鼻背软组织CT表现对鼻骨隐匿骨折诊断的临床意义

The clinical significance of CT findings of the dorsal nasal soft tissue in the nasal bone fracture

目的探讨鼻背软组织结构在鼻骨骨折时的异常改变,进一步明确鼻骨骨折尤其是隐匿骨折的CT诊断。方法收集我院行副鼻窦CT扫描的受检者60例(120侧)作为正常对照组,外伤骨折组60例(120侧)。所有图像均通过Phillips 64层螺旋CT容积扫描,骨算法及软组织算法重建,传输至Extended Brilliance TM Workspace(EBW)工作站,标准化重建鼻骨横断面及冠状面图像。观察两组鼻背软组织解剖结构,对两组进行对比分析,总结其二者在影像学的区别。结果正常对照组60例(120侧)鼻背软组织不肿,其中57例(114侧)鼻背软组织间隙清晰可见,3例(6侧)间隙不清。外伤骨折组60例(120侧)中,鼻骨骨折侧109侧/120侧,鼻背软组织肿胀109侧/109侧,软组织结构不清109侧/109侧。结论螺旋CT能够清晰显示正常鼻背软组织解剖结构。鼻背软组织肿胀,软组织层次消失可作为判断新鲜鼻骨骨折,尤其是隐匿骨折的影像学诊断依据。

Objective To study the abnormal changes of the dorsal nasal soft tissue in nasal bone fracture and to further confirm the CT diagnosis of nasal bone fracture, especially the hidden fracture. Methods 60 patients （ 120 sides） by sinus CT scans were included as the normal control group. 60 patients with bone fracture were selected as a study group. All patients were scaned by Phillips 64 layer spiral CT, the images were reconstructed by algorithm of bone and soft tissue, and were transferred to the Extended BrillianceTM Workspace （EBW） station, the standardized images of the nasal bone in cross and coronary section were reconstructed. Structures of the dorsal nasal soft tissue in both groups were evaluated to obtain the image differences. Results The swelling of dorsal nasal soft tissue was not seen in the normal control group of 60 cases （ 120 sides） , the structure of dorsal nasal soft tissue was clearly displayed in 57 cases （114 sides）. There were totally 109 sides of nasal bone fractures in traumatic fracture group of 60 patients （ 120 sides）. The swelling and vague structure of dorsal nasal soft tissue were shown in all 109 sides. Conclusion The normal nasal soft tissue anatomy can be displayed clearly by Spiral CT. The swelling of dorsal nasal soft tissue can be used as a diagnostic clue in the fresh nasal bone fracture, especially in the hidden fracture.