眼眶单纯内侧壁骨折的CT诊断及鉴别诊断

目的：分析和评价高分辨率CT(HRCT)扫描对眼眶内侧壁骨折的诊断及鉴别诊断价值。材料与方法：回顾性分析50例眼眶单纯内侧壁骨折患者的CT资料。男性42例，女性8例，40例为新鲜骨折，10例为陈旧性骨折。均行冠位及轴位扫描。结果：50例均为筛骨外侧板骨折。结论：HRCT能清楚地显示眼眶内侧壁的解剖结构，能精确地显示眼眶单纯内侧壁骨折的直接、间接征象和并发症，并能够较准确地区分骨折的新旧及是否为骨折。     

眼眶单纯内侧壁骨折的高分辨CT诊断

爆裂性眶壁骨折是指外部钝力作用于眼眶组织引起眶内压力急剧升高，间接作用于眶壁薄弱处，导致眶壁骨折或缺损，骨组织完整性受到破坏，而眶缘骨组织完整，CT扫描是目前诊断眼眶爆裂性骨折的最好影像技术。笔者通过回顾分析43例经常分辨CT（HRCT）扫描诊断的眼眶单纯内侧壁骨折，着重探讨HRCT扫描的诊断价值。     

眼眶内侧壁骨折的CT诊断

目的：探讨眼眶内侧壁骨折的CT表现及诊断价值。方法回顾38例眼眶内侧壁骨折患者的CT表现，所有病例均行常规横断位薄层扫描，必要时加扫冠状位。结果：显示骨折线14例，筛窦积血24例，筛板内陷24例，同时合并内直肌肿胀13例，筛板内陷24例，同时合并内直肌肿胀13例，眶内及眼睑积气4例，球内出血1例，眶内血肿1例，玻璃体脱位1例，球内异物1例，合并其他骨折17例。结论：CT不仅能发现眼眶内侧壁骨折，并可显示其内情况，周围软组织及邻近骨折的改变，是日前诊断眶内侧壁骨折最有效的方法。     

多层螺旋CT诊断眼外伤的临床应用价值

目的探讨多层螺旋CT（MSCT）对眼外伤的诊断价值。方法对82例眼眶骨折的患者进行MSCT常规扫描加多平面重建（MPR）结果分析。结果眼眶内、外侧壁骨折以横断面显示效果最佳,眶顶及眶下壁骨折以冠状面及矢状面显示效果最佳,混合性骨折以冠状位图像显示效果最佳。结论 MSCT扫描结合MPR能减少眼眶骨折的误、漏诊,运用窗技术对周围软组织损伤的诊断也起到重要的作用。     

MPR在眼眶爆裂骨折诊断中的应用

目的:探讨16层CT MPR对眼眶爆裂骨折的诊断价值。方法:回顾性分析46例眼眶爆裂骨折的16层CT的横断位、MPR及3D图像。结果:MPR能准确显示骨折,直接显示出骨折线11例,内直肌增粗32例,眼肌及眶内脂肪疝入副鼻窦者26例,内直肌及眶内侧壁之间脂肪间隙变窄或消失者25例,眶内及眼睑皮下积气20例,副鼻窦积液或塌陷者35例。46例均见眼眶周围软组织肿胀。眶内侧壁骨折以横断面显示最佳,眶下壁骨折以冠状面及矢状面显示最佳,混合性骨折以冠状面显示最佳。结论:16层CT容积扫描的MPR能全面而准确地诊断眼眶爆裂骨折,对临床治疗及预后评估有重要价值。     

HRCT诊断眼眶底壁骨折

目的 :探讨高分辨力CT(HRCT)诊断眼眶底壁骨折的临床价值。材料和方法 :对 10 5例眼钝力伤患者进行横断 冠状高分辨力CT扫描 ,进行图像对比分析。结论 :10 5例患者中 41例有眼眶底壁骨折 ,其中眶内下壁骨折 15例 ,眶下沟骨折 16例 ,眶底前缘骨折 10例。合并眶内容物疝出 2 5例 ,窦口—鼻道复合体狭窄 4例 ,眶下神经管或眶下孔骨折 5例 ,鼻泪管骨折 2例。结论 :HRCT冠状扫描显示眼眶底壁骨折优于横断扫描。眼眶底壁骨折HRCT诊断除应仔细观察骨折类型以外 ,还应充分估计眶下神经、窦口—鼻道复合体及鼻泪管的损伤情况 ,为临床制定治疗方案及预后提供有利依据。     

结合冠状位CT诊断眼眶爆裂性骨折价值分析

目的探讨横断位结合冠状位CT扫描对眼眶爆裂性骨折的诊断价值。方法对254例经CT诊断的眼眶爆裂性骨折进行回顾性分析。结果单纯眶内壁骨折103例,眶下壁骨折26例,复合骨折125例,同时伴有眼外肌肿胀132例,副鼻窦积血积液47例,眶内及眼睑积气25例,眶内容物疝入相邻鼻窦内18例。结论 CT扫描尤其结合冠状位扫描对眼眶爆裂性骨折的诊断具有重要价值。     

眼眶外伤螺旋CT检查的临床意义(附246例分析)

