本文選題：解剖　切入點：眶壁骨折　出處：《泰山醫(yī)學院》2012年碩士論文

【摘要】：目的: 根據臨床篩竇鼻內鏡篩竇手術及紙樣板外傷性骨折修復手術的實際需要，通過多層CT影像學解剖的研究，在影像學解剖篩竇的基礎研究之上，深入探討眼眶的解剖結構以及眶內側壁薄弱點，以此找出眶內側壁爆裂性骨折的原因，為臨床顯微外科篩竇手術及眼眶骨折修復手術提供詳盡的影像學資料。 研究方法： 1采用西門子SOMATOM SENSATION64層螺旋CT掃描，掃描方式：常規(guī)頭部多層螺旋CT掃描及MPR、VR重建正常頭顱60例，對所隨機選取的60例正常頭顱進行64層CT-VR重建，根據薄層重建時層厚不同顯示圖像不同，依次逐漸增加層厚，當層厚越厚時，圖像顯示越簡略。對所搜集正常頭顱進行骨模式采集和VR重建，依次尋找60例頭顱的薄弱點進行統(tǒng)計；。掃描范圍：自下頜骨底端與枕骨大孔中心的連線為基線，對整個頭顱的全部進行掃描，患者取仰臥位，層厚2mm層距2mm螺距1矩陣512X512。所得圖像運用多層螺旋CT的后處理功能進行掃描后重建，分別取骨窗及軟組織窗進行觀察，并測量篩骨及篩竇的徑線。 2眼眶骨折多層螺旋CT掃描及MPR、VR重建80例，按照眶內側壁受損面積進行分類，并分析統(tǒng)計。掃描范圍：眶上1cm到眶下1cm。所得圖像運用多平面重組（MPR重建）技術行冠狀面、矢狀面和斜面重組，對眶壁骨折類型及受損程度進行系統(tǒng)分析，找出眶內側壁薄弱點，闡述眶內壓升高致眶內側壁骨折的原理得出眶內側壁易骨折的原因。對80例眶壁骨折患者行64層螺旋CT平掃，采用雙盲法進行常規(guī)斷層條件下診斷，后對所得數據進行容積再現（VR），利用64層CT的“各向同性”，進行VR重建條件下的二次診斷，對兩次診斷結果進行對比并對最終診斷結果進行統(tǒng)計分析。 3從實驗室尋找男女顱骨各一個，用手鋸鋸開頭顱取眼眶內側壁，剝離篩骨觀察眶壁的各個鏈接點，對所獲得的影像圖片進行校正，便于尋找骨骼標準位置。 多層螺旋CT掃描及MPR重建參數：容積掃描，120kV380mA，機架旋轉0.33s/圈，層厚2mm螺距1陣距512X512骨窗：窗位C450，窗寬W1500;軟組織窗：窗位C40窗寬W80掃描后進行冠狀位、橫斷位及矢狀位多平面重建。 重建參數：定位像：120KV35mA 骨窗:slice0.75mm recon increment0.7mm kemel H60s sharp window Olslteo 軟組織窗：slice0.75mm recon increment0.7mm kemel H30s medium smooths+window crebrum 統(tǒng)計學處理 采用SPSS13.0統(tǒng)計軟件包，變量符合正態(tài)分布且方差齊性的計量資料采用單因素方差分析。P值小于0.05具有統(tǒng)計學意義，反之則無。 結果： 眶板薄弱點與眶壁易爆裂骨折位置關系 1薄弱點位置位于中1/3及中后2/3者33例多于位于前1/3及中前2/3者27例，差異無統(tǒng)計學意義（X2=1.20，P=0.273＞0.05，）。即薄弱點發(fā)生部位對本次研究無影響。 2眶壁骨折發(fā)生于前1/3或中前2/3者27例多于發(fā)生于中1/3及中后2/3者26例，但差異無統(tǒng)計學意義(X2=0.33,P=0.8570.05)。即骨折所累及部位無統(tǒng)計學意義。 常規(guī)斷層診斷與VR重建診斷結果的對比 80例眼眶外傷患者在平掃診斷中確診眶內側壁骨折57例，占71.25%，后進行VR重建篩查確診眼眶內側壁骨折63例，占78.75%，其余17例為外側壁骨折、或外側壁與下壁合并骨折，占21.25%。常規(guī)條件診斷漏診率為9.524%（6/63），VR診斷漏診率遠遠小于常規(guī)斷層圖像診斷。 眼眶骨縫與骨折紋理的VR成像特點對比 研究發(fā)現，在VR成像條件下眼眶的骨縫顯示為兩種類型：○1較厚骨質間的骨縫，如上頜骨與顴骨構成的骨縫（圖36A）,設定為Ⅰ型;○2較厚骨質與較薄骨質間的骨縫，如上頜骨與篩骨之間的骨縫（圖36B）,設定為Ⅱ型。骨折分為三種類型：a爆裂性骨折，多發(fā)生于眼眶內側壁(如圖36C)；b斷裂性骨折，多發(fā)生于骨折較厚的眶壁，如眶下壁（圖36D）、外側壁；c粉碎性骨折，多發(fā)生于骨質較厚處的嚴重創(chuàng)傷。粉碎性骨折易分辨，在此不作詳細闡述。 篩竇徑線測量結果見附表 結論： 1篩竇多層螺旋CT重建的三維圖像所呈現的解剖結構更加直觀，對臨床手術的開展具有重要指導作用 2眶內壁骨折是由于外力鈍物沖擊眼眶眶內壓力升高，壓力超過眶內壁所承壓的閾值，即發(fā)生眶內壁爆裂性骨折 364層CT重建眶壁進行的分型觀察更加細致明確，在眶壁骨折的診斷中MPR、VR重建具有重要價值。 4由于篩竇變異大，眶部骨折分型多，依靠單純的CT影像學三維圖像進行手術是危險的，，易導致并發(fā)癥的出現。將應用解剖數據、CT掃描后三維圖像重建和鼻竇顯微外科手術路標、仿真內窺鏡位置結合起來，所獲數據更加準確，有利于手術。
[Abstract]:Objective:
According to the actual needs of the surgical repair of nasal endoscopic sinus surgery and clinical ethmoidal lamina papyracea fracture, anatomy study by multi-slice CT images, studying the anatomy of ethmoid sinus in the image above, in-depth study of anatomical structure and the medial orbital orbital weakness, in order to find out the medial orbital wall burst fracture, and provide detailed the imaging data for clinical microsurgical surgery and orbital ethmoid fracture repair surgery.
Research methods:
