本文選題：前庭導(dǎo)水管　切入點(diǎn)：體層攝影術(shù)　出處：《山東大學(xué)》2010年碩士論文

【摘要】： 第一部分：大前庭導(dǎo)水管綜合征HRCT影像特點(diǎn) 目的探討高分辨CT (high resolution CT, HRCT)不同掃描方式對(duì)嬰幼兒大前庭導(dǎo)水管綜合癥(large vestibular aqueduct syndrome, LVAS)的診斷價(jià)值,尋求對(duì)大前庭導(dǎo)水管綜合癥的最佳診斷方法。 資料與方法對(duì)86例感音神經(jīng)性聾患者行HRCT橫斷位掃描,對(duì)原始數(shù)據(jù)行冠狀位、矢狀位及斜矢狀位的多平面重組,所得圖像由2位影像學(xué)醫(yī)師及1位耳科醫(yī)師分別進(jìn)行診斷,比較其漏診、誤診、正確率并比較作出診斷所需觀察圖像序列數(shù),選出最佳診斷影像；診斷結(jié)束后,對(duì)該86例患者分成非LVAS和LVAS兩組,隨機(jī)抽取非LVAS 20例(40耳)作為對(duì)照組,確診的LVAS作為病變組對(duì)所有HRCT原始資料進(jìn)行測(cè)量,測(cè)量數(shù)據(jù)包括：①外半規(guī)管前、后腳壺腹連線(xiàn)L1長(zhǎng)度(X)；②于直線(xiàn)L1中點(diǎn)作垂直線(xiàn)L2,測(cè)量L2介于骨島和前庭腔內(nèi)側(cè)壁的長(zhǎng)度(Y)；③外半規(guī)管前、后腳壺腹連線(xiàn)(L1)與前腳壺腹部至前庭骨島切線(xiàn)夾角(α)和后腳壺腹部至前庭骨島切線(xiàn)夾角(β)大小并進(jìn)行比較。 結(jié)果三位醫(yī)師診斷LVA軸位分別為26耳(4耳為誤診)、24耳(2耳為誤診)、24耳；冠狀位分別為18耳、18耳、20耳；矢狀位分別為21耳(1耳誤診)、24耳(1耳誤診)、19耳；斜矢狀位分別為26耳、26耳、26耳。軸位所需圖像序列數(shù)平均為6個(gè),冠狀位平均為9個(gè),矢狀位為4個(gè),斜矢狀位為1.5個(gè)；對(duì)照組：X長(zhǎng)度為6.22mm(6.22±0.55mm),Y平均長(zhǎng)度為3.21mm(3.21±0.3mm),α+β之和平均31(31±5)度；LVAS組X長(zhǎng)度為6.28mm(6.28±0.55mm),Y長(zhǎng)度為4.24±0.24mm(3.94～5.25mm),α+β之和61±6度(55～87度),,采用U檢驗(yàn),對(duì)照組、病變組X長(zhǎng)度差異無(wú)統(tǒng)計(jì)學(xué)意義(p＞0.05),對(duì)照組、病變組比較Y長(zhǎng)度差異具有統(tǒng)計(jì)學(xué)意義(p＜0.05)；α+β角之和兩組比較差異具有統(tǒng)計(jì)學(xué)意義(p＜0.05)。 結(jié)論HRCT軸位螺旋掃描,斜矢狀位多平面重組為診斷LVAS的最佳圖像。誤診、漏診率低,所需圖像序列最少,診斷正確率高,可以提高感音神經(jīng)性耳聾患者的病因檢出率；Y長(zhǎng)大于3.92mm可作為診斷LVAS的標(biāo)準(zhǔn),前庭α+β角之和大于55度合并前庭導(dǎo)水管擴(kuò)大可作為診斷LVAS的又一標(biāo)準(zhǔn)。 第二部分：嬰幼兒大前庭導(dǎo)水管綜合征ASSR和ABR聽(tīng)力學(xué)特點(diǎn) 目的利用聽(tīng)覺(jué)穩(wěn)態(tài)誘發(fā)反應(yīng)(auditory steady-state response, ASSR)與聽(tīng)性腦干反應(yīng)(auditory brainstem response, ABR)對(duì)大前庭水管綜合征(largevestibular aqueduct syndrome, LVAS)患兒進(jìn)行聽(tīng)力測(cè)試,探討其ASSR和ABR的聽(tīng)力學(xué)特點(diǎn)。 資料與方法對(duì)63例(121耳)確診為L(zhǎng)VAS和同期來(lái)我院就診的20例非LVAS感音神經(jīng)性聾患兒的聽(tīng)力學(xué)資料進(jìn)行ASSR和ABR測(cè)試,分別記錄雙耳ASSR 0.5kHz、1kHz、2kHz、4kHz的反應(yīng)閾值,列表并進(jìn)行統(tǒng)計(jì)學(xué)分析,觀察其變化趨勢(shì),同時(shí)記錄ABR引出V波最小刺激強(qiáng)度,與同側(cè)耳ASSR反應(yīng)閾值進(jìn)行比較,觀察其相關(guān)性。 結(jié)果LVAS組：ASSR在0.5～4 kHz反應(yīng)閾值呈上升趨勢(shì),直至4 kHz反應(yīng)閾消失,近成直線(xiàn)關(guān)系,隨低頻聽(tīng)閾值的升高,斜率值減�。