测量正颌外科术后复发率的三维坐标系的建立及复发程度的评价分析

doi:10.12016/j.issn.2096-1456.2022.06.006

口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (6): 419-426.DOI: 10.12016/j.issn.2096-1456.2022.06.006

测量正颌外科术后复发率的三维坐标系的建立及复发程度的评价分析

唐丽(), 何东明, 刘瑶, 刘航航, 朱照琨, 邰岳, 罗恩()

口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院口腔颌面外科,四川成都（610041）

收稿日期:2021-08-30 修回日期:2021-11-27 出版日期:2022-06-20 发布日期:2022-04-15
通讯作者: 罗恩
作者简介:唐丽,医师,博士,Email： 2496318426@qq.com
基金资助:
四川省重点研发项目(2022YFS0038);成都市科技计划项目(2021-YF05-01627-SN)

Establishment of a three-dimensional coordinate system for measuring the recurrence rate after orthognathic surgery and evaluation and analysis of the degree of recurrence

TANG Li(), HE Dongming, LIU Yao, LIU Hanghang, ZHU Zhaokun, TAI Yue, LUO En()

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2021-08-30 Revised:2021-11-27 Online:2022-06-20 Published:2022-04-15
Contact: LUO En
Supported by:
grants from Sichuan Province Key R&D Program(2022YFS0038);Science and Technology Project of Chengdu(2021-YF05-01627-SN)

摘要/Abstract

摘要：

目的建立可精确测量正颌外科术后复发率的三维坐标系,进行复发程度的评价分析。方法选取于某医院口腔正颌外科行正颌手术的患者数据,将其螺旋CT重建三维图像,两位研究者使用多平面辅助定位法分三次定点,通过组内及组间相关系数（intra-and interclass correlation coefficients,ICC）筛选出可重复定位准确的标志点,建立不同坐标系,计算面部不对称指数（asymmetry index,AI）来确定正中矢状面对称性最佳的坐标系,应用此坐标系和侧位片分别测量复发率,评价分析正颌手术的三维复发程度。结果得到可重复定点的11个标志点：N（鼻根点）、K（眶下孔点）、ANS（前鼻棘点）、PNS（后鼻棘点）、Ptm（翼上颌裂点）、Gn（颏顶点）、IZ（颧额缝最外侧点）、MZ（颧额缝最内侧点）、Ms（乳突点）、Cor（喙突点）和Go（下颌角点）,建立了三种坐标系,得出最适合的坐标系为过左侧眶下孔内上缘点、右侧眶下孔内上缘点、双侧耳点中点构成水平面（horizontal plane,HP）,过左侧颧额缝最外侧点、右侧颧额缝最外侧点并垂直于水平面构成冠状面（coronal plane,CP）,过鼻根点并同时垂直于两平面构成中矢状面（sagittal plane,SP）。对112例患者进行复发的二维、三维测量,得出新的三维复发程度评价标准：小于40%低复发,40%~61%中复发,大于61%高复发。结论本研究建立了一种适合测量正颌术后复发率的三维坐标系并得到新的三维复发程度评价标准。为正颌手术效果评估及提高稳定性提供临床试验依据。

关键词: 牙颌面畸形, 正颌外科, Lefort I型骨切开术, 下颌支矢状骨劈开术, 三维测量, 参考坐标系, 复发程度, 复发率, 螺旋CT, 头影测量, 效果评估

Abstract:

Objective To establish a three-dimensional coordinate system that can accurately measure the recurrence rate after orthognathic surgery, and evaluate and analyze the degree of recurrence. Methods Data from patients who underwent orthognathic surgery in a hospital were selected to reconstruct three-dimensional images with spiral CT. The two researchers used the multiplane assisted positioning method to fix the points three times and screened them using intra-andintreclass correlation coefficients (ICC). Reproducible and accurate landmark points were drawn to establish different coordinate systems and calculate the facial asymmetry index (AI) to determine the coordinate system with the best mid-sagittal plane symmetry. This coordinate system and lateral radiographs were used to separately measure the recurrence rate, and evaluate and analyze the three-dimensional recurrence degree of orthognathic surgery. Results Ten landmark points that may be repeatedly fixed were obtained, including N (nasion), K (K point), ANS(anterior nasal spine), PNS (posterior nasal spine), Ptm(pterygomaxillary fissure), Gn (gnathion), IZ(IZ point), MZ (MZ point), Ms (mastoideale), Cor (coronion) and and Go (gonion). Three coordinate systems were established, and the most suitable coordinate system was the upper edge point of the left infraorbital foramen. The inner upper edge of the right infraorbital foramen and both sides of the midpoint of the ear points constituted the horizontal plane (HP), which passed through the outermost point of the left zygomatic frontal suture and the outermost point of the right zygomatic frontal suture and was perpendicular to the horizontal plane to constitute the coronal plane (CP). It was perpendicular to the two planes to form a sagittal plane (SP). Two-dimensional and three-dimensional measurements of recurrence were performed on 112 patients, and new three-dimensional recurrence evaluation results were obtained. Less than 40% had low recurrence, 40% to 61% had moderate recurrence, and greater than 61% had high recurrence. Conclusion This study established a three-dimensional coordinate system suitable for measuring the recurrence rate after orthognathic surgery, obtained a new three-dimensional recurrence evaluation result, and provided a clinical experimental basis for evaluating the effect of orthognathic surgery and improving stability.