The SIEMENS SOMATOM SENSATION64 1 slice spiral CT scan, scan head: conventional multislice spiral CT scanning and MPR VR reconstruction, 60 cases of normal brain, 64 slice CT-VR reconstruction of normal skull 60 cases randomly selected, according to the reconstruction of thin layer thickness of different display different images, gradually increase the layer thickness, when the thickness of the more thick, more simple image display. The collected normal cranial bone pattern acquisition and VR reconstruction, in order to find the weak points of 60 cases of skull were analyzed.; scan range: from the mandibular foramen magnum and the bottom end of the center line as a baseline, the head of all patients were scanned in supine position thickness of 2mm layer from the 2mm pitch 1 matrix 512X512. image obtained using multi-slice spiral CT postprocessing function scans were taken after the reconstruction, bone and soft tissue windows were observed, and measuring the diameter of ethmoid and ethmoid sinus.
2 orbital fracture multi-slice spiral CT scanning and MPR VR reconstruction in 80 cases, in accordance with the classification of medial orbital wall damaged area, and statistical analysis. The scanning range: 1cm to 1cm. orbital orbital images obtained using multiplanar reconstruction (MPR reconstruction) technique for coronal, sagittal and oblique reformation, of orbital fracture the type and extent of damage are analyzed, and find out the medial orbital wall weakness, this orbital pressure caused by the principle of the medial orbital wall fracture that the medial orbital wall fracture of the reason. In 80 cases of orbital fracture underwent 64 slice spiral CT scan, by double blind method under the condition of conventional fault diagnosis, after the data of volume rendering (VR), using 64 layer CT "isotropic" two diagnosis VR reconstruction under the conditions of the two diagnostic results were compared and the final diagnosis results were statistically analyzed.
3 from the laboratory for men and women of a skull, beginning with sawn from the cranial orbital medial wall, orbital ethmoid stripping observation point on each link, the images obtained were corrected, easy to find bones position.
Multi slice spiral CT scan and MPR reconstruction parameters: volume scan, 120kV380mA, rack rotation 0.33s/ circle, thickness 2mm pitch 1 array from 512X512 bone window: window C450, window width W1500; soft tissue window: window position C40 window width, W80 scan, coronal, transversal and sagittal multiplanar reconstruction.
Reconstruction parameters: location image: 120KV35mA
Bone window: slice0.75mm Recon increment0.7mm kemel H60s sharp window Olslteo
Soft tissue window: slice0.75mm Recon increment0.7mm kemel H30s medium smooths+window crebrum
Statistical treatment
The SPSS13.0 statistical software package was used. Variables with normal distribution and homogeneity of variance were analyzed by one-way ANOVA. The.P value was less than 0.05, which was statistically significant, whereas on the contrary, there was no statistical significance.
Result錛

本文編號：1669902