先天性听小骨畸形的高分辨CT诊断

High Resolution CT Diagnosis of Congenital Deformities of Auditory Ossicles

目的 :研究先天性听小骨畸形的HRCT表现 ,以助于外科重建听力可能性的判断和手术方案的制定。材料和方法 :对临床诊断的 35例中外耳先天畸形行HRCT扫描 ,将所发现的 4 4耳听小骨畸形表现进行归类分析。男 2 4例 ,女 1 1例 ,年龄 1～ 5 0岁 ,平均 1 3岁。单纯横断扫描 5例 ,横断加冠状扫描 30例。结果 :HRCT显示听小骨畸形的类型有 :1 完全缺如 :8耳 (锤、砧骨同时缺如 6耳 ,单纯锤骨缺如 2耳 )。 2 部分缺失或形态异常 :36耳。 (锤骨 34耳 ,砧骨 35耳 ,镫骨 2 2耳 )。 3 关节异常 :2 6耳 (锤 -砧关节融合 1 6耳 ,砧 -镫关节融合 5 耳 ;砧 -镫关节夹角增大 5耳 )。 4 锤 -砧骨块位置异常 :2 7耳 (外移 2 5耳 ,前移 2耳。与鼓室壁或闭锁板粘连或融合 2 0耳 )。 5 韧带钙化或骨化 :5耳。结论 :HRCT能良好显示听小骨先天畸形的类型、范围和程度 。

Objective:To study the features of the congenital deformities of auditory ossicles on high resolution CT(HRCT)so as to judge the possibility of reconstructing hearing by surgical operation and find out the correct operative plan.Materials and methods:Thirty-five cases with congenital deformities of external and middle ear were diagnosed clinically,including 24 cases in male and 11 in femaled,age ranged 1-50 years with the average of 13 years,were scanned by HRCT.Forty-four ears with deformities of auditory ossicles found in these cases and were analysed and classified in terms of their manifestations.In this series,5 cases merely had axial scans and 30 cases had both axial and coronal scans.Results:HRCT appearances of this series with auditory ossicle abnormalities were as follows:1 whole ossicular absence in 8 ears (absence of both malleus and incus in 6 ears and only malleus in 2 ears);2 ossicular hypoplasia in 36 ears(of malleus in 34 ears,incus in 35 ears and stapes in 22 ears);3 abnormal ossicular articulation in 26 ears(fused malleoincudal articulation in 16 ears and incudostapedial joint in 5 ears;increased angles beween incus and stapes in 5 ears);4 abnormal situated malleoincudal mass in 27 ears(lateral situation in 25 ears and anterior situation in 2 ears;fused to the wall of the tympanic cavity and bony atretic plate in 20 ears);5 calcification or ossification of ossicular ligments in 5 ears.Conclusions:By means of the superiority on demonstrating patterns and extent of the congenital ossicular deformities,HRCT was very valuable clinically on making accurate diagnosis and correct decision of surgical plan.