Preoperative CT performance and surgical treatment in patients with rhinogenic headache by nasal septum deviation
-
摘要:
目的 分析鼻中隔偏曲致鼻源性头痛患者术前CT表现及手术治疗效果。 方法 选取2018年1月~2020年12月于我院收治的132例鼻中隔偏曲致鼻源性头痛患者作为研究对象，结合CT影像学检查分析鼻中隔偏曲部位、程度分布情况、CT表现及下鼻甲测量结果，比较患者头痛程度，分析不同头痛等级患者的手术治疗效果。 结果 CT影像学结果表明：132例鼻中隔偏曲患者中24例位于前部，62例位于中部，40例位于中下部，2例位于中上部，1例位于后下部，3例位于后下部；轻度偏曲者10例，中度偏曲者114例，重度偏曲者8例；CT结果显示：所有患者中呈“C”形62例（顶点变尖者2例），反“C”形59例（顶点变尖者2例），“S”形6例，反“S”形1例“， < ”形1例“，>”形2例，混合形1例。根据VAS评分对头痛等级分类，132例患者中，11例为Ⅰ级头痛，33例为Ⅱ级头痛，80例为Ⅲ级头痛，8例为Ⅳ级头痛；鼻中隔偏曲对侧下鼻甲角度及面积均大于同侧（P < 0.05）；治疗结束后随访结果显示，总治愈率为68.94%，无效率为7.58%，其中Ⅲ级及以下头痛治愈率均超过66.00%，治疗总有效率为92.42%。 结论 鼻中隔偏曲致鼻源性头痛患者术前进行CT检查可清晰准确的反映偏曲的真实情况，有助于手术有效进行，提高临床治疗效果。 Abstract:Objective To analyze the preoperative CT performance and surgical treatment effect of patients with rhinogenic headache caused by nasal septum deviation. Methods A total of 132 patients with rhinogenic headache caused by nasal septum deviation admitted to our hospital from January 2018 to December 2020 were selected as the research objects. Combined with CT imaging examination, the location, degree distribution, CT manifestations and measurement results of inferior turbinate of nasal septum deviation were analyzed to compare the headache degree of patients and analyze the surgical treatment effect of patients with different headache grades. Results In this study, CT imaging results showed that in 132 patients with deviated nasal septum, 24 cases were located anterior, 62 cases were located centrally, 40 cases in the middle and lower part, 2 cases in the middle and upper part, 1 case in the lower part and 3 cases in the lower part, 10 cases were mildly deviated, 114 cases were moderately deviated and 8 cases were severely deviated. CT results showed that 62 cases showed "C" shape (2 cases with acuminate apex), 59 cases showed reverse "C" shape (2 cases of apex sharpening), and 6 cases showed "S" shape, 1 case showed reverse "S" shape, 1 case showed " < " shape, 2 cases showed ">" shape, 1 case showed mixed shape. According to the classification of headache grade by VAS score, among 132 patients, 11 patients had grade I headache, 33 patients had grade II headache, 80 patients had grade III headache and 8 patients had grade IV headache. The angle and area of inferior turbinate on the opposite side of nasal septum deviation were larger than those on the same side, and the difference between them was statistically significant (P < 0.05). The follow-up results after the treatment showed that the total cure rate was 68.94%, the inefficiency rate was 7.58%, among which the cure rate of grade III and below headache was more than 66.00%, and the total effective rate was 92.42%. Conclusion Preoperative CT examination of patients with rhinogenic headache caused by nasal septum deviation can clearly and accurately reflect the real situation of nasal deviation, which is conducive to effective operation and improve the clinical treatment effect. -
Key words:
- nasal septum deviation /
- rhinogenic headache /
- CT performance /
- surgical treatment effect
-
图 1 患者CT影像图
A: 孤立筛窦炎; B: 左侧鼻窦炎; C: 单纯上颌窦炎; D: 鼻中隔轻度偏曲.
Figure 1. CT image of the patient.
