【作者】 林琳；

【导师】 张玉庚；

【作者基本信息】 天津医科大学 ， 耳鼻咽喉科学， 2002， 硕士

【摘要】 鼻外伤是常见的急症外伤性疾病，鼻骨骨折是面部外伤最常见的骨折类型之一。传统常规诊断鼻外伤鼻骨骨折的平片检查影像相互重叠、密度分辨力差，易出现漏诊，不能满足临床诊断的要求，并且也不利于鼻骨骨折的法医学鉴定。人们不断探讨鼻骨骨折诊断的更清楚更客观的检查诊断方法。CT比平片具有明显的诊断优势。但普通CT平扫和冠扫不能立体地显示骨折的确切部位、形态及与周围组织的关系。本研究采用先进的多螺旋CT三维重建技术诊断鼻外伤鼻骨骨折，探讨其临床应用价值。 试验步骤 对25例鼻外伤患者和18例无外伤者行多螺旋CT三维重建并对照，并对其中7例鼻外伤者同时行鼻骨CR(Computed Radiography，计算机X线摄影)检查。为了天津医科大学硕士研究主论文检验多螺旋CT对鼻骨轻微骨折诊断的准确性，我们进行了尸头解剖学与影像学对照实验，在尸头上制造一无移位的缝隙骨折作为金标准，骨折前后分别对其行鼻骨正侧位X线平片、普通 CT冠扫及多螺旋 CT三维重建检查并比较。对多螺旋CT与普通CT、X线片评分综合对比，探讨其临床诊断应用价值。 结果 18例正常人和 25例鼻外伤者外鼻多螺旋 CT三维软组织和骨重建所得外鼻及其骨架三维立体图像形态逼真清晰，软组织和骨损伤改变显而易见。 25例鼻面部外伤患者中单纯鼻骨骨折14例，鼻眶复合骨折3例，单纯眼眶骨折2例，仅软组织损伤未见骨折者6例。2 5例鼻外伤患者中 7例同时行鼻骨 CR及多螺旋 CT三维重建检查，其中1例两种检查均未见骨折，其余6例CR检查可疑骨折，而3DCT诊断骨折3例，未见骨折3例。 尸头实验平片和普通CT冠扫均未显示骨折后的影像改变。而多螺旋CT三维重建后的二维影像及立体图像均可清晰见到骨折影像，与解剖操作金标准一致。 根据 X线平片、普通 CT断层及多螺旋 CT三维重建各影像学检查成像设备结构原理和临床使用感受评分综合对比结果显示多螺旋 CT三维重建在鼻骨骨拆诊断中具有明显优天津医科人学硕上研究生论文势。 多层面螺旋CT（multislice CT，MSCT）是螺旋CT的最新进展，它采用多排探测器系统，成像时间短，空间分辨率高所以比普通CT具有更快的扫描速度和更高的图象质量，利用一次容积扫描数据进行多平面重建，获得三维立体图像，清晰地反映鼻的软组织和骨架结构变化，同时可以调换不同的方向、位置和角度，从各个方向观察立体结构的改变。 结论 用多螺旋CT扫描三维重建技术诊断鼻外伤鼻骨骨折，影像清晰立体直观，诊断明确，更为客观科学，是目前对鼻骨骨折诊断的最先进的影像诊断方法。对于临床实践有指导意义。同时对鼻外伤鼻骨骨折的诊断认识有所提高，有助于疑难病例的确诊、防止漏诊及误诊，而且有助于整复手术方案的设计更为合理可取，并且解决了法医学鉴定的相关问题，具有一定的社会意义。更多还原

【Abstract】 Fracture of nasal bone is a common disease. The traditional method in diagnosing fracture of nasal bone is plain film. It has inter-overlapping screenage and poor density resolution, which is easy to miss diagnose. It can meet the request of neither clinical diagnosis nor the Forensic identification of nasal-bone fracture. CT(Computer tomography) is superior to plain film. Just plain or corona scan of common CT can’t display the certain locus, form and the relationship with peripheral tissue of nasal-bone fractures very well. We study the clinical value of three-dimensional MSCT (multislice CT)reconstruc-tion in diagnosing fracture of nasal bones.Methods MSCT reconstruction were performed in 25 patients of nasal trauma, compared with 18 normal persons. Nasal-bone CR (Computed Radiography) was also performed in 7 of 25 patients. To determine the accuracy of MSCT reconstruction in diagnosing minor fractures, we performed a minor fracture in a dead body (from the ENT institute). We regard the result of dissection as golden standard. Then nasal-bone CR, common CT, MSCT reconstruction were performed. We compared their results in order to explore their value in diagnosing nasal-bone fractures.Results We can clearly observe the characteristics of the normal structure and fractures of the nasal bones. There are 25 consecutive patients with trauma history. There are simple fractures of nasal bones in 14 patients, fractures of nasorbital regions in 3 patients, simple fractures of orbital in 2 patients, simple soft tissue injury without fractures in 6 patients. There is coincidence betweenthe image of 3DCT and the result of dissection.MSCT is more advanced system of helical scanners. MSCT has several detectors (in this study we use 4 detectors). It collects continuous volume data, rather than sequential mechanisms, which are then resolved by the system’s computer into a series of 2D images and/or rendered in 3D at various angles. Compared with plain film and common CT, three-dimensional CT reconstruction has transparent superiority.Conclusion MSCT reconstruction, with which we can enhance the diagnosis and surgical planning of complex nasal fractures, is the most ideal methods of diagnosis.更多还原