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目的进一步提高螺旋CT及后处理技术诊断外中耳畸形的水平。资料与方法对22例(24耳)经手术治疗的先天性外中耳畸形病例,术前采用螺旋CT高分辨扫描,将原始扫描数据密集重组后进行多平面重组(MPR)(轴面、冠状面、斜轴面、斜冠状面)、曲面重组(CPR)及仿真内镜容积重组(VR)成像,与手术所见进行详细对照观察。结果手术治疗24耳,外耳道狭窄1耳,骨性闭锁18耳,膜性闭锁3耳。鼓室腔狭小12耳。锤骨畸形或缺如23耳,其中1耳CT见细小锤骨,而手术为缺如。砧骨缺如4耳,砧骨畸形16耳,其中有2耳手术见砧骨长脚长、砧骨粗大,而CT表现基本正常。镫骨细小畸形6耳,其他畸形7耳,镫骨缺如5耳;砧锤关节融合畸形14耳,轻度变形1耳,缺如4耳;砧镫关节融合1耳,不连5耳,缺如7耳;卵圆窗骨性封闭8耳,上述CT所见均与手术相符。手术见3耳圆窗骨性封闭,其中1耳CT表现正常。手术有3耳未见咽鼓管开口,其中1耳CT表现正常。手术见面神经管前位8耳,其中1耳CT表现正常。结论螺旋CT高分辨扫描及其多种后处理成像综合观察,多数可以反映外中耳畸形情况,有利于指导手术方案的制定。
Objective To further improve the diagnostic accuracy of spiral CT and postprocessing techniques in the diagnosis of middle ear deformity. Materials and Methods Twenty-two cases (24 ears) of surgically treated congenital external middle ear malformations underwent preoperative spiral CT scan. The original scan data were intensively reorganized and then subjected to multiplanar reorganization (MPR) (axial, coronal Plane, oblique axis, oblique coronal plane), surface reconstruction (CPR) and simulated endoscopic volume reconstruction (VR) imaging, and the surgical findings were compared in detail. Results Surgical treatment of 24 ears, 1 ear stenosis, bony atresia 18 ears, membranous atresia 3 ears. Tympanic cavity narrow 12 ears. Malleus deformity or absence of 23 ears, including 1 ear CT see the tiny malleus, but the surgery is absent. The incus lack of 4 ears, anvil deformity 16 ears, including 2 ear surgery see the long incarceration of the anus, incus large, and the performance of CT was normal. Tarsal bone deformity 6 ears, other deformities 7 ears, tarsus absence of 5 ears; anvil hammer joint deformity 14 ears, mild deformation 1 ear, missing 4 ears; anvil 镫 arthrodesis 1 ear, not even 5 ears, Lack of 7 ears; oval bony closed 8 ears, the above CT findings are consistent with surgery. See surgery 3 ear bony closed, including 1 ear CT performance was normal. Surgery had 3 ears without eustachian tube opening, 1 ear CT showed normal. Nerve tube in front of surgery to meet the 8 ears, 1 ear CT showed normal. Conclusion High-resolution spiral CT and its multiple post-processing imaging comprehensive observation, most can reflect the outer middle ear deformity, is conducive to guide the development of surgical options.