285例儿童鼻骨骨折影像分析及骨折分型研究

Radiographic analysis and classification of pediatric nasal bone fracture in 285 children

摘要:

目的 通过CT影像分析，探究儿童鼻骨骨折的影像学特点，为制定个性化儿童鼻骨骨折诊疗方案提供依据。方法 回顾性总结2016年1月—2021年5月在上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科就诊的285例儿童鼻骨骨折患者，其中男191例，女94例，年龄7个月至14岁，平均年龄（8.52±3.51）岁。将研究对象按年龄分为学龄前组（0～5岁），小学组（6～11岁），初中组（12～14岁），由影像科收集DICOM格式的CT影像数据，使用Mimics软件对CT影像进行三维重建，分析以上患者鼻骨骨折的特点，统计面中部其他骨骨折的发生率，并提出一种新的基于CT影像的儿童鼻骨骨折分类方法。结果 统计285例患者中，学龄前组患儿69例（24.21%）、小学组患儿145例（50.88%），初中组患儿71例（24.91%）；其中单纯型鼻骨骨折210例（73.68%），复合型鼻骨骨折75例（26.32%）。根据上述患者的CT影像，分析儿童鼻骨骨折的影像学特点，将儿童鼻骨骨折分为4种类型，其中Ⅰ型为单纯鼻骨骨折无移位，只见骨折线34例（11.93%），Ⅱ型为单纯鼻骨骨折有移位176例（61.75%），Ⅲ型为合并1种面中部其他骨骨折的鼻骨骨折70例（24.57%），Ⅳ型为合并两种及以上面中骨骨折的鼻骨骨折5例（1.75%）。结论 影像学分析儿童鼻骨骨折特点和鼻骨骨折分型方法，骨折的匹配度更高，可以更好地评估儿童鼻骨骨折的情况，并对儿童鼻骨骨折的个性化治疗有一定的指导作用。

关键词:鼻骨骨折;儿童鼻骨;鼻骨骨折分型

Abstract:

Objective To investigate the radiographic characteristics of pediatric nasal bone fracture based on the analysis of computed tomography (CT) images, and to provide a foundation for the individualized diagnosis and treatment scheme for pediatric nasal bone fracture.Methods A retrospective study was conducted on 285 pediatric patients (191 males and 94 females) with nasal bone fracture diagnosed and treated in our department between Jan 2016 and May 2021. The age range of the patients was from 7 months to 14 years with an average of 8.52±3.51. The study cohort was categorized into three groups based on age:preschool group (0-5 years), primary school group (6-11 years), and junior high school group (12-14 years). DICOM format CT images were collected from the Department of Radiology and subjected to three-dimensional reconstruction using Mimics software. The characteristics of nasal bone fracture in the aforementioned patients were analyzed, and the incidence of associated fractures in the midfacial region was documented. Furthermore, a novel CT-based classification method for pediatric nasal bone fracture was proposed.Results Based on the incidence rate statistics, the preschool group comprised 69 individuals (24.21%), the primary school group had 145 (50.88%), and the middle school group included 71 (24.91%). Regarding the statistical analysis of fracture patterns, there were 210 cases of simple nasal bone fracture (73.68%) and 75 cases of compound nasal bone fractures (26.32%). Based on the CT images of these patients, the radiological characteristics of pediatric nasal bone fractures were analyzed, and four types of pediatric nasal bone fractures were classified, as follows:type I, simple nasal bone fracture without displacement, 34 cases (11.93%); type II, simple nasal bone fracture with displacement, 176 cases (61.75%); type III, nasal bone fracture combined with one other midfacial bone fracture, 70 cases (24.57%); type IV, nasal bone fracture combined with two or more other midfacial bone fractures, 5 cases (1.75%).Conclusions The proposed classification method for nasal bone fractures, based on radiological analysis of pediatric cases, demonstrates a high degree of concordance with the actual fractures. This method enables a more accurate assessment of the condition of nasal bone fracture in children and provides valuable guidance for personalized treatment strategy.

Key words:Nasal fracture;Nasal bone in children;Nasal bone fracture classification