螺旋CT及三维重建技术诊断颌面部骨折的价值

Diagnostic value of spiral CT and three-dimensional reconstruction in maxillofacial fracture

目的:探讨螺旋电子计算机断层扫描(CT)及三维重建技术诊断颌面部骨折的价值。方法:选取86例疑似颌面部骨折患者作为研究对象,所有患者入院后行X线检查和多层螺旋CT及三维重建技术检查,以手术结果为金标准,记录两种检查方法诊断的一致性,并比较两种检查方法对颌面部骨折的诊断效能。结果:86例疑似颌面部骨折患者经手术后诊断为颌面部骨折71例,其中颧骨16例、鼻骨20例、上下颌骨11例、蝶筛骨12例、颚骨12例;非颌面部骨折15例。以临床手术诊断结果为金标准,86例疑似颌面部骨折经X线诊断为颌面部骨折56例,非颌面部骨折11例,误诊15例,漏诊4例,诊断准确率为77.91%(67/86),阳性预测值为93.33%(56/60),阴性预测值为42.31%(11/26),Kappa值为0.405,具有较低诊断一致性。86例疑似颌面部骨折经螺旋CT及三维重建技术诊断为颌面部骨折68例,非颌面部骨折9例,误诊3例,漏诊6例,诊断准确率为89.53%(77/86),阳性预测值为91.89%(68/74),阴性预测值为75.00%(9/12),Kappa值为0.606,具有较高诊断一致性。X线诊断特异度为73.33%,螺旋CT及三维重建技术诊断特异度为60.00%,差异无统计学意义(P>0.05)。螺旋CT及三维重建技术诊断敏感度为95.77%,准确率为89.53%,X线诊断敏感度为78.87%,准确率为77.91%,差异均有统计学意义(P<0.05)。结论:螺旋CT及三维重建技术在诊断颌面部骨折方面表现出更高的敏感度和诊断准确率。

Objective To explore the value of spiral computed tomography(CT) and three-dimensional reconstruction in diagnosing maxillofacial fractures.Methods A total of 86 patients with suspected maxillofacial fractures were enrolled as the research objects.All patients underwent X-ray examination and multi-slice spiral CT combined with three-dimensional reconstruction.Taking surgical results as the golden standard,the diagnostic consistencies of the two methods were recorded,and the diagnostic efficiency for maxillofacial fractures was compared between two methods.Results The surgical results showed that out of 86 patients with suspected maxillofacial fractures,there were 71 confirmed cases(16 cases of zygoma fractures,20 cases of nasal bone fractures,11 cases of mandible and maxilla fractures,12 cases of sphenethmoid fractures and 12 cases of jawbone fractures) and 15 cases of non-maxillofacial fractures.Taking the results of surgical pathology as the golden standard,X-ray showed that there were 56cases of maxillofacial fractures,11 cases of non-maxillofacial fractures,15 cases of misdiagnosis and 4 cases of missed diagnosis,and its diagnostic accuracy,positive predictive value,negative predictive value and Kappa value were 77.91%(67/86),93.33%(56/60),42.31%(11/26) and 0.405,respectively,having a low diagnostic consistency.Spiral CT combined with three-dimensional reconstruction showed that there were 68 cases of maxillofacial fractures,9 cases of non-maxillofacial fractures,3 cases of misdiagnosis and 6 cases of missed diagnosis,and its diagnostic accuracy rate,positive predictive value,negative predictive value and Kappa value were 89.53%(77/86),91.89%(68/74),75.00%(9/12) and 0.606,respectively,having a high diagnostic consistency.The difference in diagnostic specificity between X-ray and spiral CT combined with three-dimensional reconstruction was trivial(73.33% vs 60.00%,P>0.05),but the diagnostic sensitivity and accuracy between X-ray and spiral CT combined with three-dimensional reconstruction differed significantly(78.87% vs 95.77%,77.91% vs 89.53%;P<0.05).Conclusion Spiral CT combined with three-dimensional reconstruction exhibits higher sensitivity and accuracy in the diagnosis of maxillofacial fractures.