Key words: dento-maxillofacial deformities, orthognathic surgery, LeFort I osteotomy, sagittal split ramus osteotomy, three-dimensional measurement, reference coordinate system, recurrence degree, recurrence rate, spiral CT, cephalometric measurement, effect evaluation

中图分类号:

唐丽, 何东明, 刘瑶, 刘航航, 朱照琨, 邰岳, 罗恩. 测量正颌外科术后复发率的三维坐标系的建立及复发程度的评价分析[J]. 口腔疾病防治, 2022, 30(6): 419-426.

TANG Li, HE Dongming, LIU Yao, LIU Hanghang, ZHU Zhaokun, TAI Yue, LUO En. Establishment of a three-dimensional coordinate system for measuring the recurrence rate after orthognathic surgery and evaluation and analysis of the degree of recurrence[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2022, 30(6): 419-426.

图/表 5

表1 定位准确标志点的ICC

Table 1 ICC for positioning accurate landmarks

Landmarks	Intraclass coefficient between groups						Interclass correlation coefficient
Landmarks	X1	Y1	Z1	X2	Y2	Z2	X3	Y3	Z3
N	0.980	0.966	0.999	0.950	0.977	1.000	0.960	0.915	0.980
K	0.999	0.954	1.000	0.956	0.984	0.979	0.972	0.933	0.977
ANS	0.913	0.768	0.960	0.963	0.864	0.960	0.989	0.843	0.963
PNS	0.990	0.926	0.977	0.965	0.970	1.000	0.933	0.990	0.988
Ptm	0.891	0.936	0.999	0.972	0.926	1.000	0.956	0.999	0.871
Gn	0.968	0.841	0.991	0.786	0.885	0.915	0.858	0.998	0.910
IZ	0.980	0.996	1.000	0.949	0.948	0.997	0.950	0.898	0.998
MZ	0.972	0.797	0.673	0.972	0.849	0.871	0.986	0.878	0.885
Ms	0.948	0.798	0.844	0.867	0.797	0.673	0.549	0.865	0.999
Cor	0.833	0.967	0.810	0.898	0.904	0.881	0.901	0.923	0.910
Go	0.856	0.899	0.827	0.912	0.873	0.925	0.931	0.893	0.962

图1 三种复发测量坐标系

Figure 1 Three recurrence measurement coordinate systems a: P1 coordinate system; b: P2 coordinate system; c: P3 coordinate system; PL: left porion; PR: right porion; N: nasion; IZL: left IZ point; IZR: right IZ point; KL: left K point; KR: right K point

表2 三种坐标系的正中矢状面AI指数比较

Table 2 Comparison of the mid-sagittal AI index of the three coordinate systems

Midsagittal plane	AI/mm	Minimum/mm	Maximum/mm
P1	8.39 ± 0.56	2.99	10.67
P2	4.17 ± 3.89	0.44	13.71
P3	6.25 ± 1.33	1.84	10.53

图2 三种坐标系随dGn’增大所对应的AI值

Figure 2 AI values corresponding to the three coordinate systems increasing with dGn’ P1: P1 coordinate system; P2: P2 coordinate system; P3: P3 coordinate system; AI: asymmetry index; dGn’: the average distance from the patient’s Gn point to the sagittal plane in the three coordinate system

图3 二维测量递增排列后对应的三维测量结果

Figure 3 Corresponding three-dimensional measurement results after the two-dimensional measurement is arranged in increments RR: recurrence rate

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测量正颌外科术后复发率的三维坐标系的建立及复发程度的评价分析

Establishment of a three-dimensional coordinate system for measuring the recurrence rate after orthognathic surgery and evaluation and analysis of the degree of recurrence

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