腺样体及上气道的二维和三维测量的相关性研究

目的 对腺样体及上气道的二维和三维影像测量的方法学进行比较研究.方法 研究对象为正畸前因埋伏牙或颞下颌关节病而同期拍摄了头颅定位侧位片和锥形束CT (cone bine computed tomography,CBCT)图像的患者30例.其中女18例,男12例,年龄7～14岁.在头颅定位侧位片上进行腺样体A、鼻咽腔N、软组织鼻咽长度R-PNS以及A/N值的测量,利用CBCT图像于正中矢状断层、轴面断层、冠状面断层分别进行A、N、A/N值测量,以及上气道三维测量.比较和评估头颅侧位片测量腺样体及上气道的准确度.结果 头颅定位侧位片中A、N、A/N值的测量值[(13.01±3.04) mm、(26.50±3.05)mm、(0.49±0.10)]与CBCT图像正中矢状面相应的测量值(13.29±3.42) mm,(26.62±2.19) mm,(0.50±0.11),无统计学差异(P＞0.05),有较高的一致性(P＜0.01);与CBCT轴截面相应测量值[(15.36±4.87) mm、(28.54±4.65) mm、(0.54±0.10)]和冠状面的测量值A:[(16.55±)4.31mm],有统计学差异(P＜0.01),但有一定的相关性(P＜0.05).头颅定位侧位片鼻咽大小(R-PNS)、腭咽大小(VP)、下部气道大小(LP)与CBCT相应的鼻咽、腭咽、下部气道体积和平均截面积也有一定的相关性(P＜0.05).结论 头颅定位侧位片在一定程度上能够反映腺样体、上气道的大小.     

CT片与X线片在颌面部骨折检查中的对比研究

作者通过本院颌面外科 14例患者共 35处颌面部骨折的诊治情况分析 ,对 CT片与 X线片诊断颌面部骨折 ,进行了对比研究 ,现报道如下。1　方　法颌面部骨折 35处共 14例患者 ,术前分别摄取相应的 X线片和 CT片。摄 X线片的方法是上颌骨、颧骨摄华氏位片 ;颧弓摄颅底位片或颧弓切线位片 ;下颌骨摄全景片 ,对于骨折在下颌升支或下颌角区 ,加拍头颅侧位片或下颌骨侧位片 ,髁突区加拍薛氏位片。CT检查时 ,对上述各骨折区作横断位及冠状位扫描 ,层隔分别为 2 mm及 5 mm。由于全景片及冠状位 CT扫描 ,需要一定的体位配合 ,本组病例皆是在患者病…     

双胶片X线投照技术显示软硬组织侧貌

随着正畸诊断和矫治技术的不断提高,人们日益注重矫治前后软组织侧貌的改变。一些先进的头颅侧位定位投照设备有特殊的X线滤过装置,能使软硬组织较清晰地显示在一张头颅侧位片上,以便进行临床研究和矫治前后对照。多数基层医院没有相应的设备,常规的X线投照技术和冲洗技术...     

德莱尔面具结合螺旋开大器矫治早期骨性Ⅲ类错的临床应用

目的　探讨德莱尔面具结合螺旋开大器矫治早期骨性前牙反牙合的疗效,并分析颌骨、牙齿及软组织的改变。方法　选择上颌骨发育不足导致的早期骨性前牙反牙合16例,采用德莱尔面具结合螺旋开大器进行前方牵引。牵引前后均摄头颅侧位定位片,并对牵引前后X线头颅侧位片进行测量分析及临床表现比较。结果　A点前移,上前牙唇向倾斜;下颌骨生长的方向、形态改变,上下颌骨矢状向关系趋于正常,凹面型明显改善。结论　德莱尔面具结合螺旋开大器是矫治早期骨性前牙反牙合的有效方法。     

