筛骨骨折16层螺旋CT薄层扫描研究

Study of Patients with Ethmoid Fracture by 16-MDCT Thin-layer Scanning Technique

目的:探讨16层螺旋CT对外伤性筛骨骨折的诊断价值。方法:收集经常规轴位颅底5mm螺旋扫描2.5mm高分辨率骨算法重建(常规组),复查时接受2.5mm薄层螺旋扫描1.25mm高分辨率骨算法重建(薄层组),共108例,比较这两种扫描方法的骨折诊断情况。结果:108例筛骨骨折患者中,骨折线仅累及筛骨右侧40例,仅累及左侧47例,累及双侧21例;线性骨折37侧,凹陷性骨折71侧;筛骨骨折伴内直肌肿胀、迂曲46侧,筛窦眶内容物疝57侧,内直肌与纸样板间脂肪间隙变窄或消失85侧,脂肪间隙增宽9侧,脂肪间隙混浊98侧;眶内积气29侧,眼球内陷12侧,眼球突出18侧,伴视神经肿胀23侧,筛窦外伤性积液、积血59侧。比较两组骨折显示率:常规组为78.20%;薄层组为100%,经统计学(U检验)分析差异有高度显著性(P<0.01)。结论:常规组扫描法能显示筛骨骨折的直接征象和间接征象,能很好地分型,有诊断价值;缺点是漏诊率较高。薄层组扫描法对筛骨骨折的正确分型以及显示骨折的直接和间接征象的能力都明显地优于常规组,能克服常规组的不足,能充分发挥16层螺旋CT的优势,对法医伤情鉴定及临床治疗具有重要意义,值得推广。

Purpose： To evaluate the value of 16- MSCT in diagnosis of ethmoid fracture. Methods： CT features of 108 cases of patients with ethmoid fractures were evaluated and analyzed. Conventional 5 nun thinsection helical CT scanning with 2.5 mm bone algorithm reconstruction method（conventional method） was used for the first exam, and 2.5 mm thin-section helical CT scanning with 1. 25 mm bone algorithm reconstruction method （thin - section method） was used for the follow - up exam. The results with conventional method and thin - section method were compared. Results： In 108 cases, there were 40 cases of ethmoid fractures in right side, 47 in left, 21 in bilateral. There were 37 sides of linear fractures and 71 sides of depressed fractures. The rates of fracture detection in 108 cases that were scanned by two methods were calculated and analyzed with U - test. And the results showed a marked different between these two methods （P 〈 0.01） . Conclusion： Conventional method can reveal the direct and in- direct features of ethmoid fractures, it is valuable in diagnosis of traumatic ethmoid fractures, but it has higher miss diagnosis rate. Thin - section method can improve the detection rate of ethmoid micro - fractures, and it is valuable in identification of traumatic degree, and is useful for legal medical identifi- cation and clinical treatment.