【摘要】：目的：分析骨炎在慢性鼻竇炎中的CT影像學(xué)表現(xiàn)及發(fā)病特點(diǎn)，探討性別、年齡、鼻息肉、病程等與骨炎的相關(guān)性。 方法：選擇130例于2009年1月至2014年1月間在我院住院擬行初次手術(shù)的慢性鼻竇炎患者（chronic rhinosinusitis, CRS），通過查閱患者CT影像以及病例資料，利用UNISIGHT TeamView軟件及整體骨炎評分系統(tǒng)（global osteitisscore system,GOSS）、Lund-Mackay評分系統(tǒng)分析患者CT影像，分析骨炎的發(fā)生率及影像學(xué)特點(diǎn)。根據(jù)性別、年齡、鼻息肉、病程將患者分別進(jìn)行分組，采用SPSS20.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析，對比各個研究因素內(nèi)不同組間的骨炎發(fā)生率差異，研究其與骨炎發(fā)生之間的相關(guān)性。 結(jié)果： 1、130例患者中骨炎發(fā)生率34.6%（45/130），2級以上有意義骨炎31.5%（41/130）。上頜竇及前組篩竇發(fā)病率最高，左側(cè)上頜竇發(fā)病率26.9%（35/130），右側(cè)上頜竇發(fā)病率22.3%（29/130）,左側(cè)前組篩竇發(fā)病率24.6%（32/130）,右側(cè)前組篩竇發(fā)病率21.5%（28/130）。骨炎患者的GOSS介于3分-36分，，平均14.07±8.5分。 2、130例患者Lund-Mackay評分介于3分-22分之間，平均7.9±4.3分。骨炎組患者Lund-Mackay評分介于3分-22分之間，平均評分10.0±5.2分；無骨炎患者中Lund-Mackay評分介于3分-19分之間，平均評分6.6±3.7分。骨炎組與無骨炎組Lund-Mackay評分有顯著差異t=4.34，p＜0.001。 3、伴骨炎的慢性鼻竇炎患者的GOSS與Lund-Mackay評分之間呈正相關(guān)趨勢，r=0.950，p＜0.001。 4、男性慢性鼻竇炎患者的骨炎發(fā)生率35.3%（30/85），女性慢性鼻竇炎患者的骨炎發(fā)生率33.3%（15/45），兩者間無顯著差異（x2=0.05，p=0.823)。 5、伴鼻息肉的慢性鼻竇炎患者骨炎的發(fā)生率為38.9%（35/90）；不伴鼻息肉的慢性鼻竇炎患者骨炎發(fā)生率為25.0%（10/40）。兩者間無統(tǒng)計(jì)學(xué)差異，χ2=2.360，p=0.124。 6、青年組慢性鼻竇炎患者（20歲-39歲）骨炎的發(fā)生率為22.2%（6/27）；中年組慢性鼻竇炎患者（40歲-59歲）骨炎發(fā)生率為29.1%（16/55）；老年組慢性鼻竇炎患者（60歲-81歲）骨炎的發(fā)生率為47.9%（23/48）。三組間骨炎發(fā)生率有差異，χ2=6.326，p=0.042。青年組與中年組患者的骨炎發(fā)生率無顯著差異（χ2=0.435，p=0.509）.青年組、中年組患者與老年組患者的骨炎發(fā)生率均有顯著統(tǒng)計(jì)學(xué)差異（χ2=4.810，p=0.028；χ2=3.861，p=0.049）。 7、病程3月-12月的慢性鼻竇炎患者骨炎發(fā)生率13.9%（5/36），病程13月-24月的慢性鼻竇炎患者骨炎發(fā)生率25.0%（9/36），病程25月-60月的慢性鼻竇炎患者骨炎發(fā)生率45.7%（16/35），病程＞60月的慢性鼻竇炎患者骨炎發(fā)生率65.2%（15/23）。四組患者間骨炎發(fā)生率有統(tǒng)計(jì)學(xué)差異x2=17.725，p＜0.001。病程25月-60月組骨炎的發(fā)生率是病程3月-12月的5.22倍，95%可信區(qū)間為【1.65,16.58】；病程＞60月組骨炎的發(fā)生率是病程13月-24月組的5.625倍，95%可信區(qū)間為【1.79,17.63】。 結(jié)論： 慢性鼻竇炎伴有骨炎的患者在CT影像學(xué)上具有較顯著特征，可以通過GOSS進(jìn)行測量分析。約三分之一的慢性鼻竇炎患者存在骨炎，上頜竇及前組篩竇的骨炎發(fā)生率最高。性別、鼻息肉與骨炎的發(fā)生無明顯的相關(guān)性，年齡、病程與骨炎的發(fā)生具有一定相關(guān)性。
[Abstract]:Objective: To analyze the CT imaging features and pathogenesis of osteitis in chronic sinusitis, and to explore the correlation between sex, age, nasal polyps, course of disease and osteitis.