表 1 患者鼻中隔偏曲同侧及对侧下鼻甲测量结果对比
Table 1. Comparison of the measurement results of the inferior turbinate on the same side and the contralateral side of the deflection of the nasal septum (Mean±SD)
侧别 下鼻甲骨角度（°） 下鼻甲面积（cm2） 鼻中隔偏曲同侧 52.17±6.16 0.73±0.08 鼻中隔偏曲对侧 65.04±7.23 1.34±0.15 t 15.567 41.226 P < 0.01 < 0.01 
下载: 导出CSV
表 2 鼻中隔偏曲致鼻源性头痛治疗效果
Table 2. Therapeutic effect of nasal septum deviation caused by nasal headache [n(%)]
头痛等级 治愈 好转 无效 总有效率 Ⅰ级（n=11） 11（100.00） 0（0.00） 0（0.00） 11（100.00） Ⅱ级（n=33） 22（66.67） 11（33.33） 0（0.00） 33（100.00） Ⅲ级（n=80） 55（68.75） 17（21.25） 8（10.00） 72（87.50） Ⅳ级（n=8） 3（37.50） 3（37.50） 2（25.00） 6（75.00） 总计（n=132） 91（68.94） 31（23.48） 10（7.58） 122（92.42）
下载: 导出CSV
-
[1] 周芳茗, 谢艳, 刘洋, 等. 鼻源性头痛的研究动态分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(4): 130-3. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYU202004025.htm [2] Sollini G, Mazzola F, Iandelli A, et al. Sino-nasal anatomical variations in rhinogenic headache pathogenesis[J]. J Craniofac Surg, 2019, 30(5): 1503-5. doi: 10.1097/SCS.0000000000005239 [3] 赖小丽. 低龄儿童鼻源性头痛25例临床分析[J]. 广西医科大学学报, 2017, 34(12): 1803-4. https://www.cnki.com.cn/Article/CJFDTOTAL-GXYD201712039.htm [4] Aydoğdu I, Atar Y, Aydoğdu Z, et al. Comparison of olfactory function and quality of life with different surgical techniques for nasal septum deviation[J]. J Craniofac Surg, 2019, 30(2): 433-6. doi: 10.1097/SCS.0000000000005109 [5] 孙振, 查慧芳, 尤莹莹, 等. 鼻中隔贯穿缝合不填塞技术治疗鼻中隔偏曲患者的围术期快速康复护理[J]. 中国中西医结合耳鼻咽喉科杂志, 2020, 28(1): 70-2, 32. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH202001018.htm [6] 霍常友, 石磊, 田飞雨. CT指导下的鼻腔扩容术在鼻中隔偏曲中的应用[J]. 海南医学, 2014, 25(14): 2147-8. doi: 10.3969/j.issn.1003-6350.2014.14.0832 [7] 颜军, 李新梅, 杨桂花. 鼻中隔偏曲发生率的人群调查[J]. 新疆医科大学学报, 2000, 23(2): 166-7. https://www.cnki.com.cn/Article/CJFDTOTAL-XJYY200002047.htm [8] Bayrak S, Aktuna Belgin C, Orhan K. Evaluation of the relationship between olfactory Fossa measurements and nasal septum deviation for endoscopic sinus surgery[J]. J Craniofac Surg, 2020, 31(3): 801-3. doi: 10.1097/SCS.0000000000006168 [9] Villa J, Brito L, Parra M, et al. Nasal septum deviation and inferior nasal concha bone hypertrophy in class Ⅲ facial deformity[J]. Int J Morphol, 2020, 38(6): 1544-8. doi: 10.4067/S0717-95022020000601544 [10] Sakalli C, Cayonu M, Tuna EU. The impact of septoplasty operation on odor threshold score and symptom severity according to the nasal septum deviation classifications[J]. J Craniofac Surg, 2019, 30(8): 2483-5. doi: 10.1097/SCS.0000000000005870 [11] 李慧娟. 