Guss D A, Clark R F, Peitz T, Taub M
Department of Emergency Medicine, UCSD Medical Center, San Diego, CA 92103-8676, USA.
Acad Emerg Med. 2000 Feb;7(2):141-5. doi: 10.1111/j.1553-2712.2000.tb00517.x.
The two primary radiographic techniques used for the evaluation of mandible injury are a pantomographic series (PS) and the standard four-view mandibular series (MS). Despite a tenuous foundation, there is apparent bias in favor of PS compared with MS. Many emergency departments do not have ready access to the specialized equipment necessary to perform a pantomographic study. The hypothesis of this study was that a high-quality standard MS is as sensitive and specific as a PS in the detection of mandibular fractures.
This was a prospective, blinded study of 54 patients presenting with acute mandibular injury comparing MS and PS. The study design used two board-certified emergency physicians and a single staff radiologist who read a series of MS and PS films in a randomized fashion without access to clinical information or identifying patient data. The absolute number of fractures present was determined by a neuroradiologist with access to both MS and PS simultaneously as well as pertinent clinical information.
Thirty patients had 47 mandibular fractures. The sensitivity for fracture detection for each physician was 0.85, 0.77, and 0.89 with MS and 0.79, 0.74, and 0.83 with PS (p > or = 0.51, p > or = 1.00, and p > or = 0.51, respectively, McNemar's binomial test). The specificity for fracture detection for each physician was 0.88, 0.92, and 0.96 for MS and 0.96, 1.00, and 0.92 for PS (p > 0.625, p > 0.50, and p = 1.00, respectively, McNemar's binomial test).
A standard mandibular series is as sensitive and specific as pantomography in the detection of mandibular fractures.
用于评估下颌骨损伤的两种主要影像学技术是全景片系列（PS）和标准的下颌骨四视图系列（MS）。尽管依据不足，但与MS相比，明显存在对PS的偏向。许多急诊科无法随时获取进行全景片检查所需的专业设备。本研究的假设是，高质量的标准MS在检测下颌骨骨折方面与PS一样敏感和特异。
这是一项对54例急性下颌骨损伤患者进行的前瞻性、盲法研究，比较MS和PS。研究设计采用两名获得委员会认证的急诊科医生和一名放射科工作人员，他们以随机方式阅读一系列MS和PS胶片，无法获取临床信息或患者识别数据。由一名神经放射科医生同时查看MS和PS以及相关临床信息来确定骨折的实际数量。
30例患者有47处下颌骨骨折。每位医生通过MS检测骨折的敏感性分别为0.85、0.77和0.89，通过PS检测骨折的敏感性分别为0.79、0.74和0.83（分别为p≥0.51、p≥1.00和p≥0.51，McNemar二项式检验）。每位医生通过MS检测骨折的特异性分别为0.88、0.92和0.96，通过PS检测骨折的特异性分别为0.96、1.00和0.92（分别为p>0.625、p>0.50和p = 1.00，McNemar二项式检验）。
标准的下颌骨系列在检测下颌骨骨折方面与全景片一样敏感和特异。
