摘要
目的 分析髁突骨折临床常用影像学诊断方法的优缺点,探讨这些方法在髁突骨折诊断中的应用价值.方法 统计2002年1月至2013年11月就诊于上海交通大学医学院附属第九人民医院口腔医学院口腔颌面外科的髁突骨折病例共290例（405侧）.对405侧行曲面体层X线和CT检查并阅片,按囊内骨折分型（A、B、C和M型）、髁颈骨折和髁突下骨折分类统计;对其中119例174侧MRI阅片,判断关节盘损伤或移位情况.采用SAS 9.0软件对收集的数据进行配对t检验,分别比较曲面体层X线和CT对髁突骨折诊断的差异,以及不同骨折类型中关节盘损伤或移位的差异.结果 曲面体层X线可检出79.8％（323/405）髁突骨折,其中囊内骨折48.9％（198/405）,髁颈骨折20.3％（82/405）,髁突下骨折10.6％（43/405）.CT诊断出囊内骨折64.0％（259/405）[A型48.7％（126/259）、B型30.9％（80/259）、C型8.1％ （21/259）、M型12.4％ （32/259）],髁颈骨折24.0％ （97/405）,髁突下骨折12.1％（49/405）.以CT诊断结果为标准,10侧曲面体层X线原诊断为囊内骨折,冠状位CT确诊为髁颈骨折.MRI诊断囊内骨折中关节盘移位94.9％（29/136）[A型中关节盘移位95.3％（61/64）、B型中95.2％（40/42）、C型中89.0％（8/9）、M型中占95.2％（20/21）];髁颈骨折中关节盘移位53.6％（15/28）、髁突下骨折中关节盘移位占60.0％（6/10）.囊内骨折关节盘移位和髁颈骨折与髁突下骨折关节盘移位情况比较,差异有统计学意义（P＜0.05）,而髁颈骨折和髁突下骨折关节盘移位情况比较,差异无统计学意义（P＞0.05）;各型囊内骨折关节盘移位情况相互比较,差异无统计学意义（P＞0.05）.结论 曲面体层X线可初步诊断髁突骨折,但囊内骨折、细微骨折及骨裂等漏诊率较高,仅可用于髁突骨折的初筛.CT（尤其是冠状位CT）能准确诊断骨折线的位置和骨折块内外向移位角度等.
Objective To retrospectively analyze the advantages and disadvantages of radiographic methods commonly used for diagnostic of condylar fractures.Methods From Jan 2002 to Nov 2013,290 patients （405 condylars） in the temporomandibular joint （TMJ） division of Ninth People＇s Hospital Shanghai Jiao Tong University School of Medicine were diagnosed as condylar fractures.Panoramic films and CT were taken in all patients to check and count the amount of condylar fractures,including intracapsular condyle fracture （type A,B,C and M）,condylar neck fracture and subcondylar fracture.MRI was also taken in 119 patients with 174 condylar fractures to check the position of TMJ disc.The data were analyzed and compared among the three examinations in the diagnosis of the condylar fractures.Results Panoramic films showed 79.8% （323/405） condylar fractures.Among condylar fractures,intracapsular condylar fractures,condylar neck fractures and subcondylar fractures accounted for 48.9%（198/405）,20.3%（82/405） and 10.6%（43/405）respectively.CT showed 64.0% （259/405） intracapsular condylar fractures,24.0% （97/405） condylar neck fractures and 12.1%（49/405） subcondylar fractures.Among intracapsular condylar fractures,Type A fracture was the most common type of ICF,which accounted for 48.7%（126/259）,followed by Type B fracture,which accounted for 30.9%（80/259） and Type M fracture,12.4%（32/259）.Type C fracture was the least type which accounted for 8.1% （21/259）.According to the diagnostic criteria of CT,there were 10 condylar neck fractures misdiagnosed with intracapsular condylar fractures.MRI showed 94.9% （129/136） TMJ disc displacement in intracapsular condylar fractures,53.6% （15/28） in condylar neck fractures and 60.0% （6/10） in subcondylar fractures.Among intracapsular condylar fractures,there were 95.3%（61/64） TMJ disc displacement in type A,95.2%（40/42） in type B,89.0%（8/9） in type C,and 95.2%（20/21） in type M.There was significant difference of TMJ disc displacement between intracapsular condylar fractures and condylar neck fractures or subcondylar fractures （P〈0.05）,and no significant difference between condylar neck fractures and subcondylar fractures （P〈0.05）.There was also no significant difference among various type of intracapsular condylar fractures.Conclusions Panoramic films can initially diagnose condylar fractures but with the high misdiagnosis rate for intracapsular fractures,minor fractures and fractures without fragment displacement.CT,especially coronal CT,should be considered for positioning fracture lines and confirming the displacement angle of fragment.MRI should also be used to determine the position of TMJ disc in intracapsular condylar fractures.
出处
《中华口腔医学杂志》
CAS
CSCD
北大核心
2014年第7期434-439,共6页
Chinese Journal of Stomatology
基金
国家自然科学基金（81371668）
上海市自然科学基金（10ZR1418200）
作者简介
通信作者：张善勇，Email：zhangshanyong@126．com，电话：021-23271699—5156
