MSCT三维重建与MRI对下颌骨髁突骨折的诊断效果比较

黄洪; 徐旭; 严钦; 方欣

doi:10.16766/j.cnki.issn.1674-4152.002378

MSCT三维重建与MRI对下颌骨髁突骨折的诊断效果比较

doi: 10.16766/j.cnki.issn.1674-4152.002378

黄洪^1, ,,
徐旭²,
严钦³,
方欣⁴

1.
衢州市中医医院放射科，浙江衢州 324002
2.
衢州市人民医院口腔科，浙江衢州 324000
3.
浙江大学医学院附属第二医院口腔颌面外科，浙江杭州 310009
4.
衢州市中医医院口腔科

基金项目:

浙江省医药卫生科技计划项目 2018KY878

详细信息

通讯作者:
黄洪, E-mail: hhzdhjy@163.com

中图分类号: R782.4 R445.2
计量
- 文章访问数: 178
- HTML全文浏览量: 85
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-05
- 网络出版日期: 2022-08-13

Comparison of MSCT three-dimensional reconstruction and MRI in the diagnosis of mandibular condylar fracture

HUANG Hong^{1
, ,},
XU Xu²,
YAN Qin³,
FANG Xin⁴

1.
Department of Radiology, Quzhou Hospital of Traditional Chinese Medicine, Quzhou, Zhejiang 324002, China

摘要

摘要: 目的观察多层螺旋CT(MSCT)扫描三维重建检查与MRI检查对于不同特征下颌骨髁突骨折的鉴别诊断效果。方法以自2019年6月—2021年6月于衢州市中医医院及浙江大学医学院附属第二医院就诊并接受手术治疗的150例下颌骨髁突骨折患者为研究对象，分别于术前对全部患者进行MSCT扫描三维重建检查与MRI检查，统计2种检查方法对下颌骨髁突骨折类型和骨折移位情况的诊断灵敏度、特异性和准确度，以及对于软组织损伤情况的诊断符合性。结果 MSCT扫描三维重建检查与MRI检查对于髁头骨折、髁突颈部骨折和髁突下骨折等不同下颌骨髁突骨折类型的诊断灵敏度、特异性和准确度差异均无统计学意义(均P＞0.05)。MSCT扫描三维重建检查与MRI检查对于原位骨裂、弯曲移位和错动移位骨折等不同下颌骨髁突骨折移位情况的诊断灵敏度、特异性和准确度差异均无统计学意义(均P＞0.05)。MRI检查对于韧带撕裂和髁突表面软骨损伤的诊断符合性[81.97%(50/61)和80.49%(66/82)]均显著高于MSCT扫描三维重建检查水平[63.93%(39/61)和65.85%(54/82)]，χ²=5.587、4.473；P=0.018、0.034。结论 MSCT扫描三维重建检查对于下颌骨髁突骨折类型和移位情况的诊断能力可与MRI检查媲美，而MRI对于软组织损伤诊断能力更优，临床可通过2种方法联合应用，以提高下颌骨髁突骨折及周围软组织损伤的综合诊断效能。
- 多层螺旋CT扫描，三维重建 /
- 核磁共振 /
- 下颌骨髁突骨折 /
- 软组织损伤 /
- 诊断效能 /
Abstract: Objective To observe the differential diagnosis effect of MSCT three-dimensional reconstruction and MRI on mandibular condylar fracture with different characteristics. Methods A total of 150 patients with mandibular condylar fracture treated at Quzhou Hospital of Traditional Chinese Medicine and the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2019 to June 2021 were studied. All patients underwent multi-slice spiral CT(MSCT) scanning, three-dimensional reconstruction and MRI before operation. The sensitivity, specificity and accuracy of the two methods in the diagnosis of mandibular condylar fracture types and fracture displacement, as well as the diagnostic coincidence of soft tissue injury, were investigated. Results There was no significant difference in the sensitivity, specificity and accuracy of MSCT three-dimensional reconstruction and MRI in the diagnosis of different types of mandibular condylar fractures, such as condylar head fracture, condylar neck fracture and subcondylar fracture (all P>0.05). There was no significant difference in the sensitivity, specificity and accuracy of MSCT three-dimensional reconstruction and MRI in the diagnosis of different mandibular condylar fracture displacement, such as in situ bone fracture, bending displacement and dislocation fracture (all P>0.05). The diagnostic accuracy of MRI for ligament tear and condylar surface cartilage injury[81.97%(50/61) and 80.49%(66/82)] was significantly higher than that of MSCT scanning three-dimensional reconstruction[63.93%(39/61) and 65.85%(54/82)], χ²=5.587, 4.473; P=0.018, 0.034. Conclusion The diagnostic ability of MSCT scanning three-dimensional reconstruction for the type and displacement of mandibular condylar fracture is comparable to that of MRI, whereas MRI has better diagnostic ability for soft tissue injury. Clinically, the two methods can be combined to improve the comprehensive diagnostic efficiency of mandibular condylar fracture and surrounding soft tissue injury.
- Multi-slice spiral CT scanning /
- Three-dimensional reconstruction /
- Nuclear magnetic resonance /
- Mandibular condylar fracture /
- Soft tissue injury /
- Diagnostic efficiency

