成人骨性Ⅲ类错口咽气道容积大小和舌骨位置的锥形束CT研究

Cone-beam CT study for the oropharyngeal airway volume and hyoid position of adults Class Ⅲ skeletal malocclusion

目的:应用锥形束CT(cone-beam computed tomography,CBCT)和Invivo5软件测量成人骨性Ⅲ类错口咽气道容积大小和舌骨位置,分析上、下颌骨的位置对气道的影响,为正畸临床评估口咽气道容积及舌骨位置提供理论依据。方法:随机筛选CBCT资料,按纳入标准和上、下颌骨矢状位置,将研究对象分为3组,筛选出60例骨性Ⅰ类错作为对照组;将成人骨性Ⅲ类错分为上颌后缩组和下颌前突组,每组60例。采用第三方软件Invivo5将CBCT扫描数据进行三维重建,建立三维坐标系,应用测量工具测量口咽气道及舌骨位置,采用SPSS19.0软件包对上述3组进行两两比较。结果:成人骨性Ⅲ类下颌前突组分别较上颌后缩组、骨性Ⅰ类组口咽气道容积大(P<0.05),但骨性Ⅲ类上颌后缩组与骨性Ⅰ类组口咽气道容积无显著差异(P>0.05);舌骨矢状向位置由前到后为骨性Ⅲ类下颌前突组、骨性Ⅲ类上颌后缩组、骨性Ⅰ类组(P<0.05);舌骨垂直向位置,骨性Ⅲ类下颌前突组显著高于上颌后缩组、骨性Ⅰ类组(P<0.05),但骨性Ⅲ类上颌后缩组与骨性Ⅰ类组无显著差异(P>0.05)。结论:成人不同骨性错畸形上气道三维特征不同,下颌骨矢状位置、长度较上颌骨对口咽气道容积、形态、走向、舌骨矢状位置影响更为显著。CBCT及Invivo5是评价上气道的实用工具,可为正畸临床评估骨性错患者上气道三维结构及舌骨位置、制订合理有效的治疗方案提供指导。

PURPOSE： Using cone-beam CT （CBCT） and Invivo5 software to measure the oropharyngeal airway volume and hyoid position of adults Class Ⅲ skeletal malocclusion and analyze the influence of the maxillary or mandibular position, in order to evaluate oropharynx airway volume and hyoid position ,and provide guidance for reasonable and effective treatment. METHODS： One hundred and eighty cases were randomly selected from CBCT data and divided into three groups. Invivo5 software was used to rebuild 3D image data and establish a 3D coordinate system ,then to measure OPV and hyoid position. LSD t test was performed between each group with SPSS 19.0 software package. RESULTS： OPV for mandibular protrusion of Class ]]I was significantly higher than maxillary retrusion of Class Ⅲ and Class I （P〈 0.05）, whereas no difference existed between Class I and maxillary retrusion of Class Ⅲ ; H-VPS had significant difference as follows： mandibular retrusion of Class Ⅲ, maxillary retrusion of Class 11I ,and Class I （P〈0.05）, H-PS in mandibular protrusion of Class Ⅲ was significantly higher than maxillary retrusion of Class Ⅲ and Class I （P〈0.05）, whereas no difference existed between Class I and maxillary retrusion of Class Ⅲ CONCLUSIONS： The three- dimensional features of airway were different as adults have different types of skeletal malocclusion. The mandibular sagittal position and length had more significant influences on pharyngeal airway volume, shape, direction, and hyoid sagittal position compared with the maxilla. CBCT and Invivo5 are practical tools for evaluation of airway, which can provide clinical evaluation of the three-dimensional features of airway and hyoid position of different skeletal malocclusion, and provide guidance in the formulation of reasonable and effective treatment plan.