鼻部骨折的影像检查方法及诊断价值探讨

目的：探讨鼻部骨折的各种影像学检查方法及其相对应的诊断学价值,以便采用更合理的鼻部外伤影像学检查方法。方法：搜集鼻部骨折病例分三组进行讨论,比较其影像效果。第1组：鼻骨X线侧位片检查后随即进行CT改良冠状位扫描的病例52例;第2组：同时进行鼻骨改良冠状位和横断面扫描的病例34例;第3组：鼻骨改良冠状位扫描后进行三维重建的病例48例。结果：鼻骨侧位片仅能检出51.9%的鼻部骨折,漏诊、误诊率非常高;鼻骨改良冠状位＋横断面扫描诊断最准确,但费用高,照射剂量大;鼻骨改良冠状位＋三维重建诊断准确、立体感强、易理解且不增加照射剂量,但费用较高。结论：单项检查中鼻骨改良冠状位扫描诊断价值最高,是鼻部骨折的最佳影像检查方法。如果经济条件许可或鼻区复合性骨折,应辅以三维重建或横断面扫描。

Imaging methods and diagnostic value for nasal bone fracture

Objective To study the methods of imaging of nasal bone fracture and corresponding diagnostic value,in order to select the optimal method of imaging for nasal bone fracture.Method Three groups of cases of nasal bone fracture in our hospital from January 2004 to May 2009 were discussed and their image effects were compared.Group 1:52 cases that were first examined by lateral X-ray film and then by modified coronal CT scan;group 2:34 cases that were examined by improved nasal coronal scanning and cross-sectional scanning at the same time;group 3:48 cases by improved nasal coronal scanning and later by three-dimensional reconstruction.Results Only 51.9% of the cases of nasal bone fracture were showed by lateral X-ray film,causing a high misdiagnosis rate;improved nasal coronal scanning and cross-sectional scanning at the same time was most accurate,but too expensive besides large dose of radiation;the third method was accurate,with three-dimensional,intelligible and in smaller dose,but it was also expensive.Conclusion The diagnostic value of improved nasal coronal scan in single examination is best,it is the best method of imaging of nasal bone fracture;but economic conditions permitting or complex nasal fracture appearing,three-dimensional reconstruction and cross-sectional scan should be adopted as well.