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研究生:張瑞青
研究生(外文):Zwei-Chieng Chang
論文名稱:面罩治療發育中骨性三級異常咬合病患的顱顏幾何形態學分析
論文名稱(外文):Morphometric Analysis of Treatment Effects of Face Mask Therapy on Skeletal Class III Malocclusion
指導教授:張心涪張心涪引用關係
指導教授(外文):Hsin-Fu Chang
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:臨床牙醫學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:99
中文關鍵詞:骨擴張器面罩薄板仿樣分析普氏疊合分析應變張量分析法三級異常咬合主應變軸方向
外文關鍵詞:face maskProcrustes analysisthin-plate spline analysispalatal expanderstrain tensor analysisClass III malocclusionmaximum and minimum principal extensions
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黃種人孩童的三級異常咬合罹患率高於白種人,對於上顎後縮伴隨著正常或些微下顎骨前突所造成的三級異常咬合,臨床上經常採取面罩配合腭骨擴張器做早期骨性矯治治療。由於幾何形態測量學比傳統測顱分析能更有效地提供生物形態的整體與局部變化特徵及差異部位,並可以利用圖形來表示不同形態間的差異,本研究的目的是利用新式幾何形態測量法來探討使用面罩治療發育中骨性三級異常咬合病患的顱顏形態變化。
研究材料方面,樣本選自歷年來曾在台大醫院齒顎矯正科接受過面罩治療,符合選取標準且資料完整的病例,其中單獨使用面罩組病例數為15位,使用面罩合併腭骨擴張組病例數亦為15位。控制組是來自一群長期追蹤未曾接受過矯正治療的骨性三級異常咬合年輕病患,以一對一的方式從中比對選擇和治療組的年齡、性別、追蹤時程,以及顱顏形態相符合者作為控制組。研究方法整合了普氏疊合分析、薄板仿樣分析以及應變張量分析法進行治療評估,並根據主應變軸方向畫出骨骼經面罩合併或不合併腭骨擴張治療後的變化走向。
本研究以普氏疊合分析的F-檢定檢測結果發現,治療前以及治療後單獨使用面罩組和面罩合併腭骨擴張這兩組的顱顏形態變化極相似,因此把這兩個治療組合併為一個單一的治療組,病例數共計為30,來作後續的分析。經面罩治療後無論在顱底、中臉部以及下顎骨皆有明顯的整體與局部形狀變化和尺寸改變。
本研究可歸納以下結論:1. 單獨使用面罩治療組和使用面罩合併腭骨擴張治療組顱顏形態變化極為相似。2. 薄板仿樣分析法顯示面罩治療使鼻上顎複合體位置前移、長度增加,腭平面逆時針旋轉,下顎骨順時針旋轉扭曲,髁頭向前上生長,下顎聯合區及頦部受到抑制,顱底也有逆時針方向的扭曲變形。3. 利用有限元素分析法可以很明確的看出經面罩治療顱底、中臉部以及下顎骨局部形狀與尺寸的變化量。4. 單獨使用面罩治療組和使用面罩合併腭骨擴張組二者治療療效在統計學上雖然沒有顯著差異,不過合併面罩合併腭骨擴張器治療者可能在較短的時程內達到臨床上滿意的療效,牙齒的改變較少,且對顱骨形態的影響有涵誘騆�廣泛區域的傾向。5. 以新式幾何形態分析法來探討面罩的治療療效對於局部區域的變化能以圖式的方法更精確的定位以及量化。目前雖然不能證實這樣的結果真能反應出實際生物的機制,但相信能夠輔助傳統測顱分析法的不足。
The prevalence of Class III malocclusion among oriental population is much higher than among Caucasians. For the growing patients who suffer from maxillary retrognathia without or with mild mandibular prognathism, face mask therapy proves to be a promising way for treatment. Newer geometric morphometric methods for shape comparisons are preferable to conventional cephalometry in that they provide explanatory visualization of shape changes and that they highlight regions of localized dissimilarity. The purpose of this study was to investigate the treatment effects of the face mask therapy by means of morphometric techniques.
Thirty children who had been treated with face masks (15 combined with palatal expanders and 15 without) at the Orthodontic Department of National Taiwan University Hospital were compared with a group of thirty sex-matched, age-matched, observation period-matched, and craniofacial configuration-matched subjects with untreated Class III malocclusions. Average geometries, scaled to an equivalent size, were generated by means of Procrustes analysis, and these configurations were statistically tested for equivalence. Graphical analysis, utilizing thin-plate spline analysis and strain tensor methods, was performed for localization of differences in shape/size changes. Maximum and minimum principal extensions were drawn to express the directions of shape change.
Residuals from the Procrustes analysis were compared by means of an F distribution. Statistically insignificant differences occurred between the two treatment groups (the face mask only group and the face mask combined with palatal expander group) at the pretreatment and the post-treatment stages. Thus the two treatment groups were combined into a single treated group with the sample size of thirty patients. Significant treatment-induced shape/size changes involved the cranial base, the midface, and the mandible.
It is concluded that: 1. the treatment-induced changes of the face mask only group and the face mask combined with palatal expander group did not differ significantly. 2. thin-plate spline analysis revealed that major treatment effects caused by face mask therapy consisted of forward displacement of the nasomaxillary complex, increase maxillary length, counter-clockwise rotation of the palatal plane, downward and backward deformation of the mandible, upward and forward direction of condylar growth, restriction in sagittal advancement of symphysis, and counter-clockwise deformation of the cranial base. 3. strain tensor analysis indicated that the face mask treatment of the Class III malocclusion induced favorable localized size and shape changes in the cranial base, the midface, and the mandible. 4. though statistically insignificant, combined face mask and palatal expansion therapy seemed to achieve satisfactory clinical results in shorter time, have less dental effects, and cause more extensive regional changes in the craniofacial configurations. 5. the use of morphometric procedures in this study not only displayed morphological differences qualitatively but also quantitatively. Though we cannot prove that the results reveal true biological response of the individuals, the morphometric procedures seem to provide a valuable supplement for conventional cephalometric analysis.
目錄

