CBCT配准研究青春生长迸发期下颌神经管的纵向稳定性

发布时间：2018-09-01 19:15

【摘要】：目的本研究以正畸矫治前后的CBCT数据为依据,研究青春生长迸发期下颌神经管的纵向稳定性,从三维角度进一步评价Bjork结构化重叠方法的有效性,为下颌神经管在影像重叠技术中的临床应用提供重要的理论依据。材料和方法本研究选取2011到2014年间接受非拔牙正畸治疗的30名患者,其中包括16名女性(平均年龄为12.31±0.60),14名男性(平均年龄为12.69±0.79),这些患者均处于青春生长迸发期阶段,即CVM颈椎评价方法的CS3阶段,正畸治疗时间间隔平均为24.47-2.26月,所有研究对象满足一类(?)关系及一类骨面型,且无颅面部骨骼发育畸形。所有患者由同一操作者进行头颈部CBCT扫描,扫描数据以DICOM格式输出并储存,数据导入到Mimics 17.0软件中,运用Mimics手术仿真模拟工具选取下颌神经管,与重建的下颌骨模型合并形成包含下颌神经管的下颌骨三维结构,所有的三维图像模型以STL格式导出。利用Mimics软件打开患者矫治后的CBCT数据,把该患者矫治前和矫治后的STL文件同时导入到该CBCT数据文件中,利用Mimics软件的点配准及局部STL配准功能,选取颏联合内部骨皮质下缘轮廓作为配准参考面,对矫治前后的STL数据进行精确配准,配准完成后选取下颌骨可见两侧后牙邻接面的水平层面,在该水平面上选取下颌神经管的矢状向截面(S截面)和冠状向截面(C截面,C1-C4截面),S1与矫治后下颌神经管内侧缘相切,S2为S1与S3的中间截面,S3-S6分别与矫治后第二磨牙、第一磨牙、第二前磨牙以及第一前磨牙外侧缘相切,Cl与矫治后下颌管下缘相切,C2-C4分别与矫治后第二磨牙、第一磨牙以及第二前磨牙下缘相切,C5为经矫治后颏孔最下缘的水平面上与下颌神经管下缘相切的冠状截面。在S截面测量下颌神经管矢状向和垂直向矫治前后坐标变化值,在C截面测量下颌神经管冠状向矫治前后坐标变化值,左右两侧分开测量,用SPSS19.0软件对左右两侧各截面相关测量数据进行统计学分析,检验标准设为P0.05。结果1.左侧下颌神经管与右侧下颌神经管测量坐标数值的比较分析所有矢状向及冠状向截面的左右侧下颌神经管坐标测量数值均没有统计学差异。2.男性与女性下颌神经管测量坐标数值的比较分析所有矢状向及冠状向截面的男性与女性下颌神经管坐标测量数值均没有统计学差异。3.下颌神经管垂直向的变化S1矢状向截面下颌神经管矫治后向下移动了0.75±0.12mm,S2矢状向截面下颌神经管矫治后向下移动了0.32±0.10mm,S3-S6矢状向截面下颌神经管垂直方向的测量值均无统计学差异。4.下颌神经管矢状向的变化S1、S2、S3矢状向截面下颌神经管分别向前移动了0.71±0.11mm、0.49±0.09 mm、0.30±0.08mm。S4, S5, S6矢状截面下颌神经管矢状向的测量值均无统计学差异。5.下颌神经管水平向的变化C1冠状向截面下颌左右侧神经管外侧位移量分别为0.34±0.09mm和0.44±0.08mm。C2冠状向截面左右侧神经管外侧位移量分别为0.22±0.07mm和0.29±0.08mm。C3冠状向截面左右侧神经管外侧位移量分别为0.13±0.06mm和0.15±0.07mm。C4冠状向截面左右侧神经管外侧位移量分别为0.13±0.06mm和0.14±0.07mm。C5冠状向截面左右侧神经管外侧位移量分别为0.13±0.06mm和0.14±0.07mm。所有冠状向截面中的下颌左右侧神经管均存在外侧移位。结论(1)在青春生长迸发期,伴随着下颌骨的快速生长,下颌神经管发生外侧移位,下颌升支位置神经管的外侧位移量大于下颌骨体部神经管的外侧位移量。(2)在垂直向和矢状向上,下颌神经管在下颌体前部接近颏孔的部分存在稳定性,在下颌体接近升支部分及升支部分的下颌神经管存在显著地向前、向下移位。
[Abstract]:Objective To study the longitudinal stability of mandibular nerve canal during puberty outburst and to evaluate the effectiveness of Bjork's structural overlap method from three-dimensional perspective based on CBCT data before and after orthodontic treatment. Thirty patients who received non-extraction orthodontic treatment from 2011 to 2014 were selected, including 16 females (mean age 12.31 0.60), 14 males (mean age 12.69 65507 All patients were scanned by the same operator on CBCT. The scanned data were output and stored in DICOM format. The data were imported into Mimics 17.0 software. The mandibular nerve canal was selected by Mimics simulation tool and the mandibular bone model was reconstructed. All three-dimensional image models were derived in STL format. The CBCT data of the patients were opened by Mimics software. The STL files of the patients before and after treatment were imported into the CBCT data files simultaneously. The point registration and local STL registration functions of Mimics software were used. STL data before and after orthodontic treatment were accurately registered. Horizontal planes of mandibular visible posterior teeth adjacent to each other