本文選題：正常合 + 錐體束CT��； 參考：《第四軍醫(yī)大學(xué)》2016年碩士論文

【摘要】：頭影測(cè)量是口腔臨床診療工作中的重要輔助手段。在治療前,可以配合問診、模型測(cè)量和牙頜面照相獲得錯(cuò)合畸形的診斷結(jié)果,并制定治療方案;在治療過程中,可以根據(jù)臨床需要,通過階段性頭影測(cè)量分析,監(jiān)測(cè)錯(cuò)合畸形的變化情況;在治療結(jié)束后,可以對(duì)比治療前后的牙頜面形態(tài)變化,觀察矯治效果;在矯治結(jié)束后的隨訪階段,也可觀察療效的穩(wěn)定或復(fù)發(fā)情況。隨著三維影像技術(shù)的發(fā)展,錐形束CT(cone beam computed tomography,CBCT)憑借其價(jià)格低廉、輻射劑量小、掃描速度快、對(duì)硬組織成像效果好等優(yōu)勢(shì),引起越來越多的學(xué)者關(guān)注。但由于二維和三維頭影測(cè)量在定點(diǎn)方式及測(cè)量指標(biāo)的確定等方面有諸多差異,目前尚未建立公認(rèn)的三維頭影測(cè)量方法。針對(duì)上述問題,本實(shí)驗(yàn)采用CBCT對(duì)顱頜面硬組織三維定點(diǎn)方法和測(cè)量指標(biāo)的確定進(jìn)行研究,以期初步探索一套三維頭影測(cè)量分析方法。本研究分為三個(gè)部分:第一部分:三維頭影測(cè)量標(biāo)志點(diǎn)定位精確性和可靠性的研究目的:研究同一測(cè)量者兩次定點(diǎn)和不同測(cè)量者之間定點(diǎn)的可靠性。方法:隨機(jī)選取20名正畸患者的頭顱CBCT,選取31個(gè)常用顱頜面硬組織標(biāo)志點(diǎn),使用Invivo Dental5.2軟件,采用多平面重建(multi-planer reconstruction,MPR)方法對(duì)其進(jìn)行三維定點(diǎn)。分別對(duì)一名測(cè)量者的兩次定點(diǎn)結(jié)果和兩名測(cè)量者的定點(diǎn)結(jié)果的三維坐標(biāo)值進(jìn)行組內(nèi)相關(guān)系數(shù)(ICC)分析。結(jié)果:1.在同一測(cè)量者定點(diǎn)結(jié)果中:有47.7%(42/88)的坐標(biāo)值ICC值大于0.99;46.6%(41/88)坐標(biāo)值ICC值介于0.9-0.99之間;而B點(diǎn)、U1crown_R點(diǎn)、U1labial_R點(diǎn)在X軸上坐標(biāo)值可信度稍差,Zyg Arch_R點(diǎn)在Y軸上坐標(biāo)值可信度稍差;Ar_R點(diǎn)在Z軸上坐標(biāo)值可信度稍差。2.在兩名測(cè)量者定點(diǎn)結(jié)果中:有31.8%(28/88)的坐標(biāo)值ICC值大于0.99;59.1%(52/88)坐標(biāo)值ICC值介于0.9-0.99之間;A點(diǎn)、B點(diǎn)、S點(diǎn)、U1crown_R點(diǎn)、U1labial_R點(diǎn)在X軸上坐標(biāo)值可信度稍差;Zyg Arch_R點(diǎn)在Y軸上坐標(biāo)值可信度稍差;Ar_L/R點(diǎn)在Z軸上坐標(biāo)值可信度稍差。結(jié)論:1.采用多平面重建定點(diǎn)方法對(duì)基于CBCT數(shù)據(jù)的顱頜面硬組織三維定點(diǎn)具有較高的精確性和穩(wěn)定性。2.同一測(cè)量者定點(diǎn)的穩(wěn)定性較不同測(cè)量者之間更高。第二部分:基于CBCT數(shù)據(jù)的三維頭影測(cè)量值與傳統(tǒng)二維頭影測(cè)量值的差異研究目的:分析比較CBCT三維頭影測(cè)量數(shù)據(jù)與傳統(tǒng)二維頭影測(cè)量數(shù)據(jù)的差異方法:招募18-40周歲西安籍漢族青年正常合志愿者20名(男性10名,女性10名),分別拍攝頭顱CBCT和頭顱定位側(cè)位片,兩次拍攝間隔一個(gè)月。選取23個(gè)測(cè)量指標(biāo),分別使用Invivo Dental5.2軟件和winceph8.0軟件進(jìn)行三維和二維頭影測(cè)量,由同一操作者分別對(duì)三維影像和二維影像各測(cè)量兩次,兩次間隔一周。用SPSS19.0軟件對(duì)三維測(cè)量值和二維測(cè)量值分別進(jìn)行組內(nèi)相關(guān)系數(shù)(ICC)分析,并對(duì)三維及二維測(cè)量值進(jìn)行配對(duì)t檢驗(yàn)。結(jié)果:1.組內(nèi)相關(guān)系數(shù)(ICC)分析結(jié)果顯示,除二維頭影測(cè)量中ANB角ICC值小于0.9外,其他測(cè)量指標(biāo)的ICC值,無論二維頭影測(cè)量還是三維頭影測(cè)量,均大于0.9;除U1-NA(°)、L1-NB(mm)、Go Gn-SN(°)、FMA(°)、IMPA(°)、Go_R-Pog(mm)外,其余三維頭影測(cè)量結(jié)果ICC值均大于二維頭影測(cè)量結(jié)果。2.三維與二維頭影測(cè)量值比較結(jié)果顯示,除U1-NA(mm)外,其余測(cè)量值差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。其中大多數(shù)角度值二維大于三維,而線距值則相反。結(jié)論:1.二維頭影測(cè)量與三維頭影測(cè)量所得測(cè)量結(jié)果可靠性均較佳;由于絕大多數(shù)三維頭影測(cè)量結(jié)果ICC值大于二維頭影測(cè)量結(jié)果,說明大多數(shù)三維頭影測(cè)量指標(biāo)比二維測(cè)量的可重復(fù)性更高。2.由于三維與二維頭影測(cè)量定點(diǎn)方式不同,二者標(biāo)志點(diǎn)構(gòu)成的測(cè)量指標(biāo)也不完全一致,其所得測(cè)量結(jié)果有統(tǒng)計(jì)學(xué)差異,故傳統(tǒng)二維頭影測(cè)量分析方法不能直接用于三維診斷分析。第三部分:基于CBCT數(shù)據(jù)的西安地區(qū)青年人恒牙列正常合顱頜面硬組織三維形態(tài)分析目的:探索一套基于錐體束CT(CBCT)數(shù)據(jù)的三維頭影測(cè)量方法,并獲得西安地區(qū)青年正常合三維顱頜面硬組織測(cè)量數(shù)據(jù)。方法:選取符合個(gè)別正常合標(biāo)準(zhǔn)的18-40歲西安籍青年人150名(男性75名,女性75名)拍攝CBCT。選取43個(gè)測(cè)量項(xiàng)目,用Invivo Dental5.2軟件定點(diǎn)測(cè)量,測(cè)量結(jié)果由SPSS19.0統(tǒng)計(jì)軟件處理。結(jié)果:1.線距測(cè)量中,除A-NPog(mm)、U1-NA(mm)、L1-NB(mm)、Overjet(mm)外,其余測(cè)量值均有統(tǒng)計(jì)學(xué)差異(P0.05);其中僅Wits(mm)為女性大于男性。2.角度測(cè)量值中,U1-SN(°)、U1-NA(°)、U1-L1(°)、FMIA(°)、IMPA(°)、SN-FH(°)、SN-OP(°)、SN-MP(°)、Y-(growth)Axis(°)、Ar-Go-Me R(°)測(cè)量值差異有統(tǒng)計(jì)學(xué)意義(P0.05),其中U1-SN(°)、U1-NA(°)、IMPA(°)、Y-(growth)Axis(°)男性較大。結(jié)論:三維頭影測(cè)量數(shù)據(jù)顯示,男性顱頜面骨骼形態(tài)較女性更為寬大;女性下頜角的角度及下頜平面角均較大,下頜垂直向發(fā)育更明顯。
