颞骨骨折及其并发症的临床研究

为探讨颞骨骨折及其并发症的特点及救治方法，作者对1989年1月－1999年11月收治的48例颞骨骨折临床资料进行了回顾性分析。结果显示，48例颞骨骨折患者中交通事故所致的占66．7％，存活43例（89．6％），死亡5例（10．4％）；中、内耳或颅脑损伤占77．1％，听力下降或耳鸣占48％；纵行骨折的脑脊液耳漏占36．7％，面瘫占3％；横行骨折的面瘫占37．5％，脑脊液耳漏则占25％。研究结果表明，交通事故伤是造成颞骨骨折的首要高危因素，其严重并发症为颅脑损伤，合并多脏器伤常是致死性并发症；其常用并发症为听力下降或耳鸣等中、内耳损伤；纵行骨折以脑脊液耳漏多见，横行骨折易造成面瘫。     

颞骨骨折性面神经瘫痪的手术治疗

目的 探讨颞骨骨折性面瘫的处理方法。方法 对60例颞骨骨折性面瘫患者实行手术治疗。48例行颞下颅中窝径路面神经减压术，8例行乳突耳径路面神经减压术，另4例行颅内外联合径路面神经全段减压术。结果 手术中发现面神经损伤部位位于迷路段及膝状神经节周围者48例，位于水平段8例，4例膝状神经节及水平段均受损伤。以House-Brackmann（H—B）分级法作为疗效评价标准，术后随访1年达到H—B分级Ⅰ级39例，Ⅱ级18例，Ⅲ级2例，Ⅳ级1例。结论 对于颞骨骨折性面瘫的患者，应尽早明确面神经受损的程度及部位．尽早实施手术，并根据术前确定的面神经损伤的部位来决定手术径路。     

颞骨骨折86例治疗体会

颞骨为颅一颅面结构最复杂的解剖部位,骨折引起的病情不仅复杂严重,且对患者治疗后的生活质量造成严重的影响。为更好地诊治颞骨骨折,现将2002—03至2007—12治疗的86例颞骨骨折患者的临床资料进行分析。     

颞骨骨折早期干预对听力的影响

目的 探讨早期干预措施对颞骨骨折患者听力的影响。方法 采用早期干预和常规疗法对我院1999年1月-2004年3月收治的32例颞骨骨折患者进行前瞻性随机对照临床研究。结果 伤后1个月干预组纯音听力气导平均阈值明显低于对照组（P〈0．05），但听性脑干反应（ABR）、40Hz听性相关电位和声反射平均阈值两组问差异无统计学意义（P〉0．05）；伤后6个月干预组纯音听力气导平均阈值、骨导平均阈值、声反射平均阈值、ABR、40Hz听性相关电位平均阈值明显低于对照组（P〈0．05）。结论 早期干预对颞骨骨折所致的传导性聋具有治疗作用，对感音性聋具有积极预防作用，但作用仅限于维持迷路系统及邻近重要结构的完整以及内耳内环境的稳定。整体干预效果好于传统疗法。     

士兵胫骨应力骨折的病因与生物力学

我院在对某部４００名士兵的训练伤调查中发现，该部应力骨折的发病率为９．５％，其中胫骨应力骨折较多，占全部应力骨折的７８％。发病部位多发生于胫骨上中１／３水平的后侧、内侧。此部位与文献报道长跑运动员应力骨折的部位不一样。为探讨士兵应力骨折的发病机理，我...     

胫骨骨折有限元模型建立及生物力学分析

目的：建立基于CT图像的正常人和胫骨平台骨折患者的胫骨三维有限元模型,计算出骨骼模型的位移和应力分布。方法通过对1名健康成年人和1名胫骨骨折患者膝关节的多排螺旋CT扫描,获得连续断层图片,将CT断层图像导入Mimics软件中建立人体胫骨三维面网格模型后,应用ANSYS软件对模型进行体网格划分,材料赋值,生成两人胫骨有限元模型,并对模型进行分析计算。结果胫骨平台外加载荷后,正常人与患者受载面的峰值应变出现的方位相反,正常人出现在胫骨内侧,而患者则出现在胫骨外侧。两者的等效应力均沿胫骨向下逐渐减小,且均在胫骨上中1／3处出现了应力集中现象,而患者还在骨折处出现应力集中;正常人的形变位移梯度比骨折患者明显;两人在整体应力分布变化上差异明显。结论成功建立了胫骨三维有限元模型,得出了正常人与骨折患者之间胫骨的生物力学特性差异,为骨科医师手术治疗方案的制定提供了重要参考依据。     