眼眶外伤在眼科临床上非常多见,但有时外伤不很严重,也容易造成眶内壁骨折;而单纯内侧壁骨折,由于临床症状较轻,检查方法不当,常被忽视。我们通过分析246例眼眶外伤患者CT扫描的影像表现,着重探讨螺旋CT扫描在眼眶外伤中的诊断价值。1资料与方法1.1临床资料患者246例,男199例,女47例;年龄9~80岁,平均37.2岁。病程为1 h~20 d,其中拳击伤和棍棒伤220例,车祸伤12例,其他伤14例。1.2检查方法采用GE Hispeed DX/I螺旋CT扫描,层厚2 mm,层距2 mm,120 kV,160 mA,FOV14~16 cm,自眶上缘至眶下缘连续扫描,常规轴位和冠状位扫描。观察眼外肌等软…     

CT对眼眶内、下壁骨折的诊断价值(附42例分析)

目的：探讨眼眶内、下壁骨折的CT征象、诊断及临床应用价值。方法；42例眼眶内、下壁骨折患者行CT扫描，男36例，女6例， 横轴位扫描19例，横轴位加冠状位扫描23例。结果：眼眶内侧壁骨折32例，眼眶下壁骨折18例。结论：CT能清晰显示眼眶内、下壁骨质结构及骨折征象，对骨折部位、程度的发现与确定完全而精确，是当前外伤检查中性价比最高的一种方法，具有重要的临床价值。     

筛骨纸样板骨折的高分辨率CT诊断

目的:探讨高分辨率CT(HRCT)对眶内侧壁-筛骨纸样板骨折的临床应用价值。方法:对47例筛骨纸样板骨折病例进行回顾性分析,均行轴位常规CT及HRCT扫描。结果:纸样板断裂、线样骨折20例,内陷伴成角错位24例,纸样板断裂外移但并不凹陷仍保持弧形外凸形态3例,合并内直肌肿胀增粗迂曲19例,内直肌内侧脂肪间隙变窄、眶内脂肪疝入12例,眶内积气筛窦积液20例。结论:HRCT能精确显示纸样板骨折的直接、间接征象,并可对其进行进一步分型,是诊断纸样板骨折的首选方法。     

Evaluation of coronal CT findings of rare cases of isolated medial orbital wall blow-out fractures

OBJECTIVES: To report rare cases of isolated medial orbital wall blow-out fractures and to evaluate their coronal CT findings. METHODS: Nine cases of medial orbital wall blow-out fractures, diagnosed by coronal CT in a general medical hospital between 1995 and 1999, were studied. CT was performed using direct coronal acquisition with a slice thickness of 5 mm. Images were obtained at bone window settings. Clinical examination findings from the medical records were used to give information on the cause of injury, ocular symptoms and the days after injury that the CT examination was performed. RESULTS: Most of the patients (67%) were young male adults. The cause of injury was most frequently the result of fist fighting or athletics (78%). Diplopia and/or limitation of the gaze were the main ocular symptoms (78%). The average time from injury to CT examination was 4 days (range 0-16 days). Seven of the nine patients with medial orbital wall fractures had isolated medial orbital wall blow-out fractures. Herniation of orbital contents toward the ethmoid sinus was observed among all nine fractures. Only three patients (33%) had a swelling and/or medial deviation of the medial rectus muscle, all three having isolated medial orbital wall blow-out fractures. CONCLUSIONS: Nine cases of medial orbital wall blow-out fractures were examined, seven of which were isolated medial wall blow-out fractures. CT findings of this type of fracture included herniation of the orbital contents toward the ethmoid sinus. However, swelling and/or medial deviation of the medial rectus muscle was also seen.     

眼眶外壁骨折的CT分析

目的：探讨眼眶外壁骨折的临床特点并评价ＣＴ检查对其诊断价值。方法：以１５５例眼眶外壁骨折为研究对象,均行眼眶横断及冠状位ＨＲＣＴ检查。结果：眶外壁骨折受伤原因以车祸最多,失明者达５６．７７％,还可表现为眼球运动受限、眼球内陷等。眼眶外壁分为四段,以前三段骨折多见,且多波及颧骨蝶骨缝,造成骨缝分离移位;后段骨折少见,但失明发生率却明显高于其它各段（Ｐ＜０．０１）。单纯眶外壁骨折少见,仅占２１．２９％;外壁骨折伴发邻近骨折占７８．７１％,多伴发其它眶壁骨折。结论：ＨＲＣＴ检查是诊断眶外壁骨折较好的方法,眼部创伤后应及时行ＣＴ检查。     

眼眶骨折常规体位CT加直接倾斜矢状面的研究：附120例分析

目的：探讨直接倾斜矢状面ＣＴ在眼眶骨折中的应用价值。材料与方法：１２０例眼眶外伤患者，在常规横断面及冠状面ＣＴ的基础上加扫直接倾斜矢状面ＣＴ，比较观察各体位显示的信息。结果：１２０例眼眶骨折中，上下壁骨折冠状面显示１０３例，矢状面显示１０５例；横断面未能显示。上下直肌增粗冠状面显示５０例，矢状面显示７２例；视神经弯曲２７例均矢状面显示。结论：直接倾斜矢状面ＣＴ能更全面地观察眼眶上下壁的情况及上下直     