德莱尔面具结合螺旋开大器矫治早期骨性Ⅲ类错He的临床应用

目的探讨德莱尔面具结合螺旋开大器矫治早期骨性前牙反He的疗效，并分析颌骨、牙齿及软组织的改变。方法选择上颌骨发育不足导致的早期骨性前牙反He16例，采用德莱尔面具结合螺旋开大器进行前方牵引。牵引前后均摄头颅侧位定位片，并对牵引前后X线头颅侧位片进行测量分析及临床表现比较。结果A点前移，上前牙唇向倾斜；下颌骨生长的方向、形态改变，上下颌骨矢状向关系趋于正常，凹面型明显改善。结论德莱尔面具结合螺旋开大器是矫治早期骨性前牙反He的有效方法。     

锥形束CT与X线头颅侧位定位片评价骨性Ⅲ类错(牙合)的比较

目的 比较锥形束计算机体层摄影术(CBCT)生成的半颅头颅侧位定位片与传统X线头颅侧位定位片的差异,探讨CBCT生成的半颅头颅侧位定位片对骨性Ⅲ类错((牙合))患者的诊断和评价作用.方法 选取 30 例骨性Ⅲ类错((牙合))手术患者.每位患者分别在术前和术后拍摄CBCT和X线头颅侧位定位片,并通过CBCT生成相应的半颅头颅侧位定位片.对两种头侧片分别进行测量,用 Winceph 8.0软件对测量值进行比较.用Mimics 10.01软件对CBCT生成的三维模型进行测量.通过算式将CBCT生成的半颅头颅侧位定位片线距测量值进行校正,将校正值与相应CBCT三维测量值进行比较.结果 传统头颅侧位定位片的SNA、SNB、下颌平面角、下颌升支长与CBCT生成相应值间的差异有统计学意义,其余差异无统计学意义.CBCT生成的半颅头颅侧位定位片线距测量值与相应CBCT三维测量值存在差异,但校正后两者间差异无统计学意义.结论 CBCT生成的半颅头颅侧位定位片在骨性Ⅲ类错((牙合))患者诊断和评价方面更准确,可以代替传统的X线头颅侧位定位片.     

德莱尔面具结合螺旋开大器矫治早期骨性Ⅲ类错(牙合)的临床应用

目的探讨德莱尔面具结合螺旋开大器矫治早期骨性前牙反(牙合)的疗效,并分析颌骨、牙齿及软组织的改变.方法选择上颌骨发育不足导致的早期骨性前牙反(牙合)16例,采用德莱尔面具结合螺旋开大器进行前方牵引.牵引前后均摄头颅侧位定位片,并对牵引前后X线头颅侧位片进行测量分析及临床表现比较.结果 A点前移,上前牙唇向倾斜;下颌骨生长的方向、形态改变,上下颌骨矢状向关系趋于正常,凹面型明显改善.结论德莱尔面具结合螺旋开大器是矫治早期骨性前牙反(牙合)的有效方法.     

下颌骨大型缺损的个体化修复

目的探讨下颌骨大型缺损的个体化修复方法。方法选择10例(男、女各5例)华东地区正常牙合汉族成年人,常规拍摄头颅定位正、侧位片。对下颌骨外形线定量相关分析结果做可行性分析;同时为1例下颌骨大型缺损修复提供下颌骨外形线变量数据及下颌骨外侧下弧线形态。结果下颌骨外形线变量实测值与计算值无统计学差异(P>0.05),修复1例下颌骨大型缺损患者,获得良好效果。结论下颌骨外形线相关性分析可为下颌骨大型缺损修复提供依据。     