航o出最大刺激頻率中,1kHz反應(yīng)閾最后消失;其中59例(118耳)ASSR 0.25-4KHZ閾值呈上升趨勢(shì),直至4kHZ反應(yīng)閾消失,呈斜坡行曲線(xiàn),且隨低頻閾值的升高,斜率值減��；3例(5耳)0.25-4 KHZ反應(yīng)閾近呈平坦型曲線(xiàn),平均聽(tīng)閾均小于60dBHL；8例(16耳)ASSR 0.25-4 KHZ反應(yīng)閾值呈“八”型,反應(yīng)閾低值為1或2kHZ,至4kHZ反應(yīng)閾再次升高；在所有給出最大刺激頻率中,1kHZ反應(yīng)閾最后消失,僅有5例(8耳)8 kHZ在刺激強(qiáng)度小于92 dBHL引出反應(yīng),提示所有頻率中最先消失的為8 kHZ,其次為4 kHZ。非LVAS組,0.25-4kHZ 36耳聽(tīng)力曲線(xiàn)呈平坦型,2耳為”W”型,1耳為陡降型,1耳為上升型。當(dāng)ASSR聽(tīng)閾介于50～80 dBHL時(shí),若ABR以dBnHL為單位,其對(duì)應(yīng)的反應(yīng)閾數(shù)值小于ASSR聽(tīng)閾數(shù)值當(dāng)ASSR聽(tīng)閾＞100 dBHL時(shí),ABR 109.6 dBnHL已不能引出V波：84耳ABR最大聲刺激未引出v波,其對(duì)應(yīng)ASSR仍可全部或部分頻率引出反應(yīng)閾。非LVAS組：0.5～4 KHz閾值曲線(xiàn)多為平坦型,2～4 kHz均值與ABR V波反應(yīng)閾相近。 結(jié)論大前庭水管綜合征患者ASSR 0.5～4 kHz各頻率反應(yīng)閾值呈升高趨勢(shì)直至消失,在所有頻率中,最先受累者為4kHz；其數(shù)值與ABR反應(yīng)閾數(shù)值大小具有階段性改變,其改變區(qū)間在80～100 dBHL。
[Abstract]:The first part: HRCT image characteristics of large vestibule aqueduct syndrome
Objective to explore the diagnostic value of different high resolution CT (HRCT) scanning methods for infants with large vestibular aqueduct syndrome (large vestibular aqueduct syndrome, LVAS), and to find the best diagnostic method for large vestibular aqueduct syndrome (CT).
Materials and methods sensorineural hearing loss patients with transverse HRCT scans of 86 cases, the original data underwent coronal, sagittal and oblique sagittal multiplanar reconstruction, image obtained by 2 radiologists and 1 ear physicians were compared with the diagnosis, misdiagnosis, misdiagnosis, correct rate and compare the diagnosis required to observe image sequence number, select the best diagnostic imaging diagnosis; after the end of the 86 patients were divided into non LVAS and LVAS two groups, randomly selected 20 cases of LVAS (40 ears) as the control group, with LVAS as the disease group for all HRCT data measurement, measurement data including: the lateral semicircular canal, foot length (X) of L1 line; the vertical line to line L2 as the midpoint of L1, measurement of L2 between bone island and the medial wall of the vestibular cavity length (Y); the lateral semicircular canal, the rear line (L1) and the front of the ampulla to vestibular bone island (tangent angle alpha) The foot and ampulla to vestibular bone island (beta) and tangent angle size were compared.
緇撴灉涓変綅鍖誨笀璇婃柇LVA杞翠綅鍒嗗埆涓，

本文編號(hào)：1709063