Clinical Assessment of the Diagnostic Value of Facial Radiography in Facial Trauma Patients at the Emergency Department

顏面X光攝影對顏面外傷的評估價值

邱碧雲(Pi-Yun Chiu) ； 陳振德(Jen-Dar Chen) ； 葛平夷(Ping-Yi Ko) ； 張政彥(Cheng-Yen Chang)

《中華放射線醫學雜誌》 30卷6期 (2005/12) Pp. 327-333

摘要

急診外傷的X光檢查中，顏面創傷是最常見的原因之一，而顏面常規檢查中的Water's View of skull通常是作為診斷顏面有否骨折之最主要的依據與篩檢方式。在本文研究中，我們收集了從2003年9月至2005年3月的病例，因顏面創傷送至本院急診部的病患共100例；其中男性68例、女性32例，年齡在15-88歲之間平均年齡為41.4歲。一般受傷原因以車禍較多佔40例，摔落或跌倒有12例，被毆打有9例，刀傷有1例，其他原因造成的有38例。這些病患做了顏面X光檢查而且也在數天之內做了顏面電腦斷層檢查，我們把顏面X光影像和電腦斷層影像加以重新判讀並將其兩者結果加以比較；結果顯示在100例顏面受傷的病患中有81例電腦斷層證實有顏面骨折，其中73例從Water's View of skull可發現有骨折，而19例電腦斷層證實無顏面骨折當中，X光檢查卻認為有骨折的有1例，因此顏面X光檢查診斷有骨折的靈敏度為90%，特異性為94.7%，陽性預測值為98.6%，陰性預測值為69%，準確度為91%。顏面X光診斷出有骨折的病人當中，電腦斷層發現有合併顱內出血者佔16%。另外我們也同時比較顏面X光影像出現有液體在鼻竇內、顏面皮下有氣體、臉部軟組織腫脹、及異物在臉部或鼻竇內的情形，與顏面電腦斷層發現的骨折作依據來比較這四種情形所得出的靈敏度則不高。因此，當顏面X光檢查發現有骨折時，有高達十六分之一的病人有合併顱內出血之危險，而需要進一步做頭部電腦斷層之檢查。所以，顏面X光攝影在評估顏面創傷方面仍然是一項具有相當高價值的診斷工具。

關鍵字

電腦斷層 ； 顏面創傷 ； X光攝影

並列摘要

Facial injury is a common reason for patients' admission at Emergency
Department, Water's view of skull is usually used as the screening modality for facial bone fracture. We evaluated 100 patients, who received both Water's view and facial CT due to trauma during a 18-month period. There were 68 males and 32 females with the age ranging from 15 to 88 years (mean 41.4 years). The causes of trauma included traffic accident in 40 cases, falls in 12, assault in 9, stab injury in 1, and non-specified causes in 38. Both the images of Water's view and CT were evaluated and compared. Of the 81 patients with CT-proven facial fractures, it could be identified by Water's view in 73. Of 19 cases without facial fracture on CT, one was misdiagnosed with facial fracture on Water's view. The result showed sensitivity of 90%, specificity of 94.7%, positive predictive value (ppv) of 98.6%, negative predictive value (npv) of 69%, and accuracy of 91%. As to paranasal sinus fluid, subcutaneous gas, soft tissues welling, or foreign body in the face or paranasal sinus, all had low sensitivity for diagnosis of facial fractures. Furthermore, intracranial hemorrhage was also associated in 16% of facial fractures found by CT. Water's view is indeed valuable as a screening examination in the diagnosis of facial fractures for trauma patients at Emergency Department.

並列關鍵字

Computed tomography ； Face, fracture ； Radiography