HTML全文

表 1 2种检查方法对下颌骨髁突骨折类型诊断效能比较(%)

Table 1. Comparison of diagnostic efficacy of two examination methods for mandibular condylar fracture types (%)

组别	髁头骨折			髁突颈部骨折			髁突下骨折
组别	灵敏度	特异性	准确度	灵敏度	特异性	准确度	灵敏度	特异性	准确度
MSCT扫描三维重建检查	88.04(81/92)	87.93(51/58)	88.00(132/150)	89.19(33/37)	87.61(99/113)	88.00(132/150)	85.71(18/21)	8.37(114/129)	88.00(132/150)
MRI检查	93.48(86/92)	93.10(54/58)	93.33(140/150)	94.59(35/37)	92.92(105/113)	93.33(140/150)	90.48(19/21)	93.80(121/129)	93.33(140/150)
χ²值	1.620	0.904	2.521	0.725	1.813	2.521	0.227	2.339	2.521
P值	0.203	0.342	0.112	0.394	0.178	0.112	0.634	0.126	0.112

下载: 导出CSV

表 2 2种检查方法对下颌骨髁突骨折移位诊断效能比较(%)

Table 2. Comparison of diagnostic efficacy of two examination methods for displacement of mandibular condylar fracture (%)

组别	原位骨裂			弯曲移位			错动移位
组别	灵敏度	特异性	准确度	灵敏度	特异性	准确度	灵敏度	特异性	准确度
MSCT扫描三维重建检查	83.82(57/68)	91.46(75/82)	88.00(132/150)	91.43(32/35)	86.96(100/115)	88.00(132/150)	91.49(43/47)	86.41(89/103)	88.00(132/150)
MRI检查	92.65(63/68)	93.90(77/82)	93.33(140/150)	94.29(33/35)	93.04(107/115)	93.33(140/150)	93.62(44/47)	93.20(96/103)	93.33(140/150)
χ²值	2.550	0.360	2.521	0.215	2.367	2.521	0.154	2.598	2.521
P值	0.110	0.549	0.112	0.643	0.124	0.112	0.694	0.107	0.112

下载: 导出CSV

参考文献(19)

