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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (1): 90-96. doi: 10.19723/j.issn.1671-167X.2020.01.014

• 论著 • 上一篇    下一篇

Delaire头影测量分析法预测正颌手术患者上颌及颏部理想矢状向位置的可行性评估

孙现涛,何伟,刘筱菁,李自力(),王兴   

  1. 北京大学口腔医学院·口腔医院,口腔颌面外科 国家口腔疾病临床医学研究中心 口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室, 北京 100081
  • 收稿日期:2019-10-10 出版日期:2020-02-18 发布日期:2020-02-20
  • 通讯作者: 李自力 E-mail:kqlzl@sina.com
  • 基金资助:
    北京市科学技术委员会“首都特色临床应用研究”项目(Z181100001718130)

Feasibility of Delaire cephalometric analysis to predict the ideal sagittal position of the maxilla and chin for surgery-first patients in orthognathic surgery

Xian-tao SUN,Wei HE,Xiao-jing LIU,Zi-li LI(),Xing WANG   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2019-10-10 Online:2020-02-18 Published:2020-02-20
  • Contact: Zi-li LI E-mail:kqlzl@sina.com
  • Supported by:
    Supported by the Clinical Research Projects of Beijing Municipal Science & Technology Commission(Z181100001718130)

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摘要：

目的:对于使用传统头影测量分析法辅助、并采用手术优先方式治疗的骨性Ⅲ类畸形患者,本研究使用Delaire头影测量分析法回顾性分析患者治疗前后颌骨矢状向位置变化,评估Delaire头影测量分析法预测上颌骨及颏部矢状向理想位置的可行性。方法: 纳入符合标准的骨性Ⅲ类畸形患者共35例,收集治疗前(T0),治疗结束后(T1)的定位头颅侧位片、侧位面相和三维面部照片资料;使用Dolphin Imaging软件测量分析上颌鼻腭点(NP)、颏部颏下点(Me)矢状向位置参考线L1、L2与颅底前线(C1)的夹角∠C1-L1、∠C1-L2等头影测量数据;由正颌、正畸专业医生各4名,以及4名非医学专业大学生对患者侧貌美学以视觉模拟评分(visual analogue scale,VAS)的方式进行评分,对结果行统计学分析。结果: T0期男性:∠C1-L1=80.85°±3.81°,∠C1-L2=89.37°±4.10°;女性: ∠C1-L1=82.87°±4.25°,∠C1-L2=89.69°±4.95°;T1期男性:∠C1-L1=83.93°±2.99°,∠C1-L2=89.08°±2.48°,女性:∠C1-L1=85.67°±3.60°,∠C1-L2=88.30°±4.20°。男女患者T0期测量值与中国美貌人群参考值比较,差异均有统计学意义;T1期上颌NP点测量值与中国美貌人群比较,差异无统计学意义;T1期颏部Me点与中国美貌人群比较,相对靠前,差异具有统计学意义。侧貌美学评分结果,男性、女性T1期上颌、颏部和整体的评分均较T0期有提高,差异具有统计学意义。结论: Deliare头影测量分析法有助于更准确分析患者颌骨畸形状态,能够很好地反映患者治疗后上颌骨和颏部矢状向位置,可以帮助预测颌骨理想的矢状向位置,有望成为制定手术优先正颌手术方案的重要预测方法。

关键词: 头影测量分析法, 正颌外科, 手术优先

Abstract:

Objective: There is no universally accepted method for determining the ideal sagittal position of the maxilla in orthognathic surgery. The purpose of this study was to compare how well the Delaire’s cephalometric analysis correlated with postoperatively findings in patients who underwent orthognathic surgery planned using other cephalometric analyses,as well as to evaluate the feasibility of the Delaire’s cephalometric analysis in predicting the ideal sagittal position of the maxilla and chin. Methods: In the study, 35 patients with skeletal Class Ⅲ malocclusion were involved and met the criteria. Treatment plans were developed using photographs, 3-D photographs,radiographs, and standard cephalometric measurements. The Delaire’s cephalometric analysis data, like the phase measurements (∠C1-L1 and ∠C1-L2) of the sagittal positions of the maxillary and the chin separating the reference line (L1) of NP point and the reference line (L2) of Me point, were analyzed using Dolphin Imaging software. At the same time, the analyses on standard measurements were also performed. Four orthognathic doctors, 4 orthodontic doctors and 4 college students from non-medical majors were selected as aesthetic evaluators to assess the patients’ profile aesthetic by visual analogue scale (VAS). The results through the Delaire’s cephalometric analysis were statistically compared with that through standard methods. Results: The mean of ∠C1-L1 was 83.93°±2.99°and∠C1-L2 was 89.08°±2.48° for males postoperatively, and 85.67°±3.60° and 88.30°±4.20°for females postoperatively. Compared with the reference values of Chinese good-looking people, there was no significant difference of NP point, whereas there was a significant difference of Me point. The postoperative aesthetic scores were: the mean was 6.71±0.25 of upper jaws, 6.81±0.30 of chins and 6.90±0.29 of the overall for males; and 7.19±0.22, 7.26±0.34 and 7.39±0.29 for females. Compared with preoperative scores, there was a significant improvement. Furthermore, the scores of chins and the overall scores were related to the sagittal position of the chins. Conclusion: Compared with standard cephalometric analysis, the Deliare’s cephalometric analysis well unravel the preoperative deformity and the final esthetic sagittal positions of maxillary and chin in the present sample, and could be a useful tool for the planning of surgery-first approach in orthognathic surgery.