鼻内镜下鼻腔扩容术综合治疗鼻源性头痛60例[J]. 华西医学, 2017, 32(2): 217-9. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX201702015.htm [12] 赵延峰, 胡源, 郭东超, 等. 鼻中隔偏曲的形态矫正[J]. 中华整形外科杂志, 2020, 36(6): 617-22. doi: 10.3760/cma.j.cn114453-20190228-00073 [13] 廖桥淯, 林莎, 刘锦峰, 等. 鼻内镜下鼻中隔偏曲矫正及鼻腭囊肿揭盖造袋术1例[J]. 中国耳鼻咽喉头颈外科, 2018, 25(4): 225-6. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201804019.htm [14] 孙文凯, 孙卉, 邬信芳, 等. 自噬标志物Beclin-1和P62与增殖因子Ki67在鼻息肉不同部位的表达及其意义[J]. 山东大学学报: 医学版, 2020, 58(6): 76-82. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYB202006013.htm [15] Koo SK, Park GH, Koh TK, et al. Relationships of direction and degree of nasal septum deviation with nasal floor morphology[J]. J Clin Otolaryngol Head Neck Surg, 2020, 31(2): 181-7. doi: 10.35420/jcohns.2020.31.2.181 [16] 赵松花, 孙绍辉, 李红艳, 等. CT三维重建在鼻骨、鼻中隔骨折诊断中的应用价值[J]. 中国实验诊断学, 2020, 24(8): 1257-8. doi: 10.3969/j.issn.1007-4287.2020.08.008 [17] Aslan K, Saglam D, Gunbey HP, et al. Olfactory bulb microstructural changes in patients with nasal septum deviation[J]. J Craniofac Surg, 2019, 30(5): 1471-4. doi: 10.1097/SCS.0000000000005479 [18] Harju T, Numminen J. The effect of inferior turbinate surgery on nasal symptoms and inferior turbinate contractility[J]. Am J Otolaryngol, 2021, 42(1): 102778. doi: 10.1016/j.amjoto.2020.102778 [19] Chen HC, Chung CH, Chien WC. Association between deviated nasal septum with inferior turbinate hypertrophy and the risk of male infertility[J]. Am J RhinolAllergy, 2021, 35(1): 17-25. doi: 10.1177/1945892420932485 [20] 于辉, 朱丽, 刘俊秀. 鼻中隔偏曲矫正术对鼻腔结构对称性影响的主客观分析[J]. 中国微创外科杂志, 2019, 19(12): 1136-9. doi: 10.3969/j.issn.1009-6604.2019.12.020 [21] Shetty SR, Al Bayatti SW, Al-Rawi NH, et al. Analysis of inferior nasal turbinate width and concha bullosa in subjects with nasal septum deviation: a cone beam tomography study[J]. BMC Oral Health, 2021, 21(1): 206. doi: 10.1186/s12903-021-01576-2 [22] Hizli O, Kayabasi S, Ozkan D. Is nasal septal body size associated with inferior turbinate hypertrophy and allergic rhinitis?[J]. J Craniofac Surg, 2020, 31(3): 778-81. doi: 10.1097/SCS.0000000000006107 [23] 邱小雯, 胡建道. 鼻中隔偏曲伴下鼻甲肥大患者的鼻窦CT分析[J]. 中国耳鼻咽喉头颈外科, 2017, 24(7): 365-7. https://www.cnki.com.cn/Article/CJFDTOTAL-EBYT201707013.htm [24] 李祥东, 陈少华, 刘涛. 鼻内镜手术治疗非感染性鼻源性头痛60例疗效观察[J]. 广东医科大学学报, 2020, 38(2): 167-9. doi: 10.3969/j.issn.1005-4057.2020.02.010 -
点击查看大图
图(1) / 表(2)
计量
- 文章访问数: 301
- HTML全文浏览量: 170
- PDF下载量: 5
- 被引次数: 0
