基于瞳孔中点的[牙合]平面横向倾斜诊断的准确性研究

An accuracy study of a clinical method to identify transverse occlusal cant based on the pupil midpoint

目的验证基于瞳孔中点的[牙合]平面横向倾斜测量方法的诊断效果。方法选取49名患者,测量患者双侧瞳孔中点到上颌[牙合]平面的垂直距离之差作为[牙合]平面横向倾斜的临床测量值,拍摄全头颅CBCT,头位校准后选取颧额缝内侧点(FZ),眶上点(Sor),眶下点(Ior)到同侧第一磨牙近中颊尖(U6)的垂直距离,计算差值获得FZ倾斜、Sor倾斜、Ior倾斜。以倾斜值≥2 mm视为该指标阳性,若CBCT测量所得三个倾斜数据中有两个数值同时≥2 mm确诊为[牙合]平面横向倾斜阳性(CBCT倾斜(+))。对比临床倾斜和CBCT倾斜评价临床瞳孔测量法的准确性。结果49名患者CBCT倾斜(+)为49.0%,瞳孔测量法所得临床倾斜(+)为53.1%。瞳孔测量法与CBCT测量法的诊断情况一致(P=0.754),诊断结果的一致性一般(Kappa=0.592±0.115)。结论基于瞳孔的倾斜测量法可用于对[牙合]平面横向倾斜患者的初步筛查,对[牙合]平面横向倾斜的精确测量还需结合CBCT。

Objective To investigate the inspection effect of a clinical cant detective method by comparing the bilateral vertical distances from the pupil midpoint to the transverse occlusal plane.Methods Forty-nine patients participated in the study.For physical examination,the clinical cant was determined by calculating the abstract difference between bilateral vertical distance from the pupil midpoint to the transverse occlusal plane.The skeletal cant was measured from three different landmarks around the orbit.After CBCT was taken,Ior cant,FZ cant and Sor cant were calculated for the absolute difference of vertical distances from the specific landmarks to the U6.If the cant value was equal to or greater than 2 mm,this cant was regarded as positive.The golden standard of existing cant is two out of three skeletal cants reaching or passing 2 mm(CBCT cant(+)).By comparing the clinical cant with the skeletal cants,the accuracy of this clinical method was evaluated.Results The overall CBCT cant positive rate was 49.0%with clinical cant positive rate 53.1%.McNemar test revealed no significant difference between the clinical cant and the CBCT cant(P=0.754).Consistency check showed Kappa=0.592±0.115,with medium consistency.Conclusion The cant detective method based on pupil midpoint can be used as a screen examination,but for the real cant diagnosis the CBCT measurements are necessary.