自然头位下正常（牙合）人群上气道及舌骨位置的X线头影测量研究

发布时间：2018-05-24 11:02

本文选题：自然头位 + 上气道　；参考：《南方医科大学》2011年硕士论文

【摘要】：阻塞性睡眠呼吸暂停综合征(Obstructive sleep apnea syndrome, OSAS)是指睡眠期间上呼吸道各段反复发生的完全或部分阻塞,从而导致血液中血氧饱和度下降,继而影响到循环、呼吸、神经、内分泌等各大系统的功能。由于其危害比较严重且发病率较高,在临床上逐渐得到重视。 OSAS患者在睡眠期间上气道阻塞可能是上气道解剖结构改变所致。颅骨、颌骨、腭骨、舌骨及其它颌面硬组织形成上气道支架,其位置的改变可影响附着其上或相邻的软组织的位置及张力,从而影响气道的大小和稳定性。上气道结构的异常与OSAS的严重性成正相关,舌骨位置的改变是OSAS发病的一个重要因素。研究OSAS个体上气道及舌骨位置是否异常,就要比对正常样本。故本实验对自然头位下正常(?)人群的上气道及舌骨位置进行X线头影测量研究。目的在自然头位下拍摄61例广东籍无上气道疾患、骨面型正常的正常(?)人群的头颅侧位片,进行头影测量分析及研究,旨在获得广东籍正常殆人群上气道及舌骨的头影测量值,进行性别间对比分析,以供临床参考。材料与方法 1.研究对象对广州市两所职业学院的学生(约7000余人)进行健康体检,选择符合条件的学生61例(男20例,女41例),平均年龄18.77±1.72岁,年龄范围16.00～22.08岁。样本纳入标准是： ①第一恒磨牙及尖牙为中性关系,前牙覆(?)、覆盖关系正常。 ②牙列完整无缺失(除第三磨牙外),上下牙齿排列整齐,咬合良好。 ③面部左右对称,侧貌协调,上下唇在正中位时自然闭合。 ④无正畸或正颌治疗史及悬雍垂腭咽成形术等治疗史。 ⑤无夜间睡眠打鼾及日间嗜睡史,无慢性鼻炎、鼻甲及扁桃体肥大等上呼吸道疾病史,亦无气管炎、哮喘及肺气肿等慢性呼吸系统疾病。 ⑥张口度、开闭口型正常,无颞下颌关节疾病。 ⑦籍贯为广东省,无临床诊断体重超标史、无口呼吸不良习惯史、无头颈部放疗及外伤手术史。 ⑧身体健康,无精神系统疾病。 ⑨所有受试者了解本实验的目的及过程后自愿参加整个实验过程。 ⑩以Brent Hassel等提出的六个颈椎成熟阶段为参照,头颅侧位片中的颈椎成熟指征位于完成阶段,即第二、三和四颈椎的椎体下缘出现深的凹形,第三和第四颈椎的高度大于宽度。 11骨面型正常。I类矢状骨面型：ANB角位于0.7°到4.7°之间。正常型垂直骨面型：GoGn-SN角位于27.3°到37.7。之间。 2.主要材料与仪器 ①德国SIRONA公司Orthophos XG PLUS X光全景机。②中国联想集团C200-畅悦型台式电脑、日本RISE株式会社Winceph7.0头影测量分析软件。③无菌牙科器械：口镜、探针、镊子。75%酒精棉球,消毒干棉球,硫酸钡糊剂等。④头位辅助定位装置：镜子(40cmx25cm),铅锤及铅垂线。 3.研究方法与过程 (1)研究对象的筛查病史采集制定调查问卷表,包括被实验者基本情况(姓名、性别、出生日期、种族、籍贯、身高、体重等),口腔专科病史(有无牙体疾病史、有无正畸或正颌治疗史及悬雍垂腭咽成形术等治疗史、有无口腔科治疗史等)、颌面颈部疾病及外伤史、上呼吸道疾病史、有无夜间睡眠打鼾及日间嗜睡史、全身健康状况、精神心理状况和系统性疾病病史等。临床检查①面部检查：颌面部基本情况,包括颌面部对称性,侧貌情况等。②口内检查：牙齿健康状况、排列情况、咬合关系等。有无腺样体、扁桃体肥大等。③颞下颌关节检查：颞下颌关节在功能运动时有无弹响、疼痛,关节区有无触痛及压痛,开口度大小,有无开口受限,开闭口型是否正常。④X线片检查：头影测量结果显示ANB角位于0.7°到4.7°之间,GoGn-SN角位于27.3°到37.7°之间。 (2)头颅定位侧位X线片的拍摄对研究对象均采用德国SIRONA公司Orthophos XG PLUS X光全景机拍摄头颅侧位片。X线球管距患者的正中矢状平面150cm,线性放大率为11%,在测量分析中输入Winceph7.0头影测量分析软件中予以校正。受试者轻轻原地踏步,做最大幅度的头部前后摆动,逐渐减小摆动幅度直至一个很舒适的位置,即调整头部位于肌肉、韧带放松的位置,也叫做自我平衡位(self-balance position)。注视正前方的镜子,通过视觉校正系统调整两眼平视前方,获得镜位(mirror position),即通常所说的自然头位。耳塞插入时及插入后确保头位不动。嘱受试者不要吞咽,嘴唇轻轻合上,牙齿咬在正中(?)位，，放松,平静自然呼吸,于呼气末时屏气,然后拍摄头颅定位侧位片。因为在呼气末时拍摄可以去除上气道开大肌的代偿作用,从而可以去除肌肉对气管的牵拉作用。