鼻骨骨折CT和临床分类关系的探讨1.docVIP

鼻骨骨折CT分型及其与临床分型关系的探讨 安徽省马鞍山市市立医疗集团市人民医院影像科 舒荣宝 [摘要]：目的：探讨鼻骨骨折CT分型及其与临床分型的关系。方法：102例鼻外伤患者经MSCT诊断为鼻骨骨折。根据骨折线的侧别、骨折线形态及骨折断端错位成角程度，以及合并鼻中隔骨折及相邻部位骨折分为4型。Ⅰ型：单侧和/或双侧鼻骨线性骨折，无或轻度错位成角。Ⅱ型：分两个亚型，Ⅰ型的基础上出现骨折线明显错位成角为Ⅱa型，单侧和/或双侧鼻骨粉碎性骨折为Ⅱb型。 Ⅲ型：Ⅰ、Ⅱ型伴鼻中隔骨折，分两个亚型，不伴发周围骨折为Ⅲa，伴发周围骨折为Ⅲb。 Ⅳ型：Ⅰ、Ⅱ伴有鼻骨周围骨折。单侧鼻骨骨折标记为U，双侧为B；明显错位成角定义为断端移位＞1/2、塌陷或上翘≥450。将CT分型与临床分型进行比较，采用配对计数资料的Kappa统计量检验，P＜0.05具有统计学意义。结果：CT类型由高到低依次为Ⅳ型、Ⅰ型、Ⅲ型及Ⅱ型，形态和部位：1）单侧35例，双侧66例；2）鼻骨线性骨折63例，无明显移位成角49例，有明显移位成角11例；其中单侧32例，双侧31例；3）粉碎性骨折38例；单侧3例，双侧19例；一侧线性另一侧粉碎性16例；4）伴鼻中隔骨折 27例；5）合并其它骨折76例。CT分型：Ⅰ型25例，其中Ⅱa型6例，Ⅱb型6例，Ⅲ型27例，其中Ⅲa型11例，Ⅲb型16例；Ⅳ型76例。将Ⅰ型和Ⅳ型中的两个亚型合并后与临床分型比较，经配对计数资料的加权Kappa统计量检验，u= 2.34，P=0.012，CT分型与临床分型一致性较好。结论：通过CT分型，能够准确描述鼻骨骨折的复杂情况，对骨折的临床处理和法医学鉴定具有重要意义。 [关键词]：鼻骨骨折；分型；多层螺旋CT The study for the relationship between CT classification and clinical classification of nasal bone fracture [Abstract]: Objective: To investigate the relationship between CT classification and clinical classification of nasal bone fracture. Methods: 102 cases were treated in our study ,who are diagnosed as nasal bone fracture by MSCT. They are classified into four types on the base of side of the fracture line,the form of the fracture line ,the extent of fragments angular displacement and whether accompany with nasal septum fracture and adjacent zone fracture .Type Ⅰ: unilateral and / or bilateral nasal bone linear fracture, with or without angular displacement. Ⅱ:include two subtypes, type Ⅰwith angular displacement is defined as type Ⅱa . type Ⅰwith unilateral and / or bilateral nasal bone comminuted fracture is defined as type Ⅱb. Type Ⅲ: type I, II with nasal septal fracture, which is divided into two subtypes according to whether accompany wih adjacent fracture. Type Ⅳ: type I, II,associate with fractures around nasal bone. Unilateral nasal bone fracture is marked as U,while bilateral nasal bone fracture is marked as B; fracture fragment dislocation 1/2 and collapse, or upturned ≥ 45 °are defined as obvious angular displacement,. CT classifica