CT片与X线片在颌面部骨折检查中的对比研究

对４２例１０５处颌面部骨折，根据骨折部位不同，分别摄取相应的Ｘ线片及ＣＴ片：上颌骨、颧骨摄华氏位片；颧弓摄颅底位片或颧弓切线位片；下颌骨摄全景片，对于骨折在升枝或下颌角区，加拍头颅侧位片或下颌骨侧位片，髁状突区加拍薛氏位片；ＣＴ片包括横断位及冠状位扫描，层隔分别为２．０ｍｍ及５．０ｍｍ．结果发现：对于上颌骨、眶底、眶尖区骨折，应同时作冠状位及横断位ＣＴ扫描，ＣＴ片较Ｘ线片能提供更多更精确的信息量；对于颧骨、颧弓骨折，Ｘ线片是理想的辅助诊断方法；对于髁状突骨折，冠状位ＣＴ片效果最佳     

上颌前牵引对唇腭裂术后反He患者腭咽闭合功能的影响

探讨上颌前牵引对单侧完全性唇腭裂术后反Ｈｅ患者腭咽闭合功能的影响。方法。采用头颅定位侧位Ｘ线片、头颅侧位咽腔造影Ｘ线片及鼻咽纤维镜照相等方法对１０例生长期单侧完全性腭裂术后反Ｈｅ患者上颌前牵引前后结构测量结果及腭咽闭合功能进行对照定量分析。     

Relationship between jaws and the masseter muscle by superimposing MR images on the cephalogram

The purpose of this study was to observe the morphological relationship between maxillofacial skeleton and masseter by superimposing the masseter image constructed by MR image scanning on the cephalogram. Sixteen subjects with different mandibular plane angle were examined in this study. Cephalogram and MR images of each subject were taken, and the images were input to a computer by using a digitizer. The areas of masseter were selected in each MR scan image which were projected to the mid-sagittal layer of the MR scan images. The synthesized image of cephalogram and masseter was obtained by completely superimposing sagittal images of the masseter with the mid-sagittal-plane MR image on the cephalogram. The inclination of masseter was determined by the center of gravity on the cross-section of masseter. These synthesized images of cephalogram and masseter showed various shapes of masseter according to different mandibular plane angle. The inclination of masseter had a close correlation with some skeletal parameters (mandibular plane angle, ANB, Y-axis, facial angle, saddle angle) of cephalometric analysis. The volume of the masseter also had a close correlation with skeletal parameters (mandibular plane angle, gonial angle, Y-axis). These results revealed that morphometric analysis using synthesized images of cephalogram and masseter is useful, and that the inclination and the volume of masseter may have an influence on the shape of the mandibular bone and its vertical and anteroposterior development.     

X线头颅定位片硬组织形态 三维有限元分析模型的建立

目的：建立颅颌面硬组织形态三维有限元分析模型。方法：基于有限元分析和Ｂａｕｎｒｉｎｄ用头颅正、侧位定位片获取标志点三维坐标的原理,以硬组织标志点作为节点,按照解剖结构及结构间关系对硬组织进行单元划分。结果：选择头影测量硬组织标志点２３个作为节点,颅颌面硬组织划分成１３个四节点四面体单元,初步建立了一个颅颌面硬组织形态三维有限元分析模型。结论：该模型可用于颅颌面硬组织在三维方向上的形态特征及因生长、正畸矫治、正颌手术引起的形态变化研究。     

软组织侧貌预测系统的建立和研究

目的：结合临床实际,建立一个正畸治疗中软组织侧貌改变的乔治预测系统。并对系统进行实用性的可行性论证。方法：自主开发侧貌预测软件HOPS-400,以所建系统对24例安氏Ⅱ类1分类错He功能矫治的软组织头影量预测结果和治疗结果进行对比分析。比较二者的一致程度。结果：在95%可信限内,3种软组织头影测量分析方法（Burstone,Holdway,Bishara)中的30项指标有19项一致。尤其是9项角度测量指标有7项一致;18项线距测量结果有10项一致;3项线距比指标也有2项一致。结论：预测结果对临床有一定的指导作用。     