拍摄前于研究对象舌背部涂以薄层硫酸钡糊剂,以增强显影。 4.数据资料的获取与处理采用Winceph7.0头影测量分析软件,由作者于一段连续时间内完成全部X线片的定点,测量条件保持不变。采用SPSS13.0统计软件进行统计学分析。所有数据采用均数±标准差表示,应用两独立样本t检验进行性别间测量值统计学差异分析,当方差不齐时,用Satterthwaite近似t检验进行校正。所有患者头颅侧位片测量结束时,从中随机选择30例进行重复测量,以评估测量误差。重复测量与第一次测量相隔四周以上。用配对t检验来检测两次测量的误差。P0.05为差异有统计学意义。结果 1.得到自然头位下61例广东籍正常(?)人群上气道及舌骨位置的X线头影测量值,供临床参考。 2.骨性鼻咽：后鼻棘到蝶鞍点的距离(PNS-S)男性大于女性(t=4.628,P0.001),而后鼻棘到第一颈椎最前点的距离(PNS-Aa)性别间无统计学差异。软组织鼻咽(PNS-ad1、PNS-ad2)男女无显著差异。口咽部软腭尖处前后咽侧壁(P1-P2)的距离男性大于女性(t=2.212,P=0.031),而口咽部最狭窄处前后咽侧壁的距离(Ve1-Ve2)男女间无统计学差异。喉咽部前后咽侧壁距离：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),差异均有统计学意义。 3.软腭与腭平面的角度((PNS-P1)/NL)男女间差异有统计学意义(t=-4.065,P0.001),男性软腭相比女性更为直立。软腭的厚度(SP1-SP2)男性明显大于女性(t=3.161,P=0.002),而软腭长(PNS-P1)男女无明显差异。关于舌的测量结果为：男性舌的长度(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)。代表会厌位置的测量结果为：垂直方向上男性会厌谷最低点到后鼻棘的距离(Val-PNS)大于女性(t=9.246,P0.001),水平方向上：会厌谷最低点到舌骨最前点(Val-H)的距离男性大于女性(t=2.833,P=0.009)；到第三四颈椎前平面距的距离(Val-CVP)男性亦大于女性(t=3.068,P0.003)；会厌谷最低点到下颌骨联合最下后点的距离(Val-Gpost)男性平均值大于女性平均值,但差异无显著性。 4. Val-CVP与SN的比值男女间无显著性差异。Val-H与SN的比值男性大于女性(t=2.190,P=0.038), Val-PNS与SN的比值男性大于女性(t=4.170,P0.001)。 5.除H-Gpost-Bo外舌骨的各个角度男女间均未见显著性差异。H-Bo-Gpost三角中的Gpost角男性比女性大(t=2.583,P=0.012)。 6.舌骨到颈椎的距离男性大于女性：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点(H-Bo) (t=9.589, P0.001)、舌骨到关节点(H-Ar) (t=10.159, P0.001)、舌骨到蝶鞍点(Hm-S) (t=10.606, P0.001)、前颅底平面(H-NSL) (t=9.253,P0.001)、舌骨到到下颌升支平面(H-RL) (t=4.606,P0.001)、舌骨到腭平面(H-NL) (t=7.668, P 0.001)的距离男性大于女性。舌骨到颏下点的距离(H-Me) (t=-2.430, P=0.018)、舌骨最前上点到过颏顶点与下颌平面垂直的线的距离(H-MP/GN) (t=-2.362,P=0.022)男性小于女性,差异有统计学意义。舌骨到下颌骨联合最后点的距离(H-Gpost)、舌骨到颏前点的距离(H-Pg)男性平均值小于女性平均值,但差异不显著。舌骨到下颌平面的距离(H-MP)、舌骨在前颅底平面的垂足与到鼻根点的距离(H-NSLP/N)男女间无显著性差异。 7.男性大于女性、性别间有显著差异的线距与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、结论 1.软组织鼻咽、硬组织鼻咽(PNS-Aa)及口咽最小间隙无性别差异,而男性软腭的厚度、舌的长度及厚度均显著大于女性。会厌在垂直方向上男性更靠下方,而在水平方向上男女无差异。 2.男性舌骨的位置较女性更靠前下方。舌骨平面相对于其它颅面部平面的角度无性别差异,且舌骨平面变异较大。
[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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R766.43;R816.96

【参考文献】