[Abstract]:Cephalometric measurement is an important adjunct to dental clinic work. Before the treatment, can be matched with the inquiry, model measurement and diagnosis results obtained photographic dentofacial malocclusion, and treatment plan; in the course of treatment, according to clinical needs, through the stages of cephalometric analysis, monitoring changes of malocclusion deformity; after the end of treatment, can change the dentofacial morphology compared before and after treatment, observe the treatment effect; in the follow-up period after the end of treatment, can also observe the effect and stability or recurrence. With the development of three-dimensional imaging technology, cone beam CT (cone beam computed tomography, CBCT) by virtue of its low price, radiation small dosage, fast scanning speed, the imaging effect of hard tissue and other advantages, more and more scholars attention. But because of the two-dimensional and three-dimensional cephalometric in the aspects of the determination and measurement of the index point There are many differences, has yet to establish a three-dimensional cephalometric method recognized. Aiming at the above problems, this experiment adopts research to determine the craniofacial hard tissue of three dimensional fixed point method and the measurement index of CBCT, preliminary exploration of a three-dimensional cephalometric analysis method in order. This research is divided into three parts: the first part: 3D cephalometric point positioning accuracy and reliability of measurement marks Objective: the reliability of the same point between two measuring point and different measurement. Methods: 20 orthodontic patients head CBCT, selected 31 common craniofacial hard tissue landmarks, the use of Invivo Dental5.2 software, using multi planar reconstruction (multi-planer reconstruction, MPR). The methods of 3D point within group correlation value of three-dimensional coordinates of a point were measured two times and two point results of measurement The coefficient (ICC) analysis. Results: 1. in the same measuring point results: 47.7% (42/88) coordinates ICC values greater than 0.99; 46.6% (41/88) ICC value between 0.9-0.99 and B, the values of the coordinates; U1crown_R, U1labial_R coordinates on the X axis value of reliability is poor, Zyg Arch_R the point on the Y axis coordinate value of reliability is poor; Ar_R points on the Z axis value credibility slightly worse.2. in two point measurement results: 31.8% (28/88) coordinates ICC values greater than 0.99; 59.1% (52/88) ICC values between 0.9-0.99 coordinate values; A, B, S at U1crown_R point, U1labial_R point on the X axis coordinate value of reliability is poor; Zyg Arch_R on the Y axis coordinate value of reliability is poor; Ar_L/R points on the Z axis value of credibility is worse. Conclusion: 1. using multiplanar reconstruction method for 3D point point of craniofacial hard tissue based on CBCT data has a high the accuracy and stability of the same.2. The measuring point is between the stability of different measurement is higher. The second part: the three-dimensional cephalometric CBCT data value objective difference research and traditional 2D cephalometric values based on difference method CBCT three-dimensional cephalometric data with the traditional two-dimensional cephalometric data analysis: 18-40 years of recruiting young normal Han nationality in Xi'an with 20 volunteers (10 male, 