摘要目的 分析枕骨髁骨折的MSCT表现,提高对头颈部外伤患者枕骨髁骨折的诊断水平.方法 对110例头颈交界区骨折患者进行回顾性分析,发现枕骨髁骨折19例(17%);由2名骨放射专家独立对枕骨髁的MSCT表现进行评价.分型标准:Ⅰ型,枕骨髁粉碎性骨折;Ⅱ型,颅底广泛的骨折延伸至枕骨髁部;Ⅲ型,枕骨髁翼状韧带附着部撕脱骨折;Ⅳ型为混合型,即Ⅰ～Ⅲ型中的2型或2型以上骨折同时存在.结果 19例枕骨髁骨折中,左侧7例,右侧11例,双侧1例.枕骨髁骨折1型1例,骨折位于左侧.Ⅱ型5例,左侧2例,右侧3例,主要为枕骨髁后份和中份受累.Ⅲ型12例,右侧8例,左侧3例,双侧1例;撕脱骨片多数不同程度移位,并且6例骨折线累及关节面,7例翼状韧带增粗.Ⅳ型1例,为Ⅱ型和Ⅲ型枕骨髁骨折同时存在.枕骨髁骨折伴随征象:14例枕骨髁骨折患者分别或同时存在头部和颈椎损伤,包括颅骨骨折8例,硬膜外血肿4例,蛛网膜下腔出血1例,脑挫裂伤1例,颅内积气、大脑镰下疝1例及颈椎骨折脱位9例等.结论 MSCT对枕骨髁骨折能够作出及时、准确的影像学诊断,对于临床选择治疗方案非常重要.

abstractsObjective To explore the MSCT findings of occipital condyle fracture (OCF) and improve its diagnostic accuracy. Methods Nineteen patients with OCF, selected from 110 patients suffering high energy injuries at the craniocervical junction, were enrolled into the study. The MSCT appearances of OCFs were retrospectively analyzed by two experienced radiologists. OCF had four types: type Ⅰ was a comminuted fracture, type Ⅱ was a extension of basilar skull fracture, type Ⅲ was an avulsion fracture at the attachment site of alar ligament on occipital condyle, type Ⅳ was a fracture of mixed pattern consisting of two or more above fracture types. Results In 19 patients, the left, right and bilateral OCFs were seen in 7,11 cases, and 1 case, respectively. Type Ⅰ was found in one case, which was a comminution of the left occipital condyle. Type Ⅱ was found in 5 cases, which involved the middle and posterior parts of occipital condyles with 2 on the left and 3 on the right, Type Ⅲ was found in 12 cases which showed various degree of fragment displacement with 3 occuring on the left, 8 on the right, 1 involving bilateral sides, 6 involving articular surfaces and 7 accompaning by enlargment of alar ligaments. Type Ⅳ was found in one case, with coexistence of Type Ⅱ and type Ⅲ. In addition, OCFs were accompanied by head and (or) cervical spine injuries in 14 cases, which included cranial fracture in 8 cases, epidural hematoma in 4 cases, subarachnoid hemorrhage in one case, cerebral contusion and laceration in one case, subfalcial hernia in one case, cervical spine fracture and dislocation in 9 cases, and so on. Conclusion OCFs can be accurately diagnosed by MSCT, which is important for selection of treatment protocols.