颌面骨骨折时间窗动态影像分析  

Imaging features of maxillofacial fracture on serial imaging exams

作　　者：于宝海[1] 曹磊[1] 韩殊曼 史亮[1] 张晓飞[1] 史云恒[1] 郭哲[1] 吴慧钊[1] 吴文娟[1] 

机构地区：[1]河北医科大学第三医院放射科,石家庄050051

出　　处：《国际医学放射学杂志》2017年第4期401-406,共6页International Journal of Medical Radiology

摘　　要：目的探讨颌面骨骨折随时间变化的影像特征,为临床判断病人受伤程度、受伤时间提供依据。方法回顾性分析2016年1月—2017年3月间在河北医科大学第三医院进行CT检查,且受伤时间及受伤原因明确的500例颌面骨骨折病人,男369例,女131例。平均年龄(40.24±18.71)岁。按CT扫描距受伤时间间隔分为6组:超早期(<3 d)、早期(4~7 d)、中早期(8~14 d)、中期(15~21 d)、中晚期(22 d^2个月)、晚期(>2个月)。采用卡方检验对不同受伤时间组的骨折征象进行比较分析。结果统计额骨骨折共42例,均为高能量暴力骨折,均伴多发伤。骨折线1周内清晰、锐利,2~3周后骨折边缘部分吸收圆钝、硬化,2个月以上仍常见骨折线。伤后1~2周内均存在明显的软组织肿胀和鼻旁窦窦腔积液。骨折涉及额窦和/或其他含气窦壁时,伤后3 d内邻近软组织和/或颅内可见积气。12例(28.6%)伴颅内血肿,5例(10%)出现硬膜下积液。蛛网膜下腔出血吸收多在1周内,硬膜外血肿吸收在3周以上。观察期间除伴随的硬膜外血肿、硬膜下血肿和硬膜下积液征象,其他征象的动态变化差异具有统计学意义(P<0.05)。观察眶内壁骨折40例,早期骨折线锐利,均伴有筛窦积液,2~3周后骨折处出现平滑的凹陷征象,筛窦积液吸收。观察期间,除内直肌增粗变化无统计学意义,其余征象变化均具有统计学意义(P<0.05)。观察鼻骨骨折50例,早期骨折线锐利,伴邻近软组织肿胀,1周后肿胀逐渐消失,3周后常可见光滑的骨折边缘。鼻骨骨折伴随的软组织肿胀及骨折边缘随时间的变化具有统计学意义(P<0.05)。2个月以上组观察可见长期存在的鼻骨骨折线。结论认识颌面骨骨折动态变化的规律,有助于临床判断骨折程度和骨折时间。Objective By analyzing the evolution of maxillofacial fracture on serial imaging exams, to provide evi-dences for clinical assessment of the fracture degree and injury time. Method A retrospective CT imaging analysis of the patients with maxillofacial fracture who visited the Third Hospital of Hebei Medical University during January 2016-March 2017 was performed. In total, 500 patients （age, 40.24＆#177;18.71 year-old;male n=369, female n=131） were included in the study.The time and reason of injuries were all confirmed. CT images were divided into 6 groups according to the interval time after injury, ultra-early stage（within 3 days）, early stage（4 to 7 days）, early-middle stage （8 to 14 days）, middle stage （15 to 21 days）, late-middle stage（22 days to 2 months）, and late stage（after 2 months）. Chi-square test was used to assess the imaging changes of fractures in the different interval time after injury. Results Forty-two of 500 cases were frontal fracture caused by high-energy impact,and all of them associated with multiple injuries.The fracture lines were clear and sharp within 1 week. The fracture edges were absorbed and became blunt/hardening 2 to 3 weeks after injury. The fracture lines commonly presented more than 2 months after injury. The obvious soft tissue swelling around the fracture and paranasal sinus cavity effusion were revealed 1 to 2 weeks after injury, and gas collection was concomitant in cases with fracture involving the paranasal sinus wall within 3 days.Twelve cases （28.6%） combined with intracranial hemorrhage. Five cases （ 10%） showed subdural effusion . Subarachnoid hemorrhage was absorbed in a week , however , absorbing epidural hematoma took more than 3 weeks. The fracture signs at different stages were significantly different （P〈0.05） with exceptions for the epidural hematoma, subdural hematoma, and subdural effusion. Total 40 cases of medial orbital wall fractures were assessed. The fracture line was sharp with adjacent ethmoid sinus effusio

关 键 词：颌面骨 骨折 体层摄影术 X线计算机 影像征象 

分 类 号：R683.5[医药卫生—骨科学] R445.3[医药卫生—外科学]