目錄 I
表圖目錄 V
中文摘要 VII
英文摘要 IX


一、前言 1
二、文獻回顧 5
2.1 形態分析法 7
2.2 薄板仿樣分析法 8
2.3 有限元素分法,張量分析法 10
2.4 普氏疊合分析法 13

三、材料和方法 14
3.1 研究材料 14
3.2 研究方法 16
3.3 生物形態統計檢定 16
3.4 圖示分析法 17
3.4.1薄板仿樣分析法 17
3.4.2 有限元素分析法 19

四、研究結果 21
4.1 生物形態統計檢定結果 21
4.2 薄板仿樣分析法分析結果 22
4.2.1 面罩治療合併或不合併腭骨擴張治療前後顱顏形態的變化 22
4.2.2 控制組從T1到T2的顱顏形態變化 23
4.2.3 面罩合併或不合併腭骨擴張的治療療效 23
4.3有限元素分析結果 25
4.3.1 面罩合併或不合併腭骨擴張治療顱底的治療療效 25
4.3.2 面罩合併或不合併腭骨擴張治療中臉部的治療療效 26
4.3.3 面罩合併或不合併腭骨擴張治療下顱骨的治療療效 27
4.4 單獨使用面罩與面罩合併腭骨擴張治療局部形態差異 28
4.4.1 單獨使用面罩組與面罩合併腭骨擴張組顱底治療療效的比較 28
4.4.2 單獨使用面罩組與面罩合併腭骨擴張組中臉部治療療效的比較 29
4.4.3 單獨使用面罩組與面罩合併腭骨擴張組下顎骨治療療效的比較 31

五、討論 33
5.1 傳統測顱分析法與幾何形態分析法之間的差異 33
5.2 普氏疊合分析法以及生物形態統計檢定的應用 34
5.3 控制組樣本選取的考量 35
5.4 其它有關面罩治療的幾何形態學文獻 36
5.4.1 以形狀座標分析法以及張量分析法探討面罩療效 37
5.4.2 以薄板仿樣分析法探討面罩療效 37
5.4.3 這些文獻研究方法的優缺點 38
5.4.4 本研究方法優於其它文獻之處 38
5.5 薄板仿樣分析法的分析結果 39
5.6 有限元素分析法的分析結果 40
5.6.1 顱底 40
5.6.2 中臉部 43
5.6.3 下顎骨 46
5.7 面罩合併與不合併腭骨擴張之差異 49
5.8 面罩治療年齡上的考量 52
5.9 面罩治療性別上的考量 53
5.10 幾何形態分析法的侷限 53
5.11 實驗設計的缺憾 54

六、結論 55

參考文獻 59



表圖目錄


表1、顱顏特徵點之解剖定義 72
表2、3、4普氏疊合分析的F檢定所得結果 75

圖1、尺寸與形狀變化 76
圖2、所選取的解剖特徵點 77
圖3、薄板仿樣分析法中所使用的顱顏特徵點 78
圖4、面罩治療合併或不合併腭骨擴張治療前後的總薄板變化圖 79
圖5、控制組從T0到T1顱顏形態改變的總薄板變化圖 80
圖6、面罩合併或不合併腭骨擴張治療療效的總薄板變化圖 81
圖7A&B、面罩合併或不合併腭骨擴張治療之顱底療效
有限元