【摘要】：第一部分面部三維運動定量分析系統(tǒng)的研制和精度測量面部三維運動定量分析系統(tǒng)由三部分組成：數(shù)據(jù)采集部分、數(shù)據(jù)處理和結果輸出部分、固定系統(tǒng)。數(shù)據(jù)采集部分主要由六臺運動捕捉紅外矩陣攝像機(采集頻率60幀/秒)呈對稱“品”字形排列,通過多路同步控制器保證采集的一致性。數(shù)據(jù)處理部分的核心為定制的面部運動捕捉軟件。固定系統(tǒng)包括一個固定頭架和一個綜合固定椅,兩者均可固定于雙側乳突及枕骨突隆。固定系統(tǒng)既能保證與頭顱相對靜止,又不影響受試者的面部活動。固定系統(tǒng)前端有三個固定標記點,為面部分析的參考坐標系。面部運動測量時,攝像機捕捉面部的反射光線,系統(tǒng)根據(jù)標定結果進行坐標轉換,軟件進行在線計算和離線重建。應用加速度儀進行加速度試驗,該面部三維運動定量分析系統(tǒng)的速度測量最大誤差為0.0058m/s,平均誤差為0.003026m/s,加速測量誤差為0.000135m/s2。第二部分面部三維測量指標的影響因素目的：評估面部三維運動定量分析系統(tǒng)在面癱患者的應用,探討測量指標的影響因素。方法：連續(xù)收集76例單側面癱患者。應用三維運動定量分析系統(tǒng)進行靜態(tài)和動態(tài)測量。測量過程：清潔面部→黏貼標記點→受試者動作訓練→系統(tǒng)設置和安置。測量結果與年齡作偏相關分析；比較男女間指標的差異；與正常值作析因方差分析。結果：1.健側靜態(tài)指標：鼻唇溝長(產0.517)與年齡呈正相關,眥角與年齡呈負相關(γ=-0.424)。除笑角外,余指標在男女間均有統(tǒng)計學差異(P＜0.05),且男性測量值多大于女性。與正常值比較,除笑角外均有統(tǒng)計學差異(P＜0.05)。2.健側動態(tài)指標：眉弓中點(r=-0.428)、上瞼中點(=r=-0.495)和鼻旁點(r=-0.471)的最大移動速度與年齡呈負相關,余指標未見明顯相關性。男性眉弓中點最大移動距離和速度、用力閉眼上瞼中點最大移動速度、輕閉眼上瞼中點加速度均大于女性(P＜0.05)。與正常值相比：上瞼中點的最大移動速度,眉弓中點最大移動速度,鼻旁點的最大移動速度和加速度,口角的最大移動距離、速度和加速度,眥角變化,均為面癱組大于正常組(P＜0.05)。3.患側靜態(tài)指標：以神經電圖(ENoG)作為控制變量作偏相關分析,鼻唇溝長(r=0.538)、左右口角間距(r=0.353)與年齡呈正相關(r=0.538),眥角(r=-0.349)與年齡呈負相關。男女間除瞼裂高度外均有統(tǒng)計學差異(P＜0.05)。4.患側動態(tài)指標：眉弓中點(r=-0.332)、用力閉眼上瞼中點(r=-0.349)的最大移動速度與年齡呈負相關,余指標與年齡間均無明顯相關性。眉弓中點最大移動速度,撅嘴時口角最大移動距離、速度和加速度為男性大于女性(P＜0.05)。結論：(1)面部三維運動定量分析系統(tǒng)可快速評估面癱情況,評估過程患者無痛苦和創(chuàng)傷。(2)面部靜態(tài)結構和肌肉運動可隨著年齡增長而變化,但在面癱時未見額外影響。(3)大部分動態(tài)和靜態(tài)指標均為男性大于女性,而面癱時這種差異可能會減小。(4)面癱患者的健側面部運動功能可能會代償性增加。第三部分各面癱評價系統(tǒng)相關性及預后評估研究目的：比較面部三維運動定量分析系統(tǒng)與其它面癱評價系統(tǒng)間的相關性及各系統(tǒng)的預后評估價值。方法：(1)納入50例單側面癱患者。應用House-Brackmann (H-B)分級系統(tǒng)等進行主觀評價；應用肌電/誘發(fā)電位儀進行瞬目反射和面神經電圖檢查；應用中文版FaCE量表進行患者自我評價；應用面部三維運動定量分析系統(tǒng)進行三維客觀測量,計算患側與健側的對稱比。三維測量指標綜合評分=0.7×D+0.3×V-A,公式中,D為雙側各標記點的最大移動距離百分比平均得分,V為雙側各個標記點的最大移動速度百分比平均得分,A為靜態(tài)得分。最后比較不同評價系統(tǒng)結果與三維測量指標間的相關性。(2)納入發(fā)病1月以內的急性面癱患者,對其進行電生理測量、主觀評價、三維運動定量分析及患者自我評價(FaCE).對所有患者進行跟蹤隨訪,一月后和半年后復查。根據(jù)發(fā)病后半年面癱的恢復情況比較各評價系統(tǒng)對面癱預后的評估價值。結果：1.動態(tài)指標中,各標記點的最大移動距離與主觀評價系統(tǒng)間相關性強,最大移動速度次之,而最大移動加速度相關性最差,且部分無統(tǒng)計學意義。三維測量綜合評分與各主觀評價系統(tǒng)得分之間相關系數(shù)分別為-0.630(HB分級)、-0.728(面神經分級量表2.0)、0.697(Sunnybrook評分)和0.617(Fisch評分),P值均＜0.05。FaCE量表僅反映患者面部運動的評價條目與部分指標有相關性。三維動態(tài)測量結果與瞬目反射結果的相關性強于同ENoG的相關性。面部三維測量指標與瞬目反射振幅的相關性明顯強于潛伏期。與ENoG進行相關性比較,各標記點的最大移動距離指標相關性差異較大。2.共納入37例單側面癱患者,隨訪期間共有6例(16%)刪失。多元回歸分析篩選最佳預后評價指標：(1)面癱發(fā)病30內ENoG為最佳預后指標,其預測公式y(tǒng)=113.527-60.558x,公式中y為半年后SFGS評分,x為ENoG估算的面神經變性比例；(2)面癱31至60天,SFGS得分和三維測量結果為最佳預后指標,其預測公式為y=19.202+0.557x1+0.531x2,x1為SFGS得分,x2為三維測量指標得分。結論：(1)面部三維運動定量分析結果與傳統(tǒng)的主觀評價結果及電生理檢查結果間有較好的相關性,且可以提供更為細致的量化指標。(2)面癱急性期,電生理檢查仍然是預測面癱預后的最佳指標；面癱超過1月,聯(lián)合主觀評價和三維運動定量分析可提供最佳的預后評估。
[Abstract]:The first part is the development of the quantitative analysis system for facial 3D motion and its precision measurement. The quantitative analysis system for facial 3D motion consists of three parts: data acquisition, data processing and output, and fixed system. The key part of the data processing section is a customized facial motion capture software. The fixing system includes a fixed headframe and a comprehensive fixed chair, both of which can be fixed to the bilateral mastoid and occipital protuberances. The fixing system ensures relative