目的　探讨听骨链螺旋CT三维重建技术的临床应用及局限性。方法　采用螺旋CT薄层扫描 (层厚 :1.0mm ) ,Pitch :1.5 ,小视野 (FOV =9.0cm) ,密集重建 (间隔 0 .5mm)。观察 2 2例 ,其中 10例正常 ,12例耳部病变患者 ,所有病例均采用表面遮盖法 (SSD)行听骨链三维重建成像。正常及异常耳的观察阈值分别为 -2 0 0 -5 0 0HU和 10 0 30 0HU。结果　 10例正常耳听骨链重建能直观显示锤、砧骨的大小、形态及相互关系 ,砧镫关节呈“L”形 ,镫骨前后脚及底板显示欠佳。 12例患者中 ,3例胆脂瘤型及 1例肉芽肿型中耳炎患者 ,3D图像显示有不同程度听小骨破坏 ,与手术所见基本相符。 1例肉芽肿型、2例单纯型中耳炎及 2例颞骨骨折患者听骨链 3D图像均显示正常。 2例中耳畸形显示听骨链发育异常。 1例神经鞘瘤病显示听小骨被肿瘤组织破坏。结论　螺旋CT三维重建技术能很好显示正常及异常听骨链的立体影像 ,有利于中耳炎、中耳畸形及其它耳部病变的诊断 Objective To investigate the clinical application and limitations of three-dimensional reconstruction of ossicular chain helical CT. Methods Spiral CT thin-layer scanning (thickness 1.0mm), Pitch 1.5, small field of view (FOV 9.0cm), intensive reconstruction (interval 0.5mm) were performed. Twenty-two cases were observed, of which 10 were normal and 12 were patients with otopathy. All patients underwent surface reconstruction (SSD) with three-dimensional reconstruction of ossicular chain. The thresholds for normal and abnormal ears were -2 0 0 -5 0 0HU and 10 0 30 0HU, respectively. Results Ten cases of normal ear ossicular chain reconstruction showed the size, shape and relationship of the hammer and incus. The anvils and joints showed “L” shape, and the anterior, posterior stapes and the bottom of the stapes showed poor performance. In 12 patients, 3 cases of cholesteatoma type and 1 case of otitis media with granuloma, 3D images showed different degrees of destruction of the ossicular bone, and basically consistent with the surgical findings. 1 case of granuloma, 2 cases of simple otitis media and 2 cases of temporal bone fracture in patients with ossicular chain 3D images were normal. 2 cases of middle ear deformity showed dysplasia of ossicular chain. One case of schwannoma showed that the ossicles were destroyed by the tumor tissue. Conclusion Three-dimensional reconstruction of spiral CT can display the stereoscopic images of normal and abnormal ossicular chain, which is good for the diagnosis of otitis media, middle ear deformity and other ear diseases