虚拟CT耳镜对先天性耳畸形听骨链病变的诊断价值

摘要

目的 通过虚拟CT耳镜观察,探讨其对先天性耳畸形听骨链病变的诊断价值.方法 对30例(43耳)先天性耳畸形患者,高分辨率CT扫描获取病变部位的原始图像数据,经三维重建后,以虚拟CT耳镜方式观察听骨链病变情况,然后与手术探查结果对比分析.结果 虚拟CT耳镜清楚显示发育不全的听小骨及畸形听骨链状态,其中外耳道闭锁21例(30耳),包括锤骨发育不全18耳,砧骨发育不全13耳,锤砧骨缺如3耳,镫骨畸形13耳,镫骨缺如4耳,锤砧关节畸形融合20耳,砧镫关节畸形融合7耳,砧镫关节软组织连接2耳；9例(13耳)单纯性中耳畸形,其中锤骨头与砧骨体包埋在上鼓室内上壁2耳,锤骨头与上鼓室壁骨性连接3耳,锤骨柄远端与鼓环骨性连接1耳,砧骨长脚发育不全4耳,镫骨异位1耳,镫上结构缺如3耳,其中前庭窗闭锁1耳,镫上结构畸形2耳.31耳行手术治疗,术前虚拟CT耳镜观察与术中探查听骨链异常基本符合.结论 虚拟CT耳镜清楚显示先天性耳畸形听骨链异常结构,为术前明确诊断和确立手术方式提供可靠的影像学依据.%Objective To investigate the value of virtual CT endotoscope for the diagnosis of ossicular chain lesions accompanied with congenital aural deformity. Methods Thirty cases (43 ears) with congenital aural deformity were undergone high resolution CT scanning to collect the original image data from the focus in middle ear, followed by 3-dimensional reconstruction to process these images for evaluating the possibly presented lesions with the ossicular chain. Then, a comparative analysis was made on the virtual CT endotoscopic findings in a correlative consideration with that actually found during the operation on the ossicular chain lesions. Results 30 ears were aural atresia which contained malleus hypoplasia in 18 ears, incus hypoplasia in 13 ears, malleus and incus absence in 3 ears, stapes abnormity in 13 ears, stapes absence in 4 ears, fusion of malleoincudal joint in 20 ears, fusion of incudostapedial joint in 7 ears and incudostapedial joint connected with soft tissue in 2 ears. 13ears were simple ossicular deformity which contained caput mallei and incus embedded in upper inner wall of atticus in 2 ears, caput mallei connected with upper paries tympanica in 3 ears, distal end of handle of malleus connected with tpympanic ring in 1 ear, crus longum incudis hypoplasia in 4 ears, stapes aberrance in 1 ear, structure suprastapedialis absence in 3 ears,vestibular window atresia in 1 ear, structure suprastapedialis abnormity in 2ears. Thirty-one ears were treated by surgeries, The results of preoperative Virtual CT endoscopy were basically consistent with the surgical exploration. Conclusions Virtual CT endotoscope can clearly display the figure of ossicular chain and its spatial relationship with other structures in the middle ear and provide more detailed information to improve the preoperative diagnostic levels for ossicular chain lesions and to prepare a more practical strategy for surgical treatment on congenital aural deformity.