本文選題：自然頭位 + 上氣道　； 參考：《南方醫(yī)科大學(xué)》2011年碩士論文

【摘要】：阻塞性睡眠呼吸暫停綜合征(Obstructive sleep apnea syndrome, OSAS)是指睡眠期間上呼吸道各段反復(fù)發(fā)生的完全或部分阻塞,從而導(dǎo)致血液中血氧飽和度下降,繼而影響到循環(huán)、呼吸、神經(jīng)、內(nèi)分泌等各大系統(tǒng)的功能。由于其危害比較嚴(yán)重且發(fā)病率較高,在臨床上逐漸得到重視。 OSAS患者在睡眠期間上氣道阻塞可能是上氣道解剖結(jié)構(gòu)改變所致。顱骨、頜骨、腭骨、舌骨及其它頜面硬組織形成上氣道支架,其位置的改變可影響附著其上或相鄰的軟組織的位置及張力,從而影響氣道的大小和穩(wěn)定性。上氣道結(jié)構(gòu)的異常與OSAS的嚴(yán)重性成正相關(guān),舌骨位置的改變是OSAS發(fā)病的一個(gè)重要因素。 研究OSAS個(gè)體上氣道及舌骨位置是否異常,就要比對(duì)正常樣本。故本實(shí)驗(yàn)對(duì)自然頭位下正常(?)人群的上氣道及舌骨位置進(jìn)行X線頭影測(cè)量研究。 目的 在自然頭位下拍攝61例廣東籍無上氣道疾患、骨面型正常的正常(?)人群的頭顱側(cè)位片,進(jìn)行頭影測(cè)量分析及研究,旨在獲得廣東籍正常殆人群上氣道及舌骨的頭影測(cè)量值,進(jìn)行性別間對(duì)比分析,以供臨床參考。 材料與方法 1.研究對(duì)象 對(duì)廣州市兩所職業(yè)學(xué)院的學(xué)生(約7000余人)進(jìn)行健康體檢,選擇符合條件的學(xué)生61例(男20例,女41例),平均年齡18.77±1.72歲,年齡范圍16.00～22.08歲。樣本納入標(biāo)準(zhǔn)是： ①第一恒磨牙及尖牙為中性關(guān)系,前牙覆(?)、覆蓋關(guān)系正常。 ②牙列完整無缺失(除第三磨牙外),上下牙齒排列整齊,咬合良好。 ③面部左右對(duì)稱,側(cè)貌協(xié)調(diào),上下唇在正中位時(shí)自然閉合。 ④無正畸或正頜治療史及懸雍垂腭咽成形術(shù)等治療史。 ⑤無夜間睡眠打鼾及日間嗜睡史,無慢性鼻炎、鼻甲及扁桃體肥大等上呼吸道疾病史,亦無氣管炎、哮喘及肺氣腫等慢性呼吸系統(tǒng)疾病。 ⑥張口度、開閉口型正常,無顳下頜關(guān)節(jié)疾病。 ⑦籍貫為廣東省,無臨床診斷體重超標(biāo)史、無口呼吸不良習(xí)慣史、無頭頸部放療及外傷手術(shù)史。 ⑧身體健康,無精神系統(tǒng)疾病。 ⑨所有受試者了解本實(shí)驗(yàn)的目的及過程后自愿參加整個(gè)實(shí)驗(yàn)過程。 ⑩以Brent Hassel等提出的六個(gè)頸椎成熟階段為參照,頭顱側(cè)位片中的頸椎成熟指征位于完成階段,即第二、三和四頸椎的椎體下緣出現(xiàn)深的凹形,第三和第四頸椎的高度大于寬度。 11骨面型正常。I類矢狀骨面型：ANB角位于0.7°到4.7°之間。正常型垂直骨面型：GoGn-SN角位于27.3°到37.7。之間。 2.主要材料與儀器 ①德國SIRONA公司Orthophos XG PLUS X光全景機(jī)。②中國聯(lián)想集團(tuán)C200-暢悅型臺(tái)式電腦、日本RISE株式會(huì)社Winceph7.0頭影測(cè)量分析軟件。③無菌牙科器械：口鏡、探針、鑷子。75%酒精棉球,消毒干棉球,硫酸鋇糊劑等。④頭位輔助定位裝置：鏡子(40cmx25cm),鉛錘及鉛垂線。 3.研究方法與過程 (1)研究對(duì)象的篩查 病史采集制定調(diào)查問卷表,包括被實(shí)驗(yàn)者基本情況(姓名、性別、出生日期、種族、籍貫、身高、體重等),口腔專科病史(有無牙體疾病史、有無正畸或正頜治療史及懸雍垂腭咽成形術(shù)等治療史、有無口腔科治療史等)、頜面頸部疾病及外傷史、上呼吸道疾病史、有無夜間睡眠打鼾及日間嗜睡史、全身健康狀況、精神心理狀況和系統(tǒng)性疾病病史等。 臨床檢查①面部檢查：頜面部基本情況,包括頜面部對(duì)稱性,側(cè)貌情況等。②口內(nèi)檢查：牙齒健康狀況、排列情況、咬合關(guān)系等。有無腺樣體、扁桃體肥大等。③顳下頜關(guān)節(jié)檢查：顳下頜關(guān)節(jié)在功能運(yùn)動(dòng)時(shí)有無彈響、疼痛,關(guān)節(jié)區(qū)有無觸痛及壓痛,開口度大小,有無開口受限,開閉口型是否正常。④X線片檢查：頭影測(cè)量結(jié)果顯示ANB角位于0.7°到4.7°之間,GoGn-SN角位于27.3°到37.7°之間。 (2)頭顱定位側(cè)位X線片的拍攝 對(duì)研究對(duì)象均采用德國SIRONA公司Orthophos XG PLUS X光全景機(jī)拍攝頭顱側(cè)位片。X線球管距患者的正中矢狀平面150cm,線性放大率為11%,在測(cè)量分析中輸入Winceph7.0頭影測(cè)量分析軟件中予以校正。