stillness with the skull without shadow. The front end of the fixing system has three fixed markers for the reference coordinate system of facial analysis. In facial motion measurement, the camera captures the reflected light of the face, the system carries out coordinate transformation according to the calibration results, the software carries out on-line calculation and off-line reconstruction. The maximum error of velocity measurement is 0.0058m/s, the average error is 0.003026m/s, and the acceleration error is 0.000135m/s 2. Part 2: The influencing factors of facial three-dimensional measurement indicators Objective: To evaluate the application of facial three-dimensional motion quantitative analysis system in facial paralysis patients and explore the influencing factors of measurement indicators. Seventy-six patients with unilateral paralysis were collected in succession.Static and dynamic measurements were performed using a three-dimensional motion quantitative analysis system.The measurement process was as follows:clean face_sticking markers_subject movement training_system setting and placement.Partial correlation analysis was made between the measurement results and age.Differences between male and female indicators were compared.Factorial variance scores were calculated with normal values. Results: 1. Static indices of healthy side: length of nasolabial sulcus (0.517) was positively correlated with age, and canthus angle was negatively correlated with age (gamma = - 0.424). Except for laughing angle, the remaining indices were statistically different between men and women (P < 0.05), and the measured values of men were more than those of women. There were statistical differences between healthy side and normal value except laughing angle (P < 0.05). The maximum velocity of eyebrow arch midpoint (r = - 0.428), upper eyelid midpoint (= r = - 0.495) and paranasal point (r = - 0.471) was negatively correlated with age, but no significant correlation was found with other parameters. Constant comparison: the maximum moving speed of the middle point of the upper eyelid, the maximum moving speed and acceleration of the midpoint of the eyebrow arch, the maximum moving speed and acceleration of the paranasal point, the maximum moving distance of the mouth angle, the speed and acceleration, and the change of the canthus angle were all greater in the group of facial paralysis than in the normal group (P < 0.05). 3. Static index of the affected side: EEG was used as the control variable for partial correlation. The results showed that the length of nasolabial sulcus (r = 0.538), the distance between the left and right corners of mouth (r = 0.353) were positively correlated with age (r = 0.538), and the canthus angle (r = - 0.349) was negatively correlated with age. Conclusion: (1) The quantitative analysis system of facial three-dimensional movement can quickly evaluate the situation of facial paralysis, and can evaluate the process of patients without pain and trauma. (2) Facial static knot. (3) Most of the dynamic and static indexes were higher in males than in females, but this difference may be reduced in facial