高分辨率CT联合多平面重组及曲面重组诊断外伤性听力损伤及面瘫病因的价值

Value of high resolution CT combined with multiplanar reconstruction and curved planar reformation for etiological diagnosis of traumatic hearing loss and facial paralysis

目的探讨高分辨率CT(HRCT)联合听骨多平面重组(MPR)、听骨链及面神经管曲面重组(CPR)诊断外伤性听力损伤及面瘫病因的价值。方法收集2018年1月至2022年1月在西安交通大学附属西安市中心医院经临床证实的139例颞骨骨折后出现听力下降和/或面瘫患者的HRCT影像资料,所有患者均进行HRCT轴位扫描,在Philips EBW工作站上,行听骨MPR,听骨链、面神经管CPR,观察听骨链、面神经管损伤的位置、类型及邻近结构的累及情况。结果HRCT联合MPR、CPR对锤砧关节及砧镫关节脱位、听骨骨折、面神经管骨折的检出率均为100%。139耳中,单纯听骨链损伤80耳(57.55%),单纯面神经管骨折40耳(28.78%),听骨链损伤合并面神经管骨折19耳(13.67%);听骨链损伤共99耳,其中锤砧关节脱位49耳(49.49%),砧镫关节脱位27耳(27.27%),锤砧关节并砧镫关节脱位21耳(21.21%),锤骨颈骨折1耳(1.01%),砧骨短突骨折1耳(1.01%);面神经管骨折共59耳,其中面神经管迷路段骨折6耳(10.17%),面神经管膝状神经窝骨折19耳(32.20%),面神经管鼓室段骨折17耳(28.81%),面神经管膝状神经窝并鼓室段骨折11耳(18.64%),面神经管迷路段、膝状神经窝、鼓室段并乳突段骨折6耳(10.17%)。结论HRCT联合MPR及CPR技术可清晰显示听骨、面神经管损伤情况,为明确外伤性听力损伤及面瘫病因提供可靠的影像学依据。

Objective To explore the value of high resolution CT(HRCT)combined with multiplanar reconstruction(MPR),ossicular chain and facial nerve curved planar reformation(CPR)for etiological diagnosis of traumatic hearing loss and facial paralysis.Methods The imaging data of 139 patients with hearing loss and/or facial paralysis after temporal bone fracture who were confirmed clinically in Xi'an Central Hospital Affiliated to Xi'an Jiaotong University from Jan.2018 to Jan.2022 and underwent HRCT axial scanning were collected.At Philips EBW workstation,auditory ossicular MPR,auditory ossicular chain,and facial nerve canal CPR were performed.The location and type of auditory ossicular chain and facial nerve canal injury and the involvement of adjacent structures were observed.Results The detection rates of HRCT combined with MPR and CPR in incudomalleolar and incudostapedial joint dislocation,ossicular fracture,and facial nerve canal fracture was all 100%.Among 139 ears,80(57.55%)had ossicular chain injury,40(28.78%)had facial nerve canal fracture,and 19 ears(13.67%)had ossicular chain injury combined with facial nerve canal fracture.There were 99 ears with ossiculai chain injury,49 ears(49.49%)with incudomalleolar joint dislocation,27 ears(27.27%)with incudostapedial joint dislocation,21 ears(21.21%)with incudomalleolar joint and incudostapedial joint dislocation,1 ear(1.01%)with fracture of the malleus neck,1 ear(1.01%)with fracture of short process of incus.There were 59 ears with facial nerve geniculate fossa fracture,6 ears(10.17%)with facial nerve labyrinth fracture,19 ears(32.20%)with facial nerve geniculate fossa fracture,17 ears(28.81%)with facial nerve bone canal tympanic fracture,11 ears(18.64%)with facial nerve tympanic segment and geniculate fossa bone wall fracture at the same time,6 ears(10.17%)with facial nerve canal vagus segment,geniculate fossa,tympanic segment and mastoid segment fracture.Conclusion HRCT combined with MPR and CPR technology can clearly show the damage of auditory bone and facial nerve canal,and provide a reliable imaging for etiological diagnosis of traumatic hearing loss and facial paralysis.