受試者輕輕原地踏步,做最大幅度的頭部前后擺動(dòng),逐漸減小擺動(dòng)幅度直至一個(gè)很舒適的位置,即調(diào)整頭部位于肌肉、韌帶放松的位置,也叫做自我平衡位(self-balance position)。注視正前方的鏡子,通過視覺校正系統(tǒng)調(diào)整兩眼平視前方,獲得鏡位(mirror position),即通常所說的自然頭位。耳塞插入時(shí)及插入后確保頭位不動(dòng)。囑受試者不要吞咽,嘴唇輕輕合上,牙齒咬在正中(?)位，，放松,平靜自然呼吸,于呼氣末時(shí)屏氣,然后拍攝頭顱定位側(cè)位片。因?yàn)樵诤魵饽⿻r(shí)拍攝可以去除上氣道開大肌的代償作用,從而可以去除肌肉對(duì)氣管的牽拉作用。拍攝前于研究對(duì)象舌背部涂以薄層硫酸鋇糊劑,以增強(qiáng)顯影。 4.數(shù)據(jù)資料的獲取與處理 采用Winceph7.0頭影測(cè)量分析軟件,由作者于一段連續(xù)時(shí)間內(nèi)完成全部X線片的定點(diǎn),測(cè)量條件保持不變。采用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。所有數(shù)據(jù)采用均數(shù)±標(biāo)準(zhǔn)差表示,應(yīng)用兩獨(dú)立樣本t檢驗(yàn)進(jìn)行性別間測(cè)量值統(tǒng)計(jì)學(xué)差異分析,當(dāng)方差不齊時(shí),用Satterthwaite近似t檢驗(yàn)進(jìn)行校正。所有患者頭顱側(cè)位片測(cè)量結(jié)束時(shí),從中隨機(jī)選擇30例進(jìn)行重復(fù)測(cè)量,以評(píng)估測(cè)量誤差。重復(fù)測(cè)量與第一次測(cè)量相隔四周以上。用配對(duì)t檢驗(yàn)來檢測(cè)兩次測(cè)量的誤差。P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.得到自然頭位下61例廣東籍正常(?)人群上氣道及舌骨位置的X線頭影測(cè)量值,供臨床參考。 2.骨性鼻咽：后鼻棘到蝶鞍點(diǎn)的距離(PNS-S)男性大于女性(t=4.628,P0.001),而后鼻棘到第一頸椎最前點(diǎn)的距離(PNS-Aa)性別間無統(tǒng)計(jì)學(xué)差異。軟組織鼻咽(PNS-ad1、PNS-ad2)男女無顯著差異。口咽部軟腭尖處前后咽側(cè)壁(P1-P2)的距離男性大于女性(t=2.212,P=0.031),而口咽部最狹窄處前后咽側(cè)壁的距離(Ve1-Ve2)男女間無統(tǒng)計(jì)學(xué)差異。喉咽部前后咽側(cè)壁距離：Pas1-Pas2男性大于女性(t=2.031,P=0.047);Ph1-Ph2男性大于女性(t=2.165, P=0.034); Va1-Va2男性亦大于女性(t=2.405,P=0.019),差異均有統(tǒng)計(jì)學(xué)意義。 3.軟腭與腭平面的角度((PNS-P1)/NL)男女間差異有統(tǒng)計(jì)學(xué)意義(t=-4.065,P0.001),男性軟腭相比女性更為直立。軟腭的厚度(SP1-SP2)男性明顯大于女性(t=3.161,P=0.002),而軟腭長(PNS-P1)男女無明顯差異。關(guān)于舌的測(cè)量結(jié)果為：男性舌的長度(Val-T)大于女性(t=3.328,P=0.002)舌的厚度(TD-VT)也大于女性(t=4.178,P0.001)。代表會(huì)厭位置的測(cè)量結(jié)果為：垂直方向上男性會(huì)厭谷最低點(diǎn)到后鼻棘的距離(Val-PNS)大于女性(t=9.246,P0.001),水平方向上：會(huì)厭谷最低點(diǎn)到舌骨最前點(diǎn)(Val-H)的距離男性大于女性(t=2.833,P=0.009)；到第三四頸椎前平面距的距離(Val-CVP)男性亦大于女性(t=3.068,P0.003)；會(huì)厭谷最低點(diǎn)到下頜骨聯(lián)合最下后點(diǎn)的距離(Val-Gpost)男性平均值大于女性平均值,但差異無顯著性。 4. Val-CVP與SN的比值男女間無顯著性差異。Val-H與SN的比值男性大于女性(t=2.190,P=0.038), Val-PNS與SN的比值男性大于女性(t=4.170,P0.001)。 5.除H-Gpost-Bo外舌骨的各個(gè)角度男女間均未見顯著性差異。H-Bo-Gpost三角中的Gpost角男性比女性大(t=2.583,P=0.012)。 6.舌骨到頸椎的距離男性大于女性：H-CV4ia (t=5.173, P0.001) H-CV4ip(t=7.027, P0.001)、H-CV3ia(t=7.208, P0.001)、H-CV2ia(t=8.489, P0.001)、H-CVT (t=8.408,P0.001)。