合并眼眶内侧壁骨折的鼻泪管骨折螺旋CT诊断

目的探讨合并眼眶内侧壁骨折的鼻泪管骨折螺旋CT诊断价值。方法对45例临床确诊为眼眶内侧壁骨折的病人行螺旋CT横断位扫描,扫描后行MPR图像后处理。其中5例出现典型的溢泪症状,6例有明显泪管断裂或泪道阻塞的临床体征。结果检出22例(49%)病人合并鼻泪管骨折。所有具有临床症状及体征的病人均被检出。22例病人均为单侧性的鼻泪管骨折。其中除合并眼眶骨折外,6例合并其它部位骨折。22例鼻泪管骨折在螺旋CT横断位中均可显示,应用MPR图像后处理方法可显示20例。横断位显示稍优于MPR。结论眼眶内侧壁骨折易并发鼻泪管骨折,以单侧最为多见。以横断位扫描为基础,辅以MPR技术能够清楚地显示眼眶内侧壁骨折所并发的鼻泪管骨折及鼻泪管的阻塞情况。同时MPR还能清楚地显示骨折线的全程及鼻泪管的走行,对于指导手术治疗及评价预后具有重要的临床价值。

The diagnosis of nasolacrimal duct with medial orbital wall fractures by spiral CT

Purpose To explore the value of SCT for the diagnosis of nasolacrimal duct fractures with medial orbital wall fractures. Methods 45 cases who diagnosed medial orbital wall fractures by clinic were performed SCT and MPR after scans. Among them, 5 cases possessed of typical clinical symptoms of epiphora, 6 cases showed obvious clinical signs of lacrimal duct fractures and obstruction. Results 22 cases(49%)were diagnosed that they had subsequent nasolacrimal duct fractures. And all the cases with clinic symptoms and signs were detected. Nasolacrimal duct fractures of all the 22 cases were unilateral. Among them, 6 cases were accompanied with other fractures except for orbit fractures. On spiral CT axial image, nasolacrimal duct fractures were all shown in 22 cases. But MPR can show the fractures in 20 cases. It was shown that axial image was a bit better than MPR in showing nasolacrimal duct fractures. Conclusion Medial orbital wall fractures were accompanied with nasolacrimal duct fractures easily. And the most frequently, the fractures were unilateral. MPR based on spiral CT axial scan can show clearly not only the fractures and the obstruction of nasolacrimal duct in nasolacrimal duct fractures with medial orbital wall fractures, but also the path of catagmatic lines and the route of nasolacrimal duct. So they are useful for the operations and for the evaluation of prognosis.