许尔长 田超 张兰芳 岳凤文 蒋婷

[摘要]目的：探討低剂量螺旋CT在颌面部骨折诊治中的应用价值。方法：选取2017年10月-2019年10月于笔者医院就诊的60例颌面部创伤患者为研究对象，随机分为常规剂量组（160mAs螺旋CT扫描）30例和低剂量组（30mAs螺旋CT扫描）30例，比较两组图像质量，辐射剂量参数包括容积CT剂量指数（CTDIvol）、剂量长度乘积（DLP）和有效剂量（ED）。结果：两组满足诊断要求的图像比例比较，差异无统计学意义（P>0.05）;低剂量组手术发现47处骨折，常规剂量组手术发现49处骨折，两组骨折部位及比例构成无显著性差异（P>0.05），均以上、下颌骨骨折为主;低剂量组CT三维重建颌面骨折检出率为93.62%，与常规剂量组CT三维重建检出率95.92%比较，差异无统计学意义（P>0.05）;低剂量组辐射剂量参数CTDIvol、DLP和ED均显著低于常规剂量组，差异有统计学意义（均P<0.05）。结论：颌面部骨折患者临床诊疗中采用螺旋CT低剂量扫描，在保证诊断图像质量、不明显影响诊断准确性同时，大幅减少辐射剂量。

[关键词]颌面部骨折;螺旋CT;辐射剂量;图像质量;三维重建

[中图分类号]R782.2    [文献标志码]A    [文章编号]1008-6455（2021）04-0061-03

Application Value Of Low-dose Spiral CT in Cosmetic Repair of Maxillofacial Fractures

XU Er-chang， TIAN Chao， ZHANG Lan-fang， YUE Feng-wen， JIANG Ting

（Department of Burn Plastic And Aesthetic Surgery，Nanchong Central Hospital，Nanchong 637000，Sichuan，China）

Abstract： Objective  To explore application value of low-dose spiral CT in diagnosis and treatment of maxillofacial fractures. Methods  A total of 60 patients with maxillofacial trauma who were treated in the hospital from October 2017 to October 2019 were enrolled. They were randomly divided into routine-dose group （160mAs spiral CT scan） and low-dose group （30mAs spiral CT scan）， 30 cases in each group. The images quality and radiation dose parameters [CT dose index volume （CTDIvol）， dose length product （DLP）， effective dose （ED）] were compared between the two groups. Results There was no significant difference in the proportion of images meeting the diagnostic requirements between the two groups （P>0.05）. There were 47 and 49 fractures sites in low-dose group and routine-dose group， respectively. There were no significant differences in fracture sites and proportions between the two groups （P>0.05）， which were mainly on maxillofacial and mandibular fractures. There was no significant difference in detection rate of maxillofacial fractures by 3D CT reconstruction between low-dose group and routine-dose group （93.62% vs 95.92%）（P>0.05）. The radiation dose parameters （CTDIvol， DLP， ED） in low-dose group were significantly lower than those in routine-dose group （P<0.05）. Conclusion The application of spiral CT low-dose scan in the clinical diagnosis and treatment of patients with maxillofacial fractures can significantly reduce radiation dose while ensuring quality of diagnostic images and not significantly affecting diagnostic accuracy.

Key words：maxillofacial fracture; spiral CT; radiation dose; image quality; three-dimentional reconstruction

颌面部解剖结构复杂，骨骼形态多不规则，临床诊疗難度大。在临床常用的影像学检查手段中，X线检查对该区域常难以清晰显示，无法对该区域骨折部位、类型和严重程度进行准确、立体的评估[1]。多层螺旋CT及其强大的后处理功能对颌面部骨折诊断显示出较大优势，诊断准确性良好[2]。颌面骨折损伤患者，由于手术前后需要多次进行CT检查，患者不可避免地接受较大剂量辐射，尤其对眼、甲状腺等敏感部位可能产生不必要的危害[3]。既往研究显示[4-5]，在保证诊断图像质量的前提下，适当的低剂量CT扫描是可行的，不显著影响对疾病的探测诊断。本研究以颌面……