舌骨到Bolton點(diǎn)(H-Bo) (t=9.589, P0.001)、舌骨到關(guān)節(jié)點(diǎn)(H-Ar) (t=10.159, P0.001)、舌骨到蝶鞍點(diǎn)(Hm-S) (t=10.606, P0.001)、前顱底平面(H-NSL) (t=9.253,P0.001)、舌骨到到下頜升支平面(H-RL) (t=4.606,P0.001)、舌骨到腭平面(H-NL) (t=7.668, P 0.001)的距離男性大于女性。舌骨到頦下點(diǎn)的距離(H-Me) (t=-2.430, P=0.018)、舌骨最前上點(diǎn)到過頦頂點(diǎn)與下頜平面垂直的線的距離(H-MP/GN) (t=-2.362,P=0.022)男性小于女性,差異有統(tǒng)計(jì)學(xué)意義。舌骨到下頜骨聯(lián)合最后點(diǎn)的距離(H-Gpost)、舌骨到頦前點(diǎn)的距離(H-Pg)男性平均值小于女性平均值,但差異不顯著。舌骨到下頜平面的距離(H-MP)、舌骨在前顱底平面的垂足與到鼻根點(diǎn)的距離(H-NSLP/N)男女間無顯著性差異。 7.男性大于女性、性別間有顯著差異的線距與SN的比值男性均大于女性：H-CV4ia/SN(t=2.770, P=0.009)、H-CV4ip/SN(t=3.754, P=0.001)、H-CV3ia/SN (t=4.736,P0.001)、H-CV2ia/SN (t=5.631,P0.001)、H-Bo/SN (t=4.964, P0.001)、H-Ar/SN (t=5.088,P0.001)、Hm-S/SN (t=4.480,P0.001)、H-RL/SN (t=3.244, P=0.002)、H-CVT/SN (t=4.606,P 0.001)、H-NSL/SN (t=3.838,P0.001)、H-NL/SN (t=4.294、 結(jié)論 1.軟組織鼻咽、硬組織鼻咽(PNS-Aa)及口咽最小間隙無性別差異,而男性軟腭的厚度、舌的長度及厚度均顯著大于女性。會(huì)厭在垂直方向上男性更靠下方,而在水平方向上男女無差異。 2.男性舌骨的位置較女性更靠前下方。舌骨平面相對(duì)于其它顱面部平面的角度無性別差異,且舌骨平面變異較大。
[Abstract]:Obstructive sleep apnea syndrome (OSAS) refers to the repeated complete or partial obstruction of the upper respiratory tract during sleep, which leads to the decrease of blood oxygen saturation in the blood, and then affects the functions of circulatory, respiratory, nerve, endocrine and other major systems. The rate is high and is gradually paid attention to in the clinic.
The upper airway obstruction of the OSAS patients during sleep may be caused by changes in the anatomical structure of the upper airway. The upper airway stents are formed in the skull, the jaw, the palate, the hyoid bone and other maxillofacial hard tissues. The change of the position can affect the position and tension of the attached or adjacent soft tissue, thereby affecting the size and stability of the airway. It is positively correlated with the severity of OSAS. The change of hyoid position is an important factor in the pathogenesis of OSAS.
To study the abnormal position of the airway and hyoid in the OSAS individual, it is necessary to compare the normal samples. Therefore, the X-ray cephalometric study of the upper airway and the hyoid position of the normal (?) population in the natural head is carried out in this experiment.