Methods: 130 patients with chronic sinusitis (CRS) who were scheduled to undergo primary surgery in our hospital from January 2009 to January 2014 were selected. The CT images and case data of the patients were analyzed. The UNISIGHT TeamView software and the global osteitis core system (GOSS) were used to evaluate the clinical outcomes. According to sex, age, nasal polyps and course of disease, the patients were divided into groups. The data were analyzed by SPSS20.0 statistical software. The incidence of osteitis was compared among different groups in each study factor, and the correlation between osteitis and sex, age, nasal polyps and course of disease was studied.
Result:
The incidence of osteitis was 34.6% (45/130) in 1,130 patients, 31.5% (41/130) in grade 2 and above. The incidence of ethmoid sinus was the highest in maxillary sinus and anterior group, 26.9% (35/130) in left maxillary sinus, 22.3% (29/130) in right maxillary sinus, 24.6% (32/130) in left anterior group, and 21.5% (28/130) in right anterior group. OSS ranged from 3 to -36, with an average of 14.07 + 8.5.
The Lund-Mackay score of 2,130 patients ranged from 3 to 22, with an average of 7.9 (+ 4.3). The Lund-Mackay score of the osteitis group ranged from 3 to 22, with an average score of 10.0 (+ 5.2). The Lund-Mackay score of the non-osteitis group ranged from 3 to 19, with an average score of 6.6 (+ 3.7). P < 0.001.
3. There was a positive correlation between GOSS and Lund-Mackay score in chronic sinusitis patients with osteitis, r = 0.950, P < 0.001.
4. The incidence of osteitis was 35.3% (30/85) in males and 33.3% (15/45) in females. There was no significant difference between the two groups (x2 = 0.05, P = 0.823).
5. The incidence of osteitis was 38.9% (35/90) in chronic sinusitis patients with nasal polyps and 25.0% (10/40) in chronic sinusitis patients without nasal polyps.
6. The incidence of osteitis was 22.2% (6/27) in young patients (20-39 years old), 29.1% (16/55) in middle-aged patients (40-59 years old) and 47.9% (23/48) in elderly patients (60-81 years old). There was no significant difference in the incidence of osteitis between the middle-aged group and the elderly group (_2 = 0.435, P = 0.509).
7. The incidence of osteitis was 13.9% (5/36) in patients with chronic sinusitis from March to December, 25.0% (9/36) in patients with chronic sinusitis from 13 months to 24 months, 45.7% (16/35) in patients with chronic sinusitis from 25 months to 60 months, and 65.2% (15/23) in patients with chronic sinusitis over 60 months. The incidence of osteitis in 25-60 months group was 5.22 times higher than that in 3-12 months group, 95% confidence interval was [1.65, 16.58], and the incidence of osteitis in 60 months group was 5.625 times higher than that in 13-24 months group, 95% confidence interval was [1.79, 17.63].
Conclusion:
Chronic sinusitis patients with osteitis have significant CT features and can be measured and analyzed by GOSS. About one-third of chronic sinusitis patients have osteitis. The incidence of osteitis in maxillary sinus and anterior ethmoid sinus is the highest. There is no significant correlation between sex, nasal polyps and osteitis, age, course of disease and the occurrence of osteitis. There is a certain correlation.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R765.41

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