The relationship between jaw deformity and scoliosis

Objectives To analyze the relationship between lateral displacement of the mandible and scoliosis. Methods From April 2002 through July 2003, we examined posteroanterior cephalometric radiographs and chest X-rays from 85 patients with jaw deformities and a control group of 20 patients with no jaw deformities. To measure the lateral shift of the mandible, we drew a horizontal baseline (X axis) on the cephalogram connecting the intersection of the external margins of the orbits and the most lateral points of the greater wings of the sphenoid. A vertical baseline (Y axis) was then marked perpendicular to the X axis, intersecting the ethmoid crista galli. Then, we measured the lateral displacement of the mandibular mentum from the Y axis. Displacement to the right was designated positive; that to the left was designated negative. Cobb's method was used to measure scoliosis curves on chest X-rays; the direction of the curve was designated similarly. Results Of the 85 patients with jaw deformity, 23 (27.1%) had a Cobb angle exceeding 10°. None of the control group had scoliosis exceeding 10°. No correlation was found between the direction of mandibular displacement and the direction of scoliosis. Conclusion This study suggests a relationship between jaw deformities and scoliosis, as scoliosis was found in 27.1% of the patients with a main complaint of jaw deformity.     

钕铁硼永磁体矫治前牙骨性开的X线头影测量分析

应用第三代稀土永磁体钕铁硼制成垫式活动矫治器对８例前牙骨性开患者进行畸形矫治。通过矫治前后的Ｘ线头影测量分析评价其疗效。结果表明：第三代稀土永磁体钕铁硼用于前牙骨性开畸形的矫治是可行的。磁力矫治后患者的上下磨牙的压入值、下颌平面角的减小值及前下面高的降低值均有显著变化     

X线头颅侧位定位片硬组织形 态二维有限元分析模型的建立

目的：建立Ｘ线头颅侧位定位片硬组织形态二维有限元分析模型。方法：基于有限元分析的原理,选择头颅侧位定位片硬组织标志点作为节点,按照解剖结构及结构间关系对硬组织进行单元划分。结果：选择头颅侧位定位片硬组织标志点５３个作为节点,将正中矢状面颅颌面硬组织划分成３７个三角形单元,建立了一个较为全面的头颅侧位定位片硬组织形态二维有限元分析模型。结论：该模型可用于颅颌面硬组织在正中矢状面上的形态特征及因生长、正畸矫治、正颌手术引起的形态变化研究。     

正颌手术前后舌骨位置和咽下气道变化及相关性研究

目的　通过X线头影测量分析了解颌骨后退与前徙对舌骨位置及咽下气道变化的影响情况,为临床治疗提供参数。方法　下颌前突患者23例与小颌畸形患者9例,分别行双侧矢状劈开后退或前徙下颌,手术前后拍摄X线头颅定位侧位片,进行头影测量,测量项目13项,测量数值配对t检验,并将下颌后退距离与各测量项目变化值作相关分析。结果　各测量项目显著差异的有:(1)下颌前突组,下咽腔矢状面积(PSA),舌骨垂直向变化,舌根后缘至咽后壁距离(TBPW),舌背高点至FH平面距离(DTFH),会厌谷至咽后壁距离(VPW),悬雍垂尖点至后咽壁距离(UPW),下颌颏部水平、垂直向变化(PogPTV,MeFH)。舌骨垂直向变化与下颌颏部垂直向变化显著相关。(2)小颌畸形组,舌骨垂直向变化显著。结论　下颌前突组,(1)舌骨向下移位,舌背上抬,舌根向后移动。(2)咽腔气道空间缩小可表现为永久性,但后气道间隙接近正常人,不会发生通气阻塞,更未出现OSAS。舌骨与下颌前部垂直向变化呈负相关。(3)小颌畸形组,舌骨垂直向显著变化,舌骨因颏舌骨肌牵拉而上移。舌骨水平向无显著移位。除会厌谷前移外,舌体无显著移位,说明颌骨前徙对舌体形态没有大的影响。颌骨前徙对后气道无明显影响。从临床病例来看,小颌畸形愈重,前徙颌骨手术对周围组织结构的影响愈大。     