10 female), were taken by CBCT and lateral cephalograms, two shot interval for a month. We selected 23 indexes, respectively using Invivo Dental5.2 software and winceph8.0 software for 3D and 2D cephalometric, by the same operator of each measuring 3D image and image two times, two times a week. The interval and two-dimensional measurements were the intraclass correlation coefficient for three-dimensional measurements using SPSS19.0 software (ICC) analysis, and the 2D and 3D measurements of The t test results: 1.. The intraclass correlation coefficient (ICC) analysis showed that in addition to two-dimensional cephalometric ANB angle ICC value is less than 0.9, other measures ICC value, both 2D cephalometric and three-dimensional cephalometry were greater than 0.9; except U1-NA (DEG), L1-NB (mm) Go, Gn-SN (DEG), FMA (DEG), IMPA (DEG), Go_R-Pog (mm), the three-dimensional cephalometric results ICC values were greater than 2D cephalometric results.2. 3D and 2D cephalometric comparison results show that the removal of U1-NA (mm), the measured value of the differences were statistically significant (P0.05). Most of the angle value is greater than the two-dimensional and three-dimensional, line distance value is on the contrary. Conclusion: the measurement results of 1. dimensional cephalometric and three-dimensional cephalometric the reliability were good; because the vast majority of three-dimensional cephalometric results ICC value is greater than the two-dimensional cephalometric measurement results, indicating that most three-dimensional cephalometric indexes two dimensional measurement can be used More complex.2. because of different 3D and 2D cephalometric points, two points constitute the measurement index sign is not entirely consistent, the measurement results had significant difference, so the traditional two-dimensional cephalometric analysis method can not be directly used for 3D diagnosis analysis. The third part: young permanent teeth CBCT data in Xi'an objective to analyze the combined normal cranial maxillofacial hard tissue based on three-dimensional morphology: exploring a set based on cone beam CT (CBCT) three-dimensional cephalometric method data, and access to the Xi'an area youth normal 3D craniofacial hard tissue measurement data. Methods: selected individual normal standard 18-40 year old Xi'an's young people 150 (75 male, 75 female) shooting CBCT. selected 43 measurement items, using Invivo Dental5.2 software measurement, the measurement results from the SPSS19.0 statistical software. Results: 1. line distance measurement, except A-NPog (mm), U 1-NA (mm), L1-NB (mm), Overjet (mm), there were significant differences in the measured value (P0.05); Wits (mm) is the only female than male.2. angle measurements, U1-SN (DEG), U1-NA (DEG), U1-L1 (DEG), FMIA (IMPA (degrees). DEG), SN-FH (DEG), SN-OP (DEG), SN-MP (DEG), Y- (growth) Axis (DEG), Ar-Go-Me R (DEG) measurement value of the difference was statistically significant (P0.05), including U1-SN (DEG), U1-NA (DEG), IMPA (DEG), Y- (growth (Axis) the larger male degrees). Conclusion: the three-dimensional cephalometric data show that male skull shape is more generous than women; female mandibular angle and mandibular plane angle were larger, mandibular vertical development is more obvious.

【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R783.5
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本文編號(hào)：1741759