Markowitz B L, Sinow J D, Kawamoto H K, Shewmake K, Khoumehr F
UCLA School of Medicine, Los Angeles, CA 90095-6960, USA.
Ann Plast Surg. 1999 Feb;42(2):163-9. doi: 10.1097/00000637-199902000-00010.
Objective data comparing sensitivity and accuracy between traditional and computed imaging techniques used for diagnosing mandibular fractures is sparse. To address the paucity of information the authors studied prospectively 33 mandibular fractures in 21 consecutive patients with standard mandibular series, panoramic tomography, axial computed tomography (CT), and coronal CT. Differences in diagnostic accuracy and sensitivity as compiled by four blinded reviewers were calculated. Although overall sensitivities of mandibular fracture detection were not statistically significant between the imaging studies, a distinction between the four methods did exist. Coronal CT was the most accurate imaging method, followed by mandibular series, panoramic topography, and axial CT. Excluding technically inadequate studies, panoramic tomography was 100% accurate and sensitive. Diagnostic accuracy and sensitivity did not correlate measurably with reviewers' impressions of the quality of a particular exam. Axial CT detected significantly fewer angle fractures than standard radiographs (60% vs. 98%, p = 0.006) and coronal CT (60% vs. 100%, p = 0.008). False-positives were unusual except for plain mandibular radiographs. The clear definition of both coronal and axial CT scans made their analysis simpler than the plain radiographs. Lack of fracture displacement was the single most important factor in missed fractures with all modalities. Despite reviewer concerns about the quality of the plain mandibular series, the high accuracy and sensitivity of this imaging technique and applicability in all patients, coupled with its low cost, make it an excellent screening exam for all patients with suspected mandibular fractures. In clinically stable and cooperative patients with mandibular trauma, panoramic radiography and coronal CT are recommended to confirm clinical suspicions when the mandibular series is equivocal. To supplement the mandibular series in the uncooperative or multisystem trauma patient, axial CT scans have not been beneficial. These diagnostic modalities do not obviate the need for a careful physical exam.
用于诊断下颌骨骨折的传统成像技术与计算机成像技术之间对比敏感度和准确性的客观数据稀少。为解决信息匮乏问题，作者前瞻性地研究了21例连续患者的33处下颌骨骨折，采用标准下颌骨系列片、全景体层摄影、轴向计算机断层扫描（CT）和冠状位CT。计算了由四位不知情的审阅者汇总的诊断准确性和敏感度差异。尽管在成像研究之间，下颌骨骨折检测的总体敏感度无统计学显著差异，但这四种方法之间确实存在区别。冠状位CT是最准确的成像方法，其次是下颌骨系列片、全景体层摄影和轴向CT。排除技术上不充分的研究后，全景体层摄影的准确性和敏感度均为100%。诊断准确性和敏感度与审阅者对特定检查质量的印象没有明显相关性。轴向CT检测到的角部骨折明显少于标准X线片（60%对98%，p = 0.006）和冠状位CT（60%对100%，p = 0.008）。除下颌骨平片外，假阳性情况不常见。冠状位和轴向CT扫描的清晰图像使得它们的分析比平片更简单。骨折无移位是所有检查方式漏诊骨折的唯一最重要因素。尽管审阅者对下颌骨平片系列的质量有所担忧，但这种成像技术的高准确性和敏感度以及对所有患者的适用性，再加上其低成本，使其成为所有疑似下颌骨骨折患者的优秀筛查检查。对于临床稳定且配合的下颌骨创伤患者，当下颌骨系列片结果不明确时，建议采用全景X线摄影和冠状位CT来证实临床怀疑。对于不配合或有多发系统创伤的患者，轴向CT扫描对补充下颌骨系列片并无帮助。这些诊断方式并不能取代仔细的体格检查。