paralysis. (4) The motor function of healthy side of patients with facial paralysis may increase compensatively. Objective: To compare the correlation between facial three-dimensional motion quantitative analysis system and other facial paralysis evaluation systems and the prognostic value of each system.Methods: (1) 50 patients with unilateral paralysis were included. The patients were assessed by electrogram, the Chinese version of FaCE scale was used for self-evaluation, and the facial three-dimensional motion quantitative analysis system was used for three-dimensional objective measurement to calculate the symmetry between the affected side and the healthy side. At last, the correlation between the results of different evaluation systems and three-dimensional measurements was compared. (2) Patients with acute facial paralysis within 1 month of onset were included in the study, and their electrophysiological measurements, subjective evaluation, three-dimensional motion quantitative analysis and patient self-evaluation (FaCE) were performed. All patients were followed up for 1 month and 6 months. The evaluation value of each evaluation system was compared according to the recovery of facial paralysis after the onset of the disease. The correlation coefficients between the three-dimensional measurement score and the subjective evaluation system scores were - 0.630 (HB grade), - 0.728 (Facial Nerve Scale 2.0), 0.697 (Sunnybrook score) and 0.617 (Fisch score). The P values were < 0.05. The correlation between 3-D dynamic measurements and blink reflex was stronger than that of ENoG. The correlation between 3-D facial measurements and blink reflex amplitude was stronger than that of incubation period. Compared with ENoG, the correlation between the maximum moving distance of each marker was different. 2. 37 patients with unilateral paralysis were included. Multivariate regression analysis screened the best prognostic indicators: (1) ENoG was the best prognostic indicator within 30 days of facial paralysis, and its predictive formula y = 113.527-60.558x, in which y was the SFGS score after six months, and X was the ratio of facial nerve degeneration estimated by ENoG; (2) SFGS score and three-dimensional measurement were the best prognostic indicators within 31 to 60 days of facial paralysis. The predictive formula was y = 19.202 + 0.557x1 + 0.531x2, X1 was SFGS score, and X2 was three-dimensional measurement index score. Conclusion: (1) There was a good correlation between quantitative analysis of facial three-dimensional motion and traditional subjective evaluation and electrophysiological examination results, and it could provide more detailed quantitative indicators. (2) In acute facial paralysis, electrical measurements were performed. Physiological examination is still the best index for predicting the prognosis of facial paralysis. If facial paralysis lasts for more than one month, the combination of subjective evaluation and three-dimensional quantitative exercise analysis can provide the best prognostic evaluation.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R745.12

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