颧骨颧弓伴发颞骨关节面骨折的螺旋CT三维重建图像诊断

Clinical application of three-dimensional spiral CT in the fracture of temporal articularness and zygomatic arch

对30例因颌面部外伤而致的间接颞下颌关节损伤且伴有颞下颌关节区肿胀、疼痛,颧弓根部畸形等表现者,应用二维CT扫描及螺旋CT三维重建检查颞下颌关节区,观察颞骨关节窝、关节结节,比较二维CT扫描及螺旋CT三维重建对骨折诊断的差异性,并行骨折复位、固定或保守治疗。螺旋CT三维重建图像显示关节结节骨折线呈矢状,关节结节合并关节窝骨折线呈矢状向后弧形延伸至关节窝顶,移位骨折段向外成角隆起。关节结节骨折复位治疗者,未发生颧弓根部畸形及张口受限等并发症。螺旋CT三维重建能够全面、准确显示关节结节及关节窝、骨折部位、骨折线走形、骨折段移位、关节面塌陷、骨折段与周围结构的空间关系,早期明确诊断并行颞下颌关节区骨折治疗,可有效防止面部畸形、张口受限等并发症的发生。

To study the value of three dimensional（3-D）CT in diagnosis and treatment of Temporomandibular joint＇s region fracture,articuar fossa fracture,articular tubercle fracture.2-D CT and three dimensional（3-D）spiral reconstruction CT were applied to the patients of indirect temporomandibular joint＇s region fracture due to facial trauma combined with swelling of temporomandibular joint＇s region,pain,restriction of mouth opening,deformation of zygoma root.Observed the fractures in those area,and compared the differences of bone fracture between 2-D CT and three dimensional（3-D）spiral CT,and applied the reposition,fixation or expectant treatment.30 cases of fracture of articuar tubercle and articular fossa,3 D CT reconstruction clearly showed the sagittate bone fracture line,posterior extended coronal fracture line in aritcular fossa,dislocated fracture part protending to exteriorly.while 2D CT can only find the sagittate fracture line and no positive finding of coronal fracture of articuar fossa.and with no other complications as deformation of root of zygoma and restriction of mouth opening after the operation meatus of among the patients with articular tubercle fracture.The reconstruction of spiral CT technique can thoroughly and precisely showed the part of fractures,fracture lines,disposition,collapse of joints and the relationship with the neighboring structures.Early confirmed diagnosis of the fractures can effectivley prevent the complications of facial deformities and restriction of mouth opening.