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目的研究听骨链的CT曲面重建(CPR)方法,评估其临床应用价值。方法165耳(122例)行颞骨轴位高分辨率CT检查,对听骨链行CPR。50例(80耳)为正常听骨链,72例(85耳)为病变组。主要扫描参数:准直0.5mm,螺距0.875,重建间隔0.2~0.3mm,重建矩阵1024×1024。结果(1)正常听骨链组:1幅图像上清晰显示3个听骨及其关节。(2)临床应用:39例颞骨外伤中,听骨链异常的18例;锤砧关节半脱位及脱位各5例,砧镫关节半脱位及脱位分别为5例及6例,锤骨柄骨折1例。16例外耳发育不良中,骨性外耳道闭锁13例,膜性3例。骨性外耳道闭锁最常见的伴随听骨畸形是锤骨柄发育不全(10例),中耳腔变窄、听骨缺如3例,锤砧融合伴砧骨长突缺如1例。不伴随先天性外耳发育不良的听骨畸形2例,1例为双耳砧骨长突缺如,另1例为砧骨长突发育不全伴砧镫关节不连。慢性中耳乳突炎15例,6例合并胆脂瘤者听骨均有不同程度的破坏,鼓室硬化症1例。结论听骨链的多层螺旋CT曲面重建是诊断传导性耳聋的有效方法。
Objective To study the method of CT surface reconstruction (CPR) of ossicular chain and evaluate its clinical value. Methods A total of 165 ears (122 cases) underwent high resolution axial CT scan of the temporal bone and CPR of the ossicular chain. Fifty cases (80 ears) were normal ossicular chain, and 72 cases (85 ears) were lesion group. The main scanning parameters: collimation 0.5mm, pitch 0.875, reconstruction interval 0.2 ~ 0.3mm, reconstruction matrix 1024 × 1024. Results (1) Normal ossicular chain group: one image clearly shows three ossicles and their joints. (2) clinical application: in 39 cases of temporal bone trauma, ossicular chain abnormalities in 18 cases; hammer anvil joint subluxation and dislocation in 5 cases, anvizheal joint subluxation and dislocation were 5 cases and 6 cases, mastoid fracture 1 example. In 16 cases of dysplasia of the ear, bony external auditory canal atresia in 13 cases, membranous in 3 cases. Osseous external auditory canal malocclusion is the most common complication of metacarpal malleote dysplasia (10 cases), the narrowing of the middle ear cavity, lack of audius in 3 cases, hammer anvil incision with astigmatism in 1 case. There were 2 cases of metacarpal malformation without congenital malformation of auricle, 1 case of bipolar incarceration, 1 case of ankle protuberance congenital ankle joint. Chronic otitis media in 15 cases, 6 cases of cholesteatoma who had different degrees of damage to the bones, tympanosclerosis in 1 case. Conclusion The multi-slice spiral CT surface reconstruction of ossicular chain is an effective method to diagnose conductive deafness.