高分辨率CT诊断颞骨骨折及其并发症（附41例报告）

笔者用高分辨率ＣＴ诊断颞骨骨折４１例，其中纵形骨折２９例，横形骨折４例，混合型骨折４例，不典型性骨折４例。主要并发症：听骨链损伤２０例，面神经管损伤６例，内耳迷路损伤４例，耳液瘘３例。该检查方法具有重要的临床意义。     

颞骨外伤的HRCT诊断

本文报告了３２例３６耳颞骨岩部骨折的ＨＲＣＴ表面。结果表明ＨＲＣＴ能较好地显示颞骨骨折线，听小骨中断、面神经管损伤及血鼓管．它是很有价值的检查方法，对临床诊断治疗有重要的指导意义。文中还就颞骨折的ＨＲＣＴ表现及诊断及诊断影响因素做了详细的讨论。     

骶骨骨折的形态学特点及生物力学研究

目的探讨骶骨骨折的形态学及生物力学特点，为临床手术治疗提供科学依据。方法采集人体新鲜骨盆骨骼标本10具，行动态冲击试验和静态压缩试验，测量动态骨折时的一系列动力学参数，确定骨折的动力学特性；并取骶骨翼骨折块、骶骨孔块和骶边缘骨折块，进行组织学观察。结果(1)骶骨骨折的形态与受到冲击能量大小有关。低能的冲击加载，大都是发生髂骨或髋臼、髋髂嵴骨折。当高能量冲击时，骶骨发生以下三种方式骨折(按Denis骶骨骨折分类)：Ⅰ型骨折为骶骨翼骨折，Ⅱ型骨折为骶骨孔骨折，Ⅲ型骨折为中央椎管骨折，Ⅰ型、Ⅱ型和Ⅲ型骨折均可累及一侧神经根损伤或两侧神经根损伤。(2)骶骨的动态破坏机制与静态破坏机制两者在力学性质上有很大的不同，不但极限载荷不同，而且前者随应变速率的提高而快速增加，冲击能量达到25J以上会产生劈裂状通过骶骨孔骨折，并累及神经根损伤；当低于20J时，以发生髂骨骨折和骶骨骨折为多，处于20～25J之间易产生Ⅰ型骨折；而静态试验大多为髂骨或髋臼骨折；(3)骶骨的骨板开裂，层状交劈裂，分离哈佛板呈脆性断裂，导致骨板分离，也有少数横断骨板，形成裂隙错位。结论动态冲击试验以骶骨DenisⅠ型和Ⅱ型骨折居多，常累及一侧或两侧神经根损伤，骶骨骨折与其微观结构形态、骨小梁分布、骨陷窝与哈佛系统相联系。而静态压缩试验大多为髂骨或髋臼骨折，周围组织损伤轻。     

Temporal bone fractures

Temporal bone injury is frequently associated with severe brain injury which limits the clinical evaluation and detracts from the clinical signs of temporal bone fracture such as sensorineural hearing loss, conductive hearing loss, and facial nerve paralysis. Radiologists are often the first to note the presence of temporal bone fractures and should be familiar with common types of injuries and their clinical implications. We review the traditional classification systems of temporal bone fractures with respect to clinical findings and management and suggest that radiologists should be familiar with the classification systems and, more importantly, focus their attention to identifying all critical temporal bone structures and describing their status of involvement to better the individual care.     

Magnetic resonance imaging in temporal bone fracture

Summary In seven patients with temporal bone fractures examined by both CT and MRI, thin section CT proved superior to MRI in demonstrating the full extent of the fractures and the status of the ossicular chain. MR studies were able to demonstrate fractures, when these fractures contained blood or CSF, and the presence of ossicular dislocation in one case where the middle ear was completely filled with CSF or blood. Admixture of air in the middle ear gave a false impression of ossicular dislocation, while air in the fracture obscured portions of it. MR proved superior to CT in the evaluation of intracranial contents by showing 5 additional subdural hematomas, 2 epidural hematomas and 2 hemorrhagic contusions.     

