下颌骨骨折的曲面断层摄影与多层螺旋CT影像分析研究

Curved surface tomography and MSCT image analysis of mandibular fracture

目的总结下颌骨骨折的曲面断层摄影与CT影像学特点并探讨漏诊原因。方法回顾对比分析43例同时有曲面断层摄影及CT检查的下颌骨骨折影像资料,比较检出率,分析漏诊因素。结果经MSCT确诊43例共有71处下颌骨骨折及6处颞颌关节脱位,其中,体部骨折16处,颏部骨折21处,髁突骨折14处,角部骨折12处,牙槽骨折4处,升部骨折2处,冠突骨折2处。曲面断层摄影明确骨折63处;可疑骨折6处;漏诊骨折3处,其中髁突颈骨折1处,冠突骨折1处,升部骨折1处;漏诊颞颌关节脱位1处。曲面断层片的骨折诊断检出率为89%,脱位诊断检出率为83%。结论螺旋CT骨折检出率高于曲面断层摄影。螺旋CT检查结合多平面重建(MPR)、表面遮盖显示(SSD)可更好地显示骨折及其周围情况,术前正确诊断对治疗方案、手术入路及制定详细的手术计划可提供正确指导。

Objective To summarize the characteristics of curved surface tomography and CT imaging in the diagnosis of mandibular fracture, and discuss the reasons of missed diagnosis. Methods Retrospectively compare and analyze the mandibular fracture image data by simultaneous surface tomography and CT examination of 43 cases, com-pare the detection rate, and analyze missed factors. Results MSCT confirmed 43 cases, of which there were 71 mandibular fractures and 6 dislocation of the temporomandibular joint, 16 fractures of the body, 21 fractures of chin,condylar fracture 14, angle fracture 12, alveolar fracture 4, ascending branch 2 fractures, 2 fractures of the coronoid process. Curved surface tomography confirmed 63 mandibular fractures,suspected fracture 6,missed diagnosis fracture 3, of which there was 1 case with condylar neck fracture, 1 case with protrusion fracture, 1 case with ascending branch fractures, 1 case with missed diagnosis dislocation of the temporomandibular joint. The diagnosis rate of the fracture was 89%, and the detection rate was 83%. Conculusion The detection rate of spiral CT is higher than that of curved surface tomography. Multi slice spiral CT examination combined with SSD, MPR can better show the frac-ture and the surrounding condition, the correct diagnosis before operation, the surgical approach and the development of detailed surgery plan can provide the correct guidance.