鼻骨骨折损伤程度鉴定的影像学诊断方法比较

摘要

目的 从司法鉴定角度探讨鼻骨骨折的影像学精准诊断方法.方法 收集124例鼻骨骨折案件被鉴定人进行鼻骨DR侧位片、轴位重建多排螺旋CT(MSCT)及轴位+冠状位重建MSCT检查的影像学资料.前两种为胶片扫描资料,后一种为医学影像光盘资料.根据损伤等级将被鉴定人分为轻微伤组及轻伤组,分别进行组内不同影像学检查结果精准度的比较.结果 轻微伤组3次影像学检查结果的一致性有统计学差异(P<0.01),轴位+冠状位重建MSCT骨折确诊率最高,DR检查明确诊断率最低.进一步分析发现DR检查与两次MSCT确诊率之间均存在统计学差异(P<0.05).轻伤组3次影像学检查的骨折确诊率结果一致性有统计学差异(P<0.01),阳性诊断率从高到低依次为轴位+冠状位重建MSCT、轴位重建MSCT及DR检查;检查结果确诊率两两比较显示:任意两组之间均存在统计性差异(P<0.01). 结论 MSCT是目前鼻骨骨折诊断的理想方法,轴位+冠状位重建技术的合理应用能够帮助鉴定人进行鼻骨骨折的精确诊断,医学影像光盘技术为鉴定人二次审核诊断结论提供了便利,确保鼻骨骨折损伤鉴定的公正性和科学性.%Objective To explore the choice of method for the imaging precise diagnosis of nasal bone fracture using the perspective of judicial identification.Methods 124 cases of nasal bone fracture were measured with DR,axial MPR MSCT and axial-coronal MPR MSCT.The images of DR and axial MSCT were stored into medical films which were transferred into computer by using film scanner,and axial-coronal MSCT screenage were all reserved into medical image CDs.The cases were divided into minor injury group and slight injury group according to the injury level and the differences of the three imaging examination were analyzed and compared statistical in each group.Results For minor injury,there were significant differences among three methods (P<0.01),and the fracture diagnosis rates were growing from DR,axial MPR MSCT to axial-coronal MPR MSCT examination.After the following analysis,there were significant differences in the positive rates of fracture diagnosis between DR and axial MPR MSCT tests (P<0.01),and there were also obviously significant differences between DR and axial-coronal MPR MSCT tests (P<0.01).For slight injury,the results showed that the positive rates of fracture diagnosis were lower for DR tests than for both axial MPR MSCT (P<0.01) and axial-coronal MPR MSCT tests (P<0.01).There were significant variations between the latter two imaging techniques as well (P<0.01).Conclusion MSCT is an ideal method of image technology for diagnosing nasal fractures.Nasal bone fractures can be diagnosed exactly by the rational application of axial MPR combined with coronal MPR.Indeed,it's convenient for judicial identifiers to scrutinize the imaging diagnosis by using medical image CDs,which is also for guaranteeing the fairness and scientificalness of injury degree identification of nasal bone fracture.