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系統識別號 U0026-2708201411513400
論文名稱(中文) 新式三維影像分析對正顎手術治療計畫訂定及結果之影響
論文名稱(英文) A novel 3D image analysis leading to different treatment planning and outcome in orthognathic surgery
校院名稱 成功大學
系所名稱(中) 口腔醫學研究所
系所名稱(英) Institute of Oral Medicine
學年度 102
學期 2
出版年 103
研究生(中文) 林廷宣
研究生(英文) Ting-Shuan Lin
學號 t46001067
學位類別 碩士
語文別 英文
論文頁數 46頁
口試委員 口試委員-方晶晶
口試委員-姚宗珍
指導教授-王東堯
指導教授-劉佳觀
中文關鍵字 正顎手術  顏面不對稱  新式三維立體影像分析 
英文關鍵字 Orthognathic surgery  Facial asymmetry  3D CT navigation 
學科別分類
中文摘要 傳統的側面和後前向測顱分析的二維平面影像分析有兩個主要的問題:一、將三維立體結構以投影方式在二維平面成像會產生影像放大、重疊等問題,二、利用二維平面影像去分析顏面不對稱是十分困難的。二維影像分析搭配傳統三維模型來模擬正顎手術,因為有上述的限制,加上模型與二維影像的連結不足,並無法提供我們足夠的資訊診斷分析及訂定合適的治療計畫,尤其是顏面不對稱病人的下顎骨角的變化。三維立體影像分析的發展,不但令我們更加了解整個顎顏面的立體結構,也大大的補強了二維影像分析的不足,而且三維立體影像分析軟體可以重建整個顎顏面的立體結構及提供一個更精準的顏面對稱分析及預測;因此三維立體影像分析被廣泛的使用在正顎手術的病人身上,我們也發展了一套三維立體影像分析及預測系統。本研究的目的是要比較正顎手術的病人經由二維平面影像分析及三維立體影像分析對於治療計畫及治療結果的影響。本實驗的樣本是在成大醫院接受正顎手術的病人,這個實驗分成兩個部份,第一個部份是要比較正顎手術病人同時接受二維平面影像分析及三維立體影像分析所得的治療計畫之間的差異,第二部份則是要比較顏面不對稱的正顎手術病人,由二維或三維分析所定之不同治療計畫,經由分析正顎手術病人手術後的照片,後前向測顱分析及側面測顱分析之差異,比較二維及三維分析所定治療計畫對術後顏面對稱及骨頭穩定程度的差異。第一個部份比較治療計畫之間的差異收集到十八位病人的資料,二維平面影像分析及三維立體影像分析所得的治療計畫在上顎骨垂直方向,下顎骨前後向移動在統計上有顯著的差異。第二部份比較顏面不對稱的正顎手術病人手術結果,目前收集到各十位病人的資料,後前向測顱分析顯示新式三維影像術後和傳統二維平面影像分析術後結果在左右兩側 Ag plane angle統計上有顯著的差異,新式三維影像術後左右兩側 Ag plane angle較對稱,而在照片及側面測顱分析顯示新式三維影像術後和傳統二維平面影像分析術後顏面對稱及骨頭穩定程度並無顯著差異,結論為三維立體影像分析與二維平面影像分析的比較,在治療計畫於上顎骨垂直方向,下顎骨前後向移動在統計上有顯著的差異;而新式三維影像術後在下顎骨角對稱度較佳。
英文摘要 Two basic problems have been associated with traditional 2D cephalometry. First, 2D cephalometry is a 2D representation of 3D structures and is subjected to systematic errors such as magnification and projection error. Second, conventional cephalometry is difficult to evaluate patients with facial asymmetry. 2D image could not give us sufficient information to diagnose and determine a suitable treatment plan, especially to identify the mandibular angle of facial asymmetry patients even though it has combined with 3D dental casts. This is due to the above-mentioned limits of 2D image and poor connection between 2D image and dental casts. The development of 3D CT not only made us more understand the 3D nature of facial structures but also improved the insufficiency of 2D image. In addition, 3D CT navigation system software enables 3D reconstruction and provides a more accurate facial symmetry image analysis and prediction. Our department also developed a software system of 3D image analysis and prediction. The aim of the study is to know how 2D and 3D image analysis affect the treatment plans and outcome of orthognathic surgery patients. The samples in the study are patients who had orthognathic surgery in NCKUH. The study is divided into two parts. The first part is to compare the treatment plans derived from 2D and 3D image analysis simultaneously in the same patient. The second part is to compare the post treatment photographs, PA cephalometry and lateral cephalometric radiographs to identify the different treatment outcome of facial asymmetry patients with treatment plans derived from 2D or 3D image analysis individually. In first part, 18 patients were collected. Significant differences were observed in vertical movement of maxilla and sagittal movement of mandible between conventional and novel 3D treatment plans. In second part, 10 patients in each group were collected. Evaluation of post-surgical symmetry made in PA cephalograms, the Ag plane angle could be corrected better by using novel 3D method. The evaluation of postoperative facial symmetry in photographs, the faces were symmetrical in both groups. There was almost no statistical significant difference of postoperative skeletal stability between conventional and novel 3D groups. In conclusion, significant differences were observed in vertical movement of maxilla and sagittal movement of mandible between conventional and novel 3D treatment plans, and there was a significant difference in postoperative symmetry of Ag plane angle between conventional and novel 3D treatment outcome.
論文目次 Chapter 1 Introduction…………………………………………………………….1
Chapter 2 Materials and methods………………………………………………….3
2-1 Subjects………………………………………………………………………..3
2-2 Methods………………………………………………………………………..7 2-2-1 Surgical plan…………………………………………………………………7
2-2-1-1Conventional method………………………………………………………9
2-2-1-2 Novel 3D planning and prediction method…...………………………......11
2-2-2 Analysis of data……………………………………………………………..15
2-2-2-1 Dental cast Measurement…………………………………………………15
2-2-2-2 Cephalometric Measurement……………………………………………..15
2-2-2-3 Photographic Measurement………………………………………………17
2-2-2-4 Lateral Cephalometric Measurement…………………………………….18
2-2-3 Statistical Analysis……………………………………………………….....19
Chapter 3 Results…………………………………………………………………20
3-1 Differences of treatment planning……………………………………………20
3-1-1 Differences of surgical procedures…………………………………………20
3-1-2 Differences of jaw movement direction……………………...……………21
3-1-3 Differences of jaw movement distance ……………………………………21
3-2 Differences of surgical outcome…………………………………………….24 3-2-1 Evaluation of postoperative symmetry made in PA cephalograms…………24
3-2-2 Evaluation of post-surgical symmetry made in photographs…………...…..29
3-2-3 Post-surgical skeletal stability……………………………………………....31
3-2-3-1 Changes before and after surgery (T2-T3)……………………………….33
3-2-3-2 Changes from post-operative (T3) to completion of treatment…………..34
Chapter 4 Discussion……………………………………………………………...36
4-1 Differences of treatment planning……………………………………………36
4-1-1 Differences of surgical procedures…………………………………………36
4-1-2 Differences of jaw movement direction……………………………………37
4-1-3 Differences of jaw movement distance ……………………………………37
4-2 Differences of treatment planning……………………………………………38
4-2-1 Evaluation of post-operative symmetry in PA cephalograms………………38
4-2-2 Evaluation of post-surgical symmetry made in photographs………………40
4-2-3 Post-surgical skeletal stability………………………………………………40
Chapter 5 Conclusion……………………………………………………………..42
References…………………………………………………………………………43
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