objective
The cephalometric analysis and study of 61 cases of the normal (?) normal (?) normal (?) normal group of Guangdong people were taken to obtain the cephalometric value of the upper airway and hyoid in the normal people of Guangdong.
Materials and methods
1. research objects
The students (about 7000 people) from Career Academy in Guangzhou were selected for physical examination, and 61 cases (20 men and 41 women) were selected. The average age was 18.77 + 1.72 years old and the age range was 16 to 22.08 years. The sample was included in the standard:
(1) the first molar and the canine were neutral, and the coverage of the front teeth was normal.
(2) there was no missing tooth (except for third molars), and the upper and lower teeth were arranged neatly and occluded well.
(3) the facial symmetry is symmetrical, the sides are coordinated, and the upper and lower lips are naturally closed in the median position.
There was no history of orthodontics or orthognathic surgery and uvulopalatopharyngoplasty.
The history of nocturnal snoring and daytime somnolence, no chronic rhinitis, the history of upper respiratory diseases such as turbinate and tonsillar hypertrophy, and chronic respiratory diseases such as tracheitis, asthma and emphysema.
Open mouth, normal mouth opening, no temporomandibular joint disease.
Native place is Guangdong province. There is no history of clinical diagnosis of overweight, no history of respiratory failure, no head and neck radiotherapy and trauma history.
It is healthy and has no mental system.
All subjects participated in the whole process voluntarily after knowing the purpose and process of the experiment.
With the reference of six cervical vertebrae, such as Brent Hassel, the cervical maturity sign in the lateral head of the skull is located at the completion stage, that is, the lower edge of the second, third and four cervical vertebrae is deep concave, and the height of the third and fourth cervical vertebrae is greater than the width.
11 normal.I sagittal bone type: ANB angle is between 0.7 and 4.7 degrees. Normal vertical facial type: GoGn-SN angle is between 27.3 and 37.7..
