CAJ | 학술논문

目的分析枕骨髁骨折的MSCT表现,提高对头颈部外伤患者枕骨髁骨折的诊断水平.方法对110例头颈交界区骨折患者进行回顾性分析,发现枕骨髁骨折19例(17%);由2名骨放射专家独立对枕骨髁的MSCT表现进行评价.分型标准:Ⅰ型,枕骨髁粉碎性骨折;Ⅱ型,颅底广泛的骨折延伸至枕骨髁部;Ⅲ型,枕骨髁翼状韧带附着部撕脱骨折;Ⅳ型为混合型,即Ⅰ～Ⅲ型中的2型或2型以上骨折同时存在.结果 19例枕骨髁骨折中,左侧7例,右侧11例,双侧1例.枕骨髁骨折1型1例,骨折位于左侧.Ⅱ型5例,左侧2例,右侧3例,主要为枕骨髁后份和中份受累.Ⅲ型12例,右侧8例,左侧3例,双侧1例;撕脱骨片多数不同程度移位,并且6例骨折线累及关节面,7例翼状韧带增粗.Ⅳ型1例,为Ⅱ型和Ⅲ型枕骨髁骨折同时存在.枕骨髁骨折伴随征象:14例枕骨髁骨折患者分别或同时存在头部和颈椎损伤,包括颅骨骨折8例,硬膜外血肿4例,蛛网膜下腔出血1例,脑挫裂伤1例,颅内积气、大脑镰下疝1例及颈椎骨折脱位9例等.结论 MSCT对枕骨髁骨折能够作出及时、准确的影像学诊断,对于临床选择治疗方案非常重要.
목적 분석침골과골절적MSCT표현,제고대두경부외상환자침골과골절적진단수평.방법 대110례두경교계구골절환자진행회고성분석,발현침골과골절19례(17%);유2명골방사전가독립대침골과적MSCT표현진행평개.분형표준:Ⅰ형,침골과분쇄성골절;Ⅱ형,로저엄범적골절연신지침골과부;Ⅲ형,침골과익상인대부착부시탈골절;Ⅳ형위혼합형,즉Ⅰ～Ⅲ형중적2형혹2형이상골절동시존재.결과 19례침골과골절중,좌측7례,우측11례,쌍측1례.침골과골절1형1례,골절위우좌측.Ⅱ형5례,좌측2례,우측3례,주요위침골과후빈화중빈수루.Ⅲ형12례,우측8례,좌측3례,쌍측1례;시탈골편다수불동정도이위,병차6례골절선루급관절면,7례익상인대증조.Ⅳ형1례,위Ⅱ형화Ⅲ형침골과골절동시존재.침골과골절반수정상:14례침골과골절환자분별혹동시존재두부화경추손상,포괄로골골절8례,경막외혈종4례,주망막하강출혈1례,뇌좌렬상1례,로내적기、대뇌렴하산1례급경추골절탈위9례등.결론 MSCT대침골과골절능구작출급시、준학적영상학진단,대우림상선택치료방안비상중요.
Objective To explore the MSCT findings of occipital condyle fracture (OCF) and improve its diagnostic accuracy. Methods Nineteen patients with OCF, selected from 110 patients suffering high energy injuries at the craniocervical junction, were enrolled into the study. The MSCT appearances of OCFs were retrospectively analyzed by two experienced radiologists. OCF had four types: type Ⅰ was a comminuted fracture, type Ⅱ was a extension of basilar skull fracture, type Ⅲ was an avulsion fracture at the attachment site of alar ligament on occipital condyle, type Ⅳ was a fracture of mixed pattern consisting of two or more above fracture types. Results In 19 patients, the left, right and bilateral OCFs were seen in 7,11 cases, and 1 case, respectively. Type Ⅰ was found in one case, which was a comminution of the left occipital condyle. Type Ⅱ was found in 5 cases, which involved the middle and posterior parts of occipital condyles with 2 on the left and 3 on the right, Type Ⅲ was found in 12 cases which showed various degree of fragment displacement with 3 occuring on the left, 8 on the right, 1 involving bilateral sides, 6 involving articular surfaces and 7 accompaning by enlargment of alar ligaments. Type Ⅳ was found in one case, with coexistence of Type Ⅱ and type Ⅲ. In addition, OCFs were accompanied by head and (or) cervical spine injuries in 14 cases, which included cranial fracture in 8 cases, epidural hematoma in 4 cases, subarachnoid hemorrhage in one case, cerebral contusion and laceration in one case, subfalcial hernia in one case, cervical spine fracture and dislocation in 9 cases, and so on. Conclusion OCFs can be accurately diagnosed by MSCT, which is important for selection of treatment protocols.