鼻区骨细微结构及其骨折的MSCT表现  

MSCT findings of the normal microanatomy and fracture of the nasal bone

作　　者：敖振杰[1] 张得旺[1] 黄炎标[1] 唐光健[2] 刘振堂[3] 常青林[4] 李欣[5] 韩淑珍[6] 官树雄[7] 

机构地区：[1]广东医学院附属厚街医院放射科,广东东莞523945 [2]北京大学第一医院 [3]西安交通大学医学院第二附属医院放射科 [4]北京同仁医院 [5]唐山工人医院 [6]广东医学院附属厚街医院病理科 [7]广东医学院附属厚街医院五官科

出　　处：《实用放射学杂志》2012年第3期358-362,383,共6页Journal of Practical Radiology

摘　　要：目的 探讨易与骨折混淆的鼻区骨细微结构及其MSCT表现,提高诊断鼻区骨折的正确率.方法 ①正常组：选取鼻区骨完整的25个干颅标本,5个防腐湿颅标本及无伤志愿者100例,均行MSCT 多平面重建（MPR）及容积再现（VR）成像.对其中25个干颅鼻区骨表面细微结构进行肉眼观察,然后对3个干颅和2个湿颅鼻区骨常规断骨解剖,并对其中一些细微结构内组织行病理切片确定其成分.观察易与骨折混淆细微结构的形态、位置、走行、大小.②骨折组：随机选取曾行MSCT MPR及VR成像检查并经临床手术或病例复查证实的鼻区骨折的患者250例,分析不同成像诊断准确性,观察骨折征象与鼻区骨细微结构区别.结果 ①正常组：MPR较满意显示易与骨折混淆的鼻区骨众多细微结构,但其中上颌骨额突孔19个、鼻骨孔27个、鼻骨其它孔16个、鼻骨骨髓腔中7例、上颌骨额突骨髓腔9例形似低密度锐利骨折线.鼻骨及上颌骨额突畸形中5例形似骨折及游离骨折片.19例偏侧型鼻缝形似锐利骨折线或缝分离.12例缝间骨形似微小游离骨折片,筛沟9例和3例鼻骨表面压迹致鼻骨菲薄形似骨折.这些结构在VR图像上显示出与骨折不同的影像特征,但VR对部分细微结构显示不足.②骨折组：250例鼻区骨折中,MPR准确诊断鼻区骨折219例,假阳性27例,漏诊4例,正确率87.6%;VR准确诊断鼻区骨折171例,漏诊79例,正确率约68.4%;MPR结合VR准确诊断246例骨折,漏诊4例,无假阳性,诊断正确率98.4%.结论 熟悉了解易与骨折混淆的正常鼻区骨细微结构的MSCT的 MPR及VR影像表现,两者充分结合,可以明显提高鼻区骨折诊断的准确性.Objective To study MSCT findings of the normal mieroanatomic structures of nasal hone area which is easy to be confused with the bone fracture, so that to improve the accurate rate in diagnosing nasal bone fracture. Methods （1）Control group： MSCT multi-plane reconstruction （MTR） and volume rendering（ VR） were performed in 100 healthy volunteers,25 skulls and 5 head speeimens. The surface structures of nasal bone area were observed in 25 skulls, subsequently, 3 dry skulls and 2 head specimens were dissected to observe the microanatomy and to obtain the inforrnations about the shape, location, course and size of the mrcrostructures of nasal bone parts which were easy to be confused with bone fracture. （2） Fracture group： 250 cases with nasal fractures confirmed by operation or reexamined were selected randomly in which all the patients were examined by MPR and MR, the imaging feat tires at MPR and VR were compared, the differences between the bone fracture and normal fine structures were observed. Results （1） Control group： many of the normal fine structures of nasal bene easily confused with fracture could be showed satisfactorily by MPR. However, the shape of foramens of frontal process of maxilla（n= 19 ） , foraminas of nasal bone（n= 27 ） , other foraminas of nasal bone（ n= 16） , nasal bone marrow cavity in 7 cases and cavity of frontal process of maxilla in 9 cases showed similar to low density sharp shape fracture line. The shape of deformity in nasal bone an.d frontal process of maxilla in S cases showed similar to fraclure and lree hone chips, respectively. The deviated nasal suture in 19 cases looked like sharp-shape fracture or seperated suture. The sutural bone in 12 eases seemed to be tiny free bone chips. The shape of thinned nasal bone induced by ethmoid sulcus indentation in 9 cases and by surface indentation of nasal bone in 3 cases showed similar to fracture. While these structures appeared to be different imaging features on VR images in comparison with t

关 键 词：鼻骨 骨折 体层摄影术 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学]