were selected. Sagittal section (S section) and coronal section (C section, C1-C4 section) of mandibular nerve canal were selected on the horizontal plane. After treatment, the lateral margin of the mandibular nerve canal is tangent, S2 is the middle section of S1 and S3, S3-S6 is tangent with the second molar, the first molar, the second premolar and the lateral margin of the first premolar respectively, Cl is tangent with the lower margin of the mandibular canal, C2-C4 is tangent with the second molar, the first molar and the lower margin of the second premolar respectively, C5 is tangent after treatment. The coordinate changes of the mandibular nerve canal before and after sagittal and vertical correction were measured on the S-section. The coordinate changes of the mandibular nerve canal before and after the coronal correction were measured on the C-section. The measurement data were statistically analyzed, and the test standard was set as P 0.05. Results 1. Comparing the measured coordinates of the left mandibular canal with that of the right mandibular canal, there was no statistical difference between the measured coordinates of the left and right mandibular canal in all sagittal and coronal sections. There was no significant difference between male and female mandibular canal coordinate measurements in all sagittal and coronal sections. There was no significant difference in the sagittal direction of the mandibular canal between - S6 and - S6. There was no significant difference in the sagittal direction of the mandibular canal between - S6, S5 and S6. The lateral displacement of the left and right mandibular canals on the coronal section of C1 was 0.34 (+ 0.09mm) and 0.44 (+ 0.08mm). The lateral displacement of the left and right canals on the coronal section of C2 was 0.22 (+ 0.07 mm) and 0.29 (+ 0.08mm). The lateral displacement of the left and right canals on the coronal section of C3 was 0.13 (+ 0.06mm) and 0.15 (+ 0.07 mm) respectively. The lateral displacement of the left and right canals on the coronal section were 0.13 (+ 0.06mm) and 0.14 (+ 0.07 mm) respectively. The lateral displacement of the left and right canals on the coronal section were 0.13 (+ 0.06mm) and 0.14 (+ 0.07 mm) respectively. There were lateral displacements of the left and right canals of the mandible in all coronal sections. The lateral displacement of the mandibular nerve canal was greater than that of the nerve canal in the mandibular body. (2) In the vertical and sagittal directions, the mandibular nerve canal was stable in the anterior part of the mandible near the mandibular foramen, and in the mandible near the ascending branch and the mandibular part. The neural tube is significantly moving forward and downward.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783.5

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