常规头颅CT对眼眶内侧壁骨折的诊断价值分析

目的评价常规头颅CT对眼眶内侧壁骨折的诊断价值。方法对40例常规头颅CT可疑眼眶内侧壁骨折者行眼眶CT扫描。结果40例中35例在眼眶CT上确诊为眼眶内侧壁骨折,常规头颅CT显示的眼眶内侧壁骨折征象包括:眼眶内侧壁内陷、内直肌增粗、筛窦密度增高及眶内积气。结论常规头颅CT可以作为眼眶内侧壁骨折诊断或筛查手段。     

Direct oblique sagittal CT of orbital wall fractures

Direct oblique sagittal CT was used to evaluate trauma to 77 orbits. Sixty-seven orbital wall fractures with intact orbital rims (36 floor, 22 medial wall, nine roof) were identified in 47 orbits. Since persistent diplopia and/or enophthalmos may warrant surgical repair of orbital floor fractures, optimal imaging should include an evaluation of extraocular muscle status, the nature and amount of displaced orbital contents, and an accurate definition of fracture margins. For orbital floor fractures, a combination of the direct oblique sagittal and direct coronal projections optimally displayed all fracture margins, the fracture's relationship to the inferior orbital rim and medial orbital wall, and the amount of displacement into the maxillary sinus. Inferior rectus muscle status with 36 floor fractures was best seen on the direct oblique sagittal projection in 30 fractures (83.3%) and was equally well seen on sagittal and coronal projections in two fractures (5.5%). Floor fractures were missed on 100% of axial, 5.5% of sagittal, and 0% of coronal projections. Since the direct oblique sagittal projection complements the direct coronal projection in evaluating orbital floor fractures, it should not be performed alone. A technical approach to the CT evaluation or orbital wall fractures is presented.     

眼眶骨膜下间隙血肿的CT、MRI表现

目的分析眼眶骨膜下间隙血肿的CT、MRI表现并探讨其临床价值。资料与方法36例（36眼）眼眶外伤性骨膜下血肿患者中,同时行眼眶CT、MRI检查2例。仅行眼眶CT检查30例．横断位、冠状位检查25例,横断位1例,冠状位检查4例。仅行MRI检查4例。结果跟眶CT显示骨膜下间隙血肿32例,其中上壁18例,外上壁7例,外壁5例,下壁2例。病变广基附于眶壁,内缘清楚,密度均匀,一般不跨越骨缝。眼眶MRI显示上壁骨膜下间隙血肿6例,信号取决于出血时间。结论眼眶骨膜下间隙血肿多发生于眼眶上壁。CT、MRI有助于对该病的诊断及鉴别诊断。     

The usefulness of orbital lines in detecting blow-out fracture on plain radiography

The purpose of this study was to assess the diagnostic value of orbital line changes on plain radiographs in detecting blow-out fracture. 92 cases of surgically confirmed blow-out fracture were retrospectively analysed in regard to plain radiographs and CT. Anterior and posterior lamina papyracea lines (ALPL and PLPL, respectively) of the orbital medial wall as well as the posteromedial floor line (PMFL) were assessed on orbital posteroanterior projections. The inferomedial orbital line (IMOL) and the inferior wall line were assessed on Waters projections. Orbital lines on plain radiographs were compared with CT findings. Of 53 cases of lamina papyracea fracture, 47 cases showed orbital line changes on plain radiographs (sensitivity 88.7%). Changes of PLPL (41/47), IMOL (29/47), ALPL (4/47) and PMFL (2/47) were demonstrated as depression, loss, discontinuity and irregularity. In four cases showing normal radiographs, the fractures measured less than 9 mm in size on CT. All 25 cases with orbital floor fracture accompanying medial wall fracture demonstrated orbital line changes of PMFL (16/25), PLPL (14/25), ALPL (3/25) and IMOL (2/25) (sensitivity 100%). 12 of 14 cases with orbital floor fracture demonstrated changes of inferior wall line (7/12) and PMFL (6/12) (sensitivity 85.7%). Two cases demonstrated asymmetric focal soft tissue density without orbital line changes. Orbital line changes on plain radiographs corresponded well with CT findings, confirming the usefulness of plain radiographs in detecting blow-out fracture.     

螺旋CT对眼眶内侧壁骨折的诊断价值

目的探讨SCT对眼眶内侧壁骨折的诊断价值。方法通过对48例面部外伤后眼眶内侧壁骨折行轴位、冠位扫描,同时进行多方位MPR及3D成像,综合分析影像特征。结果眼眶内侧壁骨折直接SCT征象为眶壁骨质的连续性中断、粉碎、凹陷和曲度失常。新鲜骨折36例多合并有眼球旁或球后积气、筛窦积液、内直肌增粗等间接征象,陈旧性骨折12例,表现为骨折片移位或塌陷。结论SCT容积扫描能全面准确地诊断眼眶内侧壁骨折并能区分新鲜与陈旧性骨折及骨折程度。