锥形束CT在下颌骨髁头骨折诊疗中的应用价值

Application Value of Cone Beam Computed Tomography in Diagnosis of Mandibular Condylar Fractures

目的比较锥形束电子计算机断层扫描(cone beam computed tomography,CBCT)与X线全景片、螺旋CT对下颌骨髁头骨折的诊断和分型结果,探讨CBCT的应用价值。方法回顾作者医院2016-01~12月经治下颌骨髁头骨折病例21例(27侧),均应用CBCT扫描,CBCT检查前已行X线全景片检查13例,行颅颌CT扫描11例(3例同时有全景片)。比较分析各检查方法的诊断率和分型率。结果 CBCT在髁头骨折的诊断率与X线全景片、CT冠状位扫描或三维重建比较差异均无统计学意义(P>0.05),但明显高于水平位CT,二者比较差异有统计学意义(P<0.05);CBCT的分型率高于X线全景片和水平位CT,比较差异均有统计学意义(P<0.05),与CT冠状位扫描或三维重建比较差异无统计学意义(P>0.05)。27侧(21例)确诊髁头骨折中,分别发生在髁突外的A型骨折11侧、B型骨折9侧、C型骨折者2侧,M型粉碎性骨折5侧。结论 CBCT能直观、立体、多方位显示下颌骨髁头骨折,在其诊断、分型和临床处理中具有重要价值。

Objective To compare cone beam computed tomography（CBCT）,panoramic X-rays and spiral CT in the diagnosis and classification of mandibular condylar fractures,and discuss the apply values of CBCT.Methods Twenty-one patients with 27 mandibular condylar fractures in authors＇ hospital from January 2016 to December 2016 were reviewed.CBCT was performed in all patients for confirmation of diagnosis and classification.Before CBCT examinations,13 patients received panoramic X-rays,and 11 patients underwent CT scan（3 of 11 also received panoramic X-rays）.The diagnostic and classification rate of each methods were compared and analyzed.Results Although there was no significantly difference between CBCT and panoramic X-rays,coronal CT scan or 3D reconstruction on diagnostic ratio（P0.05）,CBCT was higher than transverse CT（P0.05）.The classification accuracy of CBCT was significantly higher than that of panoramic X-rays and transverse CT scanning（P0.05）,but no difference was found between CBCT and coronal CT scan or 3D reconstruction（P0.05）.Of the 27 condylar fractures（21 patients）evaluated,11 were classified as type A outside condylar process fractures,9 were type B,2 were type C,and 5 were type M of comminuted fractures on the basis of Yangchi classification system.Conclusion CBCT was valuable in diagnosis,classification and clinical treatment of mandibular condylar fracture because of intuition sense,stereoscopic image and diversification.