依据螺旋CT三维重建定量测量指导颧骨复合体骨折的修复  

Three-dimensional spiral CT measurement in instructing the operation on zygomatic complex fractures

作　　者：赖仁发[1] 刘湘宁[1] 沈山[1] 邓玉瑛[2] 史长征[2] 陈铁[1] 

机构地区：[1]暨南大学附属第一医院口腔颌面外科,广东省广州市510630 [2]暨南大学附属第一医院影像中心,广东省广州市510630

出　　处：《中国临床康复》2006年第13期122-124,i0006,共4页Chinese Journal of Clinical Rehabilitation

基　　金：广东省科技计划项目(粤科社字:2003-245-16);广东省科技厅社会发展科技项目(粤科社字:2004-139-18);国家教委留学回国人员科研基金资助项目(245027)~~

摘　　要：目的:评价螺旋CT三维重建及立体定量测量对颧骨复合体骨折手术患者的相关指导作用。方法:选择2001/2005在暨南大学附属第一医院口腔颌面外科手术治疗的76例颧骨复合体骨折患者,伤后至CT检查的时间为24h～2周。所有患者做两次螺旋CT扫描、进行三维重建和立体定量测量:①术前:确定健侧的颧突的前后径(Dmp)及颧骨下缘的前后径(Dzm)后,在患侧确定与健侧对称之颧突前后径后点(bmp)及颧骨下缘的前后径后点(bzm),连接患侧的颧突点(mp)与颧突前后径后点(bmp),颧颌点(zm)与颧骨下缘的前后径后点(bzm)。计算健患侧颧突的前后径及颧骨下缘的前后径的差值。代表颧突点及颧突下缘后缩或前突的程度,以明确骨折移位的程度,指导术中定量移动颧骨。②术后:术后一两周以相同的方法计算健患侧颧突的前后径及颧骨下缘的前后径的差值,代表患侧颧突点及颧突下缘术后恢复程度,以评价手术复位效果(两差值小于2mm为复位达到三维完全对称;颧突的前后径差值小于2mm而颧骨下缘的前后径差值大于2mm为三维基本对称;两差值均大于2mm则为三维不对称)。术后4～6个月,用三维定位面弓对面部软组织外形进行测量,观察患者面形是否对称。结果:76例全部进入结果分析。①74例颧骨复位固定后均达到三维完全对称,2例达到三维基本对称。②术后4～6个月检查76例面形恢复均对称。结论:螺旋CT三维重建量测量能明确骨折移位的程度,指导颧骨复合体手术复位,并能准确评价手术复位效果。AIM： To evaluate the instructional effect of spiral CT three-dimensional reconstruction and stereo-measurement on zygomatic complex fracture operation. METHODS： From 2001 to 2005, at the Department of Oral ＆ Maxillafacial Surgery of the First Hospital Affiliated to Jinan University, Spiral CT scan, three dimensional reconstruction and stereo-measurement were used twice for everyone in the 76 patients with zygomatic complex fractures, and CT scan was used in them just in the time of 24 hours to 2 weeks after their injury, ①Before operation： We measured anteropesterior diameter of zygomatic process （Dmp） and anteropesterior diameter of the lower part of zygomatic bone （Dzm） of the healthy side, marked two points of bmp and bzm in the fractured side, then connected mp with bmp, also zm with bzm and compared the difference of Dmp and Dzm of two sides, and use the difference for guiding the reduction of zygomatic fractures. ② After operation： The difference of Dmp and Dzm of two sides was calculated again in the same way to evaluate the restoration results of the operation in the time of 1-2 weeks after operation （The difference 〈 2 mm represented complete symmetry in three dimensional structure; Drop 〉 2 nun and Dzm 〈 2 mm represented basic symmetry in three dimensional structure; Drop and Dzm both 〈 2 nun represented dissymmetry in three dimensional structure. Three dimensional orientation face bow was used to evaluate the symmetry of facial shape in the time of 4-6 months after operation. RESULTS： All the 76 patients entered the stage of result analysis. ① 74 patients got the complete symmetry after restoration , and 2 got basic symmetry in three dimensional structure. ②The facial appearance of 76 patients recovered synunetrically. CONCLUSION： Spiral CT three-dimensional reconstruction measurement can identify the degree of fracture shift, exactly instruct and evaluate the operational restoration of zygomatic complex fractures.

关 键 词：颧骨骨折 体层摄影术 螺旋计算机 成像 三维 

分 类 号：R496[医药卫生—康复医学]