64排螺旋CT及工作站重建功能在颅骨骨折中的诊断价值

Value of 64-slice spiral CT and workstation reconstruction functions in the diagnosis of skull fracture

目的探讨64排螺旋CT及工作站重建功能在颅骨骨折中的诊断价值。方法收集我院颅脑外伤住院患者77例,全部患者行常规64排螺旋CT扫描,根据外伤的部位选用相应软件进行三维重建,检查结果进行分析、统计。结果颅骨骨折频发部位依次为:鼻骨19例,颧骨16例,上、下颌骨15例,眼眶骨和颞骨鳞部各13例,额骨11例,颞骨乳突部8例,顶骨7例,枕骨6例,颅底骨折6例。其中28例患者合并多发颅骨骨折。VR重建像对显示骨折整体形态较好,可清楚显示骨折线与硬脑膜中动脉和静脉窦的关系;Surface MIP重建像对显示骨折线的延伸范围和对分离性骨缝骨折效果较好,尤其对微细骨折显示良好;约20%骨折患者引发了颅内延时出血;合理联合应用多种重建软件可提高对颅骨骨折诊断准确率。结论颅骨骨折有频发部位,合理利用64排螺旋CT及工作站后处理功能,可提高对颅骨骨折诊断正确率,通过显示骨折线的走行及与颅内重要结构的解剖关系,可为临床医师设计皮瓣、骨瓣,选择手术时机,选择手术部位及评估手术风险和预后提供重要参考信息。

Objective To investigate the value of 64-slice spiral CT and workstation reconstruction functions in the diagnosis of skull fracture. Methods Seventy-seven patients with craniocerebral injury were enrolled and underwent 64-slice spiral CT. According to the injury site, the corresponding sottware of 3D reconstruction was used. The examina- tion results were statistically analyzed. Resdts Skull fracture was prone to occur in： nasal bone （19 cases）, cheekbones （16 cases）, the upper and lower jaw （15 eases）, orbital bone （13 cases） and squamous bone （13 cases）, frontal bone （11 eas- es）, temporal bone mastoid （8 cases）, parietal bone （7 cases）, occipital bone （6 cases）, and basion （6 cases）. 28 cases were found with multiple skull fi＇actures. The VR reconstruction of fractures showed better overall shape, which can clearly show the relationship between fracture line and venous sinus, middle arterial of the dura mater. Surface MIP reconstruction showed good performance in displaying the extended scope of fracture line and dissociative bone fracture. About 20% of the patients were found with delayed intracranial hemorrhage. Combined application of various reconstruction soflwares can improve the diagnostic accuracy of skull fracture. Conclusion The rational utilization of 64-slice spiral CT and work- station function can improve the diagnostic accuracy of skull fracture, and provides reference for the design of flap, the se- lection of the timing of surgery, surgical site, as well as the assessment of risks and prognosis.