,应用SAS6.12软件包进行统计学分析。结果:囊内骨折、髁颈骨折和髁突下骨折分别为155侧、45侧和20侧,全景片未检出及检出髁突骨折分别为38侧和182侧,囊内骨折中有33侧全景片未检出骨折,122侧检出骨折但均无法定位骨折位置。囊内骨折组检出率显著低于髁颈骨折及髁突下骨折组(P=0.0149)。结论:全景片可初步诊断髁突骨折,但对于囊内骨折,特别是细微骨折及无移位的骨折漏诊率较高。对于骨折线的定位、骨折块内外向移位角度的确定,全景片作用有限。

PURPOSE： The study aims to evaluate the value of panoramic films in diagnosis of condylar fractures. METHODS： Panoramic films of 163 cases （220 joints） diagnosed as condylar fractures by CT were examined. Panoramic films of all types of condylar fractures classified by CT were analyzed. According to the position of fracture, the samples were divided into two groups, intracapsular fractures and extracapsular fractures（condylar neck fractures and subcondylar fractures）. The detection of fractures in two groups were compared and statistically analyzed with SAS6.12 software package. RESULTS： All 163 condylar fractures （220 joints） could be classified by CT as intracapsular fractures （155 joints） , neck fractures （45 joints） and subeondylar fractures （20 joints）. Panoramic films showed 38 joints without fractures and 182 joints with fractures. Among them, 33 joints without fractures and 122 joints with fractures were in the group of intracapsular fractures. The detection rate of intracapsular fractures group was significantly lower than that of condylar neck fractures and subcondylar fractures group （P=0.0149）. CONCLUSION： Panoramic films can initially diagnose condylar fractures, but the misdiagnosis rate is high for intracapsular fractures, particularly for minor fractures and fractures without fragment displacement. CT should be considered for positioning of fracture lines and confirming the displacement angle of fragment on coronal plane.