Retrognathic maxilla in “Habsburg jaw”: Skeletofacial analysis of Joanna of Austria (1547–1578)

Objective:To evaluate the dentoskeletal features of the “Habsburg jaw” by analyzing the skull of Joanna of Austria.Materials and Methods:The skull, the panoramic radiograph, and the lateral cephalogram of Joanna of Austria were analyzed. The cephalometric values of Joanna were compared to cephalometric standards for adult female subjects.Results:The analysis of the dentition on the dry skull and on the panoramic radiograph showed a generalized horizontal alveolar bone resorption with severe bone loss that was interpreted as a sign of severe periodontal disease with respect to the young age (31 years). The cephalometric analysis revealed the presence of a skeletal Class III disharmony associated with maxillary retrusion and normal sagittal position of the mandible. The maxilla exhibited a reduction in the sagittal dimension while the mandible presented with increased dimensions both in total mandibular length (Co-Gn) and in the mandibular body (Go-Gn). The skeletal open bite contributed to the lack of mandibular protrusion though in presence of increased mandibular sagittal dimensions.Conclusion:Joanna of Austria appeared to be affected by a peculiar type of “Habsburg jaw” as the Class III skeletal disharmony was due to a retrognathic maxilla rather than to a prognathic mandible.     

The mandibular catch-up growth controversy in Pierre Robin sequence.

The purpose of this retrospective longitudinal cephalometric study was to investigate differences in craniofacial and especially mandibular morphology between patients with Pierre Robin sequence and isolated cleft palates. The experimental group comprised 96 patients (54 males and 42 females) with a history of Pierre Robin sequence. This group was compared cephalometrically with a control group of 50 patients (25 males and 25 females) with a history of isolated clefting of the palate. All 96 patients in the PR group had a lateral cephalogram at a mean age of 5.5 years. Thirty-eight of those patients had additional cephalograms at the mean ages of 10.3 years and 16.8 years. All patients in the cleft palate group had 3 corresponding cephalograms at the following mean ages: 5.7 years, 10.6 years, and 17.0 years. Twenty-nine cephalometric measurements were performed on each cephalogram with the use of computerized cephalometric software. Significant differences were identified between the 2 groups, particularly in the size and sagittal position of the mandible, which was consistently shorter in the Pierre Robin group at all 3 ages. Less severe differences were noted in the inclination of the palatal plane, the facial height proportions, and the midface depth. We conclude that patients with Pierre Robin sequence have a significantly smaller mandible as compared with patients with isolated cleft palate, and the difference does not change after the age of 5 years.     

青春发育高峰期骨性Ⅱ类女性正畸患者下颌骨生长量预测的研究

目的探讨预测青春发育高峰期骨性Ⅱ类女性正畸患者治疗后下颌骨生长量的方法。方法选择18名青春发育高峰期骨性Ⅱ类女性患者,拍摄正畸治疗前后头颅侧位片,对治疗时间、颈椎骨龄、下颌角、FMA角、ANB角、Y轴角、SGo/NMe比值等因素与下颌骨综合长、下颌体长、下颌升支长分别进行多元相关分析。结果青春发育高峰期骨性Ⅱ类女性正畸患者下颌骨综合长Co-Gn的增长量与生长时间成正相关关系,与SGo/NMe比值成负相关关系,其预测方程为：Y1=15.398＋0.176×X1-25.711×X2（R^2=0.687）。青春发育高峰期骨性Ⅱ类女性正畸患者下颌体长Go-Pog的增长量与下颌角（Ar-Go-Me）成正相关关系,与颈椎骨龄成负相关关系,其预测方程为：Y2=-3.977＋0.117×X3-0.118×X4（R2=0.579）。结论预测方程可以对青春发育高峰期骨性Ⅱ类女性的下颌骨生长量进行预测。