以上颌窦为基准的三维CT测量对单侧颧骨复合体骨折治疗效果的评价

摘要

Objective: To establish a three dimensional CT measurement based on maxillary sinus and to evaluate clinically in the treatment of unilateral zygomatic complex fracture. Methods: 17 patients suffered with unilateral zygomatic complex fracture and accompanied with fracture of maxillary sinus were retrospectively reviewed. Before reduction surgery, the patients were examined by CT scanning of the jaws and zygomas bilaterally, observing the morphological change of maxillary sinus and using the relevant software on the CT workstation to measure the highpoints of zygomatic bone's distance, based on the maxillary sinus mark points. To measure and compare the shifting distances between healthy and fractured sides to guide the reduction operation. After the operation, observing the morphological recovery of maxillary sinus and reexamining the patients with the help of the same method used before to compare the difference between the healthy patients and to evaluate the effect of the treatment. Results: CT images showed, before operation, the patients highpoint of zygomatic bone mainly shifted toward to backside (mean=4.4 mm ), and mainly accompanied shift toward to outside (mean=4.08 mm), shifting to downside (mean=2.03 mm ) and only few patients shifted to inside. After reduction operation, the shifting distances in three directions diminished or decreases to less than 2mm, the difference was significant (P<0.01). Facial contour and mouth-opening function was good, the result was satisfactory.Conclusion: Three dimensional CT measurements can observe the morphological changes of maxillary sinus on unilateral zygomatic complex fracture. The measurements based on the maxillary sinus can realize the quantitative measurement upon the shiftings of the highpoints of zygomatic bone in three dimension spaces, which has a remarkable guiding significance to evaluate the operation result of unilateral zygomatic complex fracture.%目的：在单侧颧骨复合体骨折治疗中建立以上颌窦为基准的三维CT测量方法并应用于临床。方法：收集单侧颧骨复合体骨折并需要手术的患者17例，术前做上颌骨、颧骨三维CT扫描，观察上颌窦形态的改变，并在CT工作站上应用相关软件，以双侧上颌窦的标志点为基准对颧骨高点的内外、前后及上下距离测量，根据差值算出颧骨高点在各向的移位程度并指导手术复位。术后复查CT观察上颌窦形态的恢复并用同样方法测量，对比双侧数据的差值，评价治疗效果。结果：17例单侧颧骨复合体骨折的患者术前均存在上颌窦后外侧壁和前壁的骨折并移位，其中有2例合并存在上颌窦内侧壁的骨折。 CT测量结果显示：手术前患侧颧骨高点以向后移位为主（平均4.40 mm ），多伴有向外移位（平均4.08 mm），向下移位（平均2.03 mm），仅个别患者向内移位。术后所有患者上颌窦形态基本恢复，在三个方向上的移位基本消失或减少至2 mm，对三个方向上的移位进行手术前后t检验，差异有统计学意义（P<0.01），面部外形及张口功能良好，效果满意。结论：三维CT测量可以观察颧骨复合体骨折上颌窦形态的改变，以上颌窦为基准的三维CT测量可以实现颧骨高点在三维空间上的移位的定量测量，对颧骨复合体骨折的手术复位和疗效的评判具有指导意义，术中及术后上颌窦形态的恢复可以作为复位成功的标准。