【作者】 张海钟；

【导师】 周刚； 归来；

【作者基本信息】 中国协和医科大学 ， 整形外科， 2002， 博士

【摘要】 目的：当下颌骨处于正常生理位置时，建立正常人颅面骨三维定量测量的数据库。探讨颅面骨生长规律。方法：选择正常成人100名，男女各50名，8～15岁少年21名，在正常牙尖交错位状态下行螺旋CT扫描，由工作站进行颅面骨三维重建，使用三维测量软件对颅面骨三维影像结构进行三维测量。并创立三维角度测量项目，如∠Ramus、∠Go-N-Go’、∠Go-Me-Go’、∠Cde-Me-Cde’等。将测得线距，角度，比值等数据以SAS软件为基础制作动态数据库，每行为一名受测者的所有数据包括编号、年龄、各线距、角度等，每一列为一个测量项目。在动态数据库中，由计算机自动计算任意例数组的平均数、标准差、标准误、中位数、变异系数和95％的可信区间，求出任意两组数据的的比值和任意几组数据的相关关系，回归方程等。结果：由计算机求出各数据之间的比值及数据本身构成较大容量的数据库。涉及下颌骨的线距和角度的变异系数大于上颌骨大于颅底，下颌骨的变异程度较大。数据比值的标准差远小于数据范围的标准差。下颌角宽度的多元逐步回归方程Y=0.602X1+0.805X2+0.276X3-0.608X4-14.442；颧面宽：Y=0.812X1+0.178X2+0.339X3+0.106X4+30.178。下颌角过宽患者可通过多元逐步回归方程，求出该患者“理想”下颌角宽度，并运用其95％的可信区间分析。少年组与成人比较发现颅底和眶颧区测量值可达到成人89％～97％，如N-S，TZ-TZ，ORE-ORE。下颌骨的各项测量项目变化较大，如Go-Go，ANS-ME，Cd-Go。结论：由于三维影像结构可从任意视角测量，运用多参照系建立较大容量的动态数据库，并能对任意组进行众多的数理统计分析，自创立的三维测量项目能更全面表达颅面骨在三维空间的解剖结构。本数据库有助于对颅面骨正常发育过程进行形态学研究，少年与成人数据对比，认识在不同年龄段的变异特征；对颅面骨比例发育失调的患者进行定量分析、诊断，有助于决定手术方案及手术后长期随访，并评价手术效果是否达到比例和谐的“理想值范围”。显示颅面骨生长按一定比例协调生长，为颅面骨畸形患者的诊断提供客观依据。更多还原

【Abstract】 Objective: The three-dimensional(3d) craniofacial measurements were studied through the quantitative computed tomography(CT). The dynamic database of quantitative measurement of three-dimensional craniofacial bone was established as mandible in physiological position. Methods: 100 native adults were examined by spiral volumetric CT(Philips Tomoscan SR-7000). 21 children (age 8-15) were examined by mutislice helical CT(GE lightspeed Qxi). 3d craniofacial bone images were reformatted and 3d measurements were performed in Easy Vision Workstation and SUN Workstation respectively. 33 points were defined in the 3-d craniofacial structure in screen, 14 distances and 11 angles were measured, and 12 ratios were calculated in each case. All data were transferred into the database based on the SAS software packages. There is all information of one case (such as number, sex, age, distances, angles) in one row; each column is a measurement item. The mean, standard deviation, standard error, medium, coefficient of variation and 95% confidence interval of data can be calculated and the correlation, regression between several groups of measurement item can be proceeded by computer automatically in the dynamic database. Results: 3d craniofacial bone images were displayed in arbitrary views without disturbing superposition by using cutting, rotating and 3D measurement procedures. The large data volume provides more information of spacial relationship of skull base, zygomatic bone, maxilla, mandible and vertebra. The coefficient of variation of skull base is less than that of maxilla and mandible, The standard deviation of ratios is further smaller than the standard deviation of distances and angles. With stepwise regression, the equation is (Go-Go)Y=0.602X1+0.805X2+0.276X3-0.608X4-14.442 ; (Tz-Tz) :Y=0.812X1+0.178X2+0.339X3+0.106X4+30.178. The overall size of the cranio-orbito-zygomatic skeleton reaches 89% to 97% of adult size by age 8-15 years.更多还原