2. main materials and instruments
(1) German SIRONA company Orthophos XG PLUS X light panorama. (2) China Association group C200- smooth type desktop computer and Winceph7.0 cephalometric analysis software of Japanese RISE Corporation. (3) aseptic dental instruments: oral mirror, probe, tweezers.75% alcohol cotton ball, disinfectant dry cotton ball, barium sulfate paste, etc. (40cmx25c): mirror (40cmx25c) M), plumb and plumb line.
3. research methods and processes
(1) screening of research objects
History collection and formulation questionnaire, including the basic situation of the subjects (name, sex, birth date, race, native place, height, weight, etc.), oral specialist history (history of dental disease, history of orthodontic or orthognathic treatment and uvula palatopharyngoplasty, history of Department of Stomatology treatment, etc.), maxillofacial and neck disease and trauma history, History of respiratory diseases, history of nocturnal sleep, snoring and daytime sleepiness, general health, mental health and systemic disease history.
Clinical examination: facial examination: maxillofacial basic situation, including maxillofacial symmetry, side appearance, and so on. (2) intraoral examination: dental health status, arrangement, occlusal relationship, or without adenoid, tonsillar hypertrophy, etc. (3) TMJ examination: temporomandibular joint in functional movement, pain, pain, pain, and pain in the joint area Pressure pain, the size of opening, whether or not the opening is limited, the opening and closing is normal. (4) x - ray examination: the cephalometric results show that the ANB angle is between 0.7 and 4.7 degrees, and the GoGn-SN angle is between 27.3 and 37.7.
(2) the shooting of the lateral position X-ray film of the skull
The subjects were taken by German SIRONA company Orthophos XG PLUS X light panorama. The median sagittal plane 150cm, the linear magnification rate of 11%, was corrected in the Winceph7.0 cephalometric analysis software in the measurement analysis. Move, gradually reduce the amplitude of the swing to a very comfortable position, that is, to adjust the position of the head in the muscle, the position of the ligament relaxation, also called the self-balance position. Look at the front mirror, adjust the eyes straight ahead through the visual correction system and obtain the mirror position (mirror position), that is, the usual natural head position. Make sure the head is not moved at the time of insertion and after insertion. The subjects are not swallowed, the lips are gently closed, the teeth are bitten in the median (?) position, relaxed, calm and natural breath, hold the breath at the end of the exhalation, and take the position of the head position. Because the filming can remove the compensatory function of the upper muscle opening muscle at the end of the breath, the muscles can be removed to the trachea. Before the shooting, a thin layer of barium sulfate paste was applied on the back of the tongue to enhance the development.
4. data data acquisition and processing
The Winceph7.0 cephalometric analysis software was used by the author to complete the fixed points of all X-ray films in a continuous period of time. The measurement conditions remained unchanged. Statistical analysis was carried out by the SPSS13.0 statistical software. All data were represented by mean number of standard deviation, and the statistical difference analysis was analyzed with two independent sample t tests. At the end of the difference, the Satterthwaite was used to approximate the t test. At the end of the lateral cephalometric measurement of all the patients, 30 cases were randomly selected to carry out repeated measurements to assess the measurement error. The repeated measurement was more than four weeks apart from the first measurement. The error of the error.P0.05 measured by paired t test was statistically significant.
Result
1. the cephalometric values of the upper airway and hyoid bone of 61 normal population in Guangdong were obtained for clinical reference.
2. bone nasopharynx: the distance between the posterior nasal Spina and the sella sphenoid point (PNS-S) was greater than that of the female (t=4.628, P0.001), and there was no statistical difference between the sex of the anterior nasal spines to the first cervical vertebra (PNS-Aa). There was no significant difference between men and women in the soft tissue nasopharynx (PNS-ad1, PNS-ad2). The distance between the pharynx and the lateral pharyngeal wall (P1-P2) at the apex of the pharynx was greater than that of the female (t=2.). 212, P=0.031), and the distance between the pharynx and the pharynx lateral wall (Ve1-Ve2) had no statistical difference between men and women. The distance between the pharynx lateral wall and the pharynx wall was greater than that of the female (t=2.031, P=0.047), and the male of Ph1-Ph2 was greater than the female (t=2.165, P=0.034), and the Va1-Va2 male was greater than the female (t=2.405, P=0.019), and the difference was statistically significant.