准静态下颞骨撞击伤模型的建立

目的 建立颞骨撞击伤模型，研究不同撞击模式下颞骨骨折的发生情况，探讨颞骨撞击后损伤的发生特点与机制。方法 选取成人尸头12具，撞击前于螺旋CT下行横断面、冠状面扫描。将头颅固定于BIM—Ⅱ型生物撞击机致伤架上，使撞击部位暴露于二次锤的正前方并与二次锤的中心重合，分别选取800，1200，1400kPa的驱动压力进行撞击，将撞击后尸头于螺旋CT下行横断面、冠状面扫描，将撞击后螺旋CT影像与撞击前对照研究分析。结果 建立了3种不同损伤程度的颞骨撞击伤模型：（1）800kPa撞击组主要为软组织的损伤，颞骨骨折只局限在某些层面发生；（2）1200kPa撞击组除撞击侧颞骨发生线性骨折外，并可波及到对侧颞骨形成对冲性骨折；（3）1400kPa撞击组撞击侧颞骨发生混合型骨折或粉碎性骨折，并形成了对冲性骨折。结论 建立的3种程度颞骨撞击伤模型可以反映出颞骨撞击后3种不同损伤特点的颞骨骨折，对交通事故中颞骨撞击伤的防治研究有重要的意义。     

Chondroblastoma of temporal bone

Summary The case of a 55-year-old female with chondroblastoma arising from the left temporal bone is presented. Although 10 cases of temporal chondroblastoma have been reported, this is the first in which plain radiography, pluridirectional tomography, computed tomography (CT) and angiography were performed. We discuss the clinical and radiological aspects of this rare tumor.     

Temporal bone fractures and their complications

Summary A total of 84 patients with 89 fractures of the temporal bone were examined with high resolution CT (HRCT) a few hours to 21 months after the initial trauma. Axial HRCT disclosed 63 longitudinal, 13 transverse, 10 complex and 3 atypical fractures. The diagnosis of a temporal bone fracture was established by axial HRCT in almost every case. However, for the precise topographic analysis of the course of the fracture, additional coronal HRCT proved helpful. The most common, surgically treatable complication of temporal bone fracture is disruption of the ossicular chain. Twenty-three such lesions were demonstrated by combined axial and coronal HRCT; 22 lesions of the facial canal could be demonstrated in 27 patients presenting with facial nerve palsy. The most common site of injury to the facial canal was the region of the geniculate ganglion. The only life-threatening complication of a temporal fracture may be otorhinoliquorrhea. This was present in 9 cases. The most common site of leakage identified was the tegmen tympani. With Metrizamide-HRCT precise localisation of the dural laceration was possible in 7 of these 9 cases.     

Aneurysmal bone cyst of the temporal bone

Summary Aneurysmal bone cysts occurring within the calvarium are uncommon. The following case report describes the radiological and pathological findings of a temporal bone aneurysmal bone cyst with intra- and extracranial manifestations. The pertinent literature is reviewed.     

Surgical anatomy of the temporal bone: an atlas

This atlas demonstrates the usefulness of reconstructed high-resolution CT for planning temporal bone surgery. The first part focuses on a sagittal plane, the second on a rotated longitudinal plane, and the third on a rotated transverse plane. We believe knowledge of temporal bone anatomy in these planes facilitates surgical planning by showing anatomic relationships and providing a customized map for each patient. This decreases the likelihood of surgical mishap and improves teaching. Received: 9 May 2000/Accepted: 20 July 2000     

Spiral CT of the temporal bone: value of image reconstruction at submillimetric table increments

Axial spiral CT of the temporal bones with a nominal slice thickness of 1 mm and 180° linear interpolation was performed in 13 patients. In 18 temporal bones, the spiral data set was used to reconstruct overlapping axial images with a table increment of 0.1 mm. These images gave additional information in four cases: in two by examining the heavily overlapping axial images themselves, and in two by obtaining supplementary information from secondary image reconstructions. In two cases less information was obtained than by using the conventional incremental images. This study shows that reconstructing overlapping slices can be useful, even if the temporal bone is scanned at 1 mm nominal slice thickness.     

Transverse axial plane anatomy of the temporal bone employing high spatial resolution computed tomography

Summary Anatomical relationships of temporal bone structures are demonstrated by thin section edge detection computed tomography. Many otic structures are best appreciated in axial view, but reorientation to anatomy as seen in this plane is needed for optimal diagnosis. A level by level review of key structure is presented toward this end. The limitations and advantages of computed tomography are discussed.     

CT and MRI of the semicircular canals in the normal and diseased temporal bone

Imaging of the semicircular canals specifically is part of the imaging process of the temporal bone in general. The semicircular canals are easily seen on CT images and 3DFT-CISS-weighted MR images, both performed with 1.0-mm-thick slices, or even thinner slices. In selected cases, the T1-weighted images give unique information on the semicircular canals. This article briefly reviews the variety of semicircular canal anomalies that are most frequently present and can be routinely seen on CT and MR examinations of the temporal bone. It also provides a list that can be used by the radiologist in clinical practice to decide which technique, CT or MR, should be used to detect specific anomalies at the level of the semicircular canals.