Key words: Cephalometric analysis, Orthognathic surgery, Surgery-first

中图分类号: 

  • R782.2

图1

Delaire头影测量分析法的标志点和线"

图2

传统头影测量分析法中的标志点及线"

图3

患者T0、T1侧貌美学评价"

表1

患者SNA及SNB角度值"

Items SNA/(°) SNB/(°) t P
Male 82.00±2.66 84.30±2.87 -2.996 0.030
Female 82.29±3.54 84.16±4.89 -3.319 0.003
t -0.191 0.070
P 0.850 0.945

表2

T0期患者SNA和SNB与正常参考值比较"

Items SNA/(°) Reference value/(°) t P SNB/(°) Reference value/(°) t P
Male 82.00±2.66 83 -0.922 0.399 84.30±2.87 80 3.675 0.014
Female 82.29±3.54 83 -1.076 0.291 84.16±4.89 80 4.576 <0.001

表3

T0期患者的NP点和Me点矢状向位置"

Items ∠C1-L1/(°) ∠C1-L2/(°) t P
Male 80.85±3.81 89.37±4.10 -6.776 0.001
Female 82.87±4.25 89.69±4.95 -10.188 <0.001
t -0.625 0.010
P 0.536 0.992

表4

患者T0和T1期∠C1-L1和∠C1-L2与正常参考值比较"

Items ∠C1-L1/(°) Reference value/(°) t P ∠C1-L2/(°) Reference value/(°) t P
T0 Male 80.85±3.81 85 -2.665 0.045 89.37±4.10 85 2.612 0.048
Female 82.87±4.25 85 -2.700 0.012 89.69±4.95 85 5.095 <0.001
T1 Male 83.93±2.99 85 -0.874 0.422 89.08±2.48 85 4.041 0.010
Female 85.67±3.60 85 1.005 0.324 88.30±4.20 85 4.251 <0.001

表5

患者T0、T1切牙交角(U1/L1)与法国正常人群参考值比较"

Items Male Female
U1/L1/(°) French reference t P U1/L1/(°) French reference t P
T0 127.22±7.35 135 2.595 0.049 133.73±8.92 135 -0.766 0.450
T1 128.43±4.20 135 3.833 0.012 129.08±5.64 135 -5.652 <0.001

表6

患者T0、T1期侧貌美学评分对比结果"

Items Male Female
T0 T1 t P T0 T1 t P
Maxillary 3.52±0.41 6.71±0.25 14.87 <0.001 3.80±0.57 7.19±0.22 24.93 <0.001
Chin 3.35±0.37 6.81±0.30 14.72 <0.001 3.89±0.57 7.26±0.34 25.66 <0.001
Overall 3.39±0.43 6.90±0.29 16.97 <0.001 3.76±0.66 7.39±0.29 24.85 <0.001

表7

男性患者T1期NP、Me矢状向位置角度与侧貌美学评分相关性"

Items NP(∠C1-L1-85°) Me(∠C1-L2-85°) NP/Me(L1-L2)
Pearson P Pearson P Pearson P
Maxillary -0.014 0.979 -0.238 0.659 0.394 0.440
Chin 0.492 0.321 -0.754 0.084 0.284 0.586
Overall -0.330 0.524 -0.612 0.196 0.382 0.455

表8

女性患者T1期NP、Me矢状向位置与侧貌美学评分相关性"

Items NP(∠C1-L1-85°) Me(∠C1-L2-85°) ∠L1-L2
Pearson P Pearson P Pearson P
Maxillary 0.272 0.154 -0.402 0.031 0.287 0.131
Chin 0.462 0.012 -0.550 0.002 0.258 0.176
Overall 0.382 0.041 -0.493 0.007 0.280 0.141
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