[1]	徐旭, 朱慧勇, 李志勇, 等. 手术导航系统在下颌骨修复重建术中的疗效研究[J]. 中华全科医学, 2017, 15(5): 738-741. doi: 10.16766/j.cnki.issn.1674-4152.2017.05.003 XU X, ZHU H Y, LI ZY, et al. Clinical evaluation of surgical navigation system in the reconstruction of mandibular defects[J]. Chin J Gen Prac, 2017, 15 (5): 738-741. doi: 10.16766/j.cnki.issn.1674-4152.2017.05.003
[2]	林晨阳, 罗艳荣, 许志亮. 微型钛板复位内固定治疗下颌骨髁突囊内骨折的效果[J]. 中华临床医师杂志(电子版), 2016, 10(13): 1900-1903. doi: 10.3877/cma.j.issn.1674-0785.2016.13.012 LIN C Y, LUO Y R, XU Z L. Effect of mini titanium plate reduction and internal fixation in the treatment of mandibular condylar fractures[J]. Chinese Journal of Clinicians (Electronic Edition), 2016, 10 (13): 1900-1903. doi: 10.3877/cma.j.issn.1674-0785.2016.13.012
[3]	任荣, 司家文, 张剑飞, 等. 下颌骨髁突囊内骨折治疗研究进展[J]. 中国口腔颌面外科杂志, 2017, 15(6): 559-563. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKQ201706027.htm REN R, SI J W, ZHANG J F, et al. Research progress in the treatment of diacapitular condylar fractures[J]. China Journal of Oral and Maxillofacial Surgery, 2017, 15(6): 559-563. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGKQ201706027.htm
[4]	堵梦雨, 宋飞翔, 张令达. 不同类型下颌骨髁突骨折手术治疗的疗效分析[J]. 安徽医药, 2018, 22(11): 2116-2119. doi: 10.3969/j.issn.1009-6469.2018.11.016 ZHU M Y, SONG F F, ZHANG L D. Efficacy of surgical treatment for different types of mandibular condyle fractures[J]. Anhui Medical and Pharmaceutical Journal, 2018, 22(11): 2116-2119. doi: 10.3969/j.issn.1009-6469.2018.11.016
[5]	张军. 下颌髁突骨折的诊治进展[J]. 北京口腔医学, 2016, 24(3): 170-173. https://www.cnki.com.cn/Article/CJFDTOTAL-BJKX201603014.htm ZHANG J. Progress in diagnosis and treatment of mandibular condylar fracture[J]. Beijing Journal of Stomatology, 2016, 24(3): 170-173. https://www.cnki.com.cn/Article/CJFDTOTAL-BJKX201603014.htm
[6]	李豪培, 李金超, 李守宏. 下颌骨髁状突囊内骨折分类及手术治疗新进展[J]. 临床口腔医学杂志, 2020, 36(6): 379-382. doi: 10.3969/j.issn.1003-1634.2020.06.019 LI H P, LI J C, LI S H. Classification and surgical treatment of mandibular condylar intracapsular fractures[J]. Journal of Clinical Stomatology, 2020, 36(6): 379-382. doi: 10.3969/j.issn.1003-1634.2020.06.019
[7]	杨思遥, 马宇锋. 髁突骨折的治疗方法及研究进展[J]. 全科口腔医学电子杂志, 2017, 4(17): 57-58. doi: 10.3969/j.issn.2095-7882.2017.17.036 YANG S Y, MA Y F. Progress in the treatment of condylar fractures and research[J]. The Department of Oral Medicine Electronic Magazine(Electronic Edition), 2017, 4(17): 57-58. doi: 10.3969/j.issn.2095-7882.2017.17.036
[8]	汤颖峰. 应用小型钛板治疗下颌骨髁状突创伤性骨折对患者咬合功能的影响及预后分析[J]. 中国美容医学, 2017, 26(11): 83-86. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX201711030.htm TANG Y F. Effect of surgical treatment with small titanium plate on the occlusal function of the patients with the traumatic fracture of mandibular condyle and the analysis of the prognosis[J]. Chinese Journal of Aesthetic Medicine, 2017, 26(11): 83-86. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX201711030.htm
[9]	刘月军. 螺旋CT三维重建在下颌骨髁状突骨折中的应用价值研究[J]. 临床医学研究与实践, 2016, 1(16): 156. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201616132.htm LIU Y J. Application value of spiral CT three-dimensional reconstruction in mandibular condylar fracture[J]. Clinical Research and Practice, 2016, 1(16): 156. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201616132.htm
[10]	徐晓峰, 徐兵. 下颌骨前段骨折伴发髁突骨折的诊治现状[J]. 华西口腔医学杂志, 2014, 32(2): 206-208. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201402033.htm XU X F, XU B. Current diagnosis and therapy of anterior mandibular fracture associated with condyle fractures[J]. West China Journal of Stomatology, 2014, 32(2): 206-208. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201402033.htm