3. the differences in the angle between the soft palate and the palate plane ((PNS-P1) /NL) were statistically significant (t=-4.065, P0.001), and the male soft palate was more erect than the female. The thickness of the soft palate (SP1-SP2) was significantly greater than that of the female (t=3.161, P=0.002), but the soft palate length (PNS-P1) was not significantly different between men and women. The measurement of the tongue was that the length of the tongue (Val-T) was greater than that of the male. The thickness of the tongue (TD-VT) of the female (t=3.328, P=0.002) was also greater than that of the female (t=4.178, P0.001). The measurement of the position of the epiglottis was that the distance between the lowest point of the male epiglottis Valley in the vertical direction (Val-PNS) was greater than that of the female (t=9.246, P0.001), and in the horizontal direction, the distance from the lowest point of the epiglottis Valley to the front of the hyoid bone (Val-H) was greater than that of the female. (t=2.833, P=0.009); the distance to the distance between the anterior plane of the three or four cervical vertebra (Val-CVP) was greater than that of the female (t=3.068, P0.003); the mean value of the lowest point of the epiglottis Valley to the lower jaw joint of the mandible (Val-Gpost) was greater than the female average, but the difference was not significant.
There was no significant difference in the ratio of 4. Val-CVP to SN between men and women. The ratio of.Val-H to SN was greater than that of women (t=2.190, P=0.038), and the ratio of Val-PNS to SN was greater than that of women (t=4.170, P0.001).
5. there was no significant difference in the angle of hyoid bone between male and female except for H-Gpost-Bo, and the Gpost angle in.H-Bo-Gpost triangle was larger than that in female (t=2.583, P=0.012).
The distance between 6. hyoid bones to cervical vertebra is greater than that of women: H-CV4ia (t=5.173, P0.001) H-CV4ip (t=7.027, P0.001), H-CV3ia (t=7.208, P0.001), H-CV2ia (t=8.489, P0.001), hyoid bone to joint point, hyoid bone to joint point, hyoid to sella point 1) the anterior cranial base plane (H-NSL) (t=9.253, P0.001), the hyoid bone to the mandibular ramus (t=4.606, P0.001), the hyoid bone to the palatine (H-NL) distance (t=7.668, P 0.001) more than the female. The distance between the hyoid bone to the submental point (H-Me) (t=-2.430, P=0.018), the distance between the top of the hyoid bone and the vertical line of the mandibular plane (t=-2.362, P=0.022) men were less than women. The difference was statistically significant. The distance between the hyoid bone to the mandible (H-Gpost), the distance between the hyoid bone to the anterior Chin (H-Pg) was less than the female average, but the difference was not significant. The distance from the hyoid to the mandibular plane (H-MP), the distance between the hyoid bone in the front of the skull base and the distance to the root point of the anterior skull base was the distance from the hyoid bone to the mandibular plane. (H-NSLP/N) there was no significant difference between men and women.
7. men are more than women. The ratio of line distance to SN is greater than that of women: H-CV4ia/SN (t=2.770, P=0.009), H-CV4ip/SN (t=3.754, P=0.001), H-CV3ia/SN (t=4.736, P0.001), H-CV2ia/SN (t=5.631, P=0.009). P=0.002), H-CVT/SN (t=4.606, P 0.001), H-NSL/SN (t=3.838, P0.001), H-NL/SN (t=4.294,
conclusion
1. soft tissue nasopharynx, hard tissue nasopharynx (PNS-Aa) and the minimum gap of oropharynx had no gender difference, but the thickness of the soft palate, the length and thickness of the tongue were significantly greater than that of the female. The epiglottis was lower in the vertical direction, but in the horizontal direction, there was no difference between men and women.
2. the location of hyoid bone in males is more anterior and inferior than that in females. There is no difference in the aspect of hyoid plane relative to other craniofacial planes, and the hyoid plane is more variable.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R766.43;R816.96

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