MSCT眼内直肌损伤对筛骨纸板骨折的评价价值

The evaluation value of MSCT internal rectus muscle injury on lamina papyracea fracture

目的:应用MSCT探讨眼内直肌损伤对筛骨纸板骨折的评价价值,为明确筛骨纸板骨折尤其是隐匿性骨折提供影像诊断依据。方法:回顾性分析经我院眼眶MSCT扫描的120例眼外伤患者影像资料,所有患者均行常规轴位容积扫描,用0.625mm层厚重建数据,通过PACS系统传输至GE AW4.6工作站进行矢、冠状位及MPR重建,矢状位与眼内直肌平行,冠状位与双侧眼眶前缘连线平行,采用骨算法和软组织算法显示责任病灶,观察眼内直肌损伤情况及筛骨纸板骨折程度,以对侧健康眼眶作为对照,对比分析二者区别。结果:98例眼眶筛骨纸板发生凹陷骨折,左眼57例,右眼41例,双眼5例,Ⅰ度27.5%(27/98),Ⅱ度42.9%(42/98),Ⅲ度29.6%(29/98)。内直肌及眶脂体疝入筛窦71例,合并眶下壁骨折36例,颧骨骨折27例,上颌窦窦壁骨折31例,视神经管骨折3例,额骨骨折9例,上颌骨骨折3例。筛骨纸板微骨折22(18.3%)例。内直肌增粗水肿81例,合并筛骨纸板Ⅰ度骨折19.8%(16/81),Ⅱ度29.7%(24/81),Ⅲ度23.5%(19/81),17例筛骨纸板骨折患者未发现内直肌损伤。眶脂体模糊65例,副鼻窦积液、积血69例。结论:眼内直肌损伤和筛骨纸板骨折及骨折程度有联系,对于临床治疗及法医鉴定具有可靠实用价值。

Objective To evaluate the evaluation value of the injury of the intraocular rectus muscle on the fracture of the lamina papyracea, and to provide the diagnostic basis for the diagnosis of the fracture of the lamina papyracea, especially the occult fracture. Methods Retrospective analysis of 120 cases of ocular trauma patients with MSCT scan in our hospital. All patients underwent conventional axial volume scan. The data were reconstructed with 0.625 mm thickness. The sagittal coronal and MPR reconstruction was transmitted through the PACS system to GE AW4.6 workstation. The sagittal position was parallel to internal rectus muscle, and the coronal and bilateral orbit.The anterior border was parallel to the line. The bone and soft tissue algorithms were used to show the focal lesion. The injury of the rectus muscles and the degree of the fracture of the lamina papyracea were observed. The contrast of the healthy eyes of the side was compared and the two differences were compared and analyzed. Results 98 cases of orbital lamina papyracea had sunken fracture, 57 left eye, 41 right eye, 5 eyes, Ⅰ degree 27.5%(27/98), Ⅱ degree 42.9%(42/98), Ⅲ degree 29.6%(29/98). There were 71 cases of internal rectus and orbital fat in ethmoid sinus, 36 cases of supraorbital wall fracture, 27 cases of zygomatic fracture, 31 cases of maxillary sinus wall fracture, 3 cases of optic canal fracture, 9 cases of frontal bone fracture and 3 cases of maxillary fracture. 22(18.3%) cases of microfracture of the lamina papyracea. 81 cases of internal rectus muscle thickening edema, Ⅰ degree fracture of lamina papyracea 19.8%(16/81), Ⅱ degree 29.7%(24/81), Ⅲ degree 23.5%(19/81), 17 cases of lamina papyracea fracture were not found in the medial rectus muscle injury. Orbital fat body was vague in 65 cases, paranasal sinuses and effusion in 69 cases. Conclusion The injury of medial rectus muscle is related to the degree of fracture and fracture of lamina papyracea. It has reliable and practical value for clinical treatment and forensic identification.