[11]	曾朝强, 王晶, 张福洲, 等. 下颌骨骨折的曲面断层摄影与多层螺旋CT影像分析研究[J]. 实用医学影像杂志, 2017, 18(1): 28-30. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXY201701009.htm ZENG C Q, WANG J, ZHANG F Z, et al. Curved surface tomography and MSCT image analysis of mandibular fracture[J]. Journal of Practical Medical Imaging, 2017, 18(1): 28-30. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXY201701009.htm
[12]	宋涛. 分析螺旋电子计算机断层扫描(CT)三维重建、核磁共振(MRI)在下颌骨髁突骨折中的诊断价值[J]. 影像研究与医学应用, 2019, 3(8): 157-158. doi: 10.3969/j.issn.2096-3807.2019.08.109 SONG T. Analyze of the diagnostic value of spiral computed tomography(CT) three-dimensional reconstruction and nuclear magnetic resonance(MRI) in mandibular condylar fracture[J]. Imaging Research and Medical Application, 2019, 3(8): 157-158. doi: 10.3969/j.issn.2096-3807.2019.08.109
[13]	周万臣. 下颌骨骨折的曲面断层摄影与多层螺旋CT影像分析研究[J]. 影像研究与医学应用, 2019, 3(21): 44-45. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY201921021.htm ZHOU W C. Curved surface tomography and MSCT image analysis of mandibular fracture[J]. Journal of Practical Medical Imaging, 2019, 3(21): 44-45. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY201921021.htm
[14]	何亚林, 周刚, 刘启球, 等. 螺旋CT三维成像在颌面部复杂骨折中的临床应用价值[J]. 中国医药科学, 2018, 8(13): 155-157. doi: 10.3969/j.issn.2095-0616.2018.13.045 HE Y L, ZHOU G, LIU Q Q, et al. Clinical application of spiral CT three-dimensional imaging in complicated maxillofacial fractures[J]. China Medicine and Pharmacy, 2018, 8(13): 155-157. doi: 10.3969/j.issn.2095-0616.2018.13.045
[15]	徐颖, 田林, 李芷萱. 多层螺旋CT扫描三维重建技术在颌面部骨折临床诊治中的应用价值探讨[J]. 中国CT和MRI杂志, 2020, 18(3): 113-116. doi: 10.3969/j.issn.1672-5131.2020.03.035 XU Y, TIAN L, LI Z X. Analysis of the value of three-dimensional reconstruction with multi-slice spiral CT in the Diagnosis and treatment of maxillofacial fractures[J]. Chinese Journal of CT and MRI, 2020, 18(3): 113-116. doi: 10.3969/j.issn.1672-5131.2020.03.035
[16]	樊文萍, 刘梦琦, 张晓欢, 等. 颞下颌关节紊乱病患者髁突位置和形态的MRI观察[J]. 中华口腔医学杂志, 2019, 54(8): 522-526. doi: 10.3760/cma.j.issn.1002-0098.2019.08.004 FAN W P, LIU M Q, ZHANG X H, et al. MRI observation of condylar location and morphology in the patients with temporomandibular disc displacement[J]. Chinese Journal of Stomatology, 2019, 54(8): 522-526. doi: 10.3760/cma.j.issn.1002-0098.2019.08.004
[17]	隋国华. 磁共振动态扫描技术在颞下颌关节盘移位中的应用效果观察[J]. 中国医药指南, 2019, 17(30): 20. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK201930017.htm SUI G H. Application of dynamic magnetic resonance scanning technique in temporomandibular joint disc displacement[J]. Chinese Medical Guidelines, 2019, 17(30): 20. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK201930017.htm
[18]	汪子平. CT三维重建与磁共振技术对下颌骨髁突骨折的诊断效果比较[J]. 浙江创伤外科, 2019, 24(5): 1025-1027. doi: 10.3969/j.issn.1009-7147.2019.05.077 WANG Z P. Comparison of CT three-dimensional reconstruction and magnetic resonance imaging in the diagnosis of mandibular condylar fracture[J]. Zhejiang Journal of Traumatic Surgery, 2019, 24(5): 1025-102.7. doi: 10.3969/j.issn.1009-7147.2019.05.077
[19]	雷欣, 邓书海, 关崧华, 等. 螺旋CT三维重建和MRI在下颌骨髁突骨折中的临床应用比较[J]. 口腔医学研究, 2018, 34(7): 746-750. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYZ201807022.htm LEI X, DENG S H, GUAN S H, et al. Comparison of clinical application of spiral CT three-dimensional reconstruction and MRI in mandibular condylar fracture[J]. Stomatological Research, 2018, 34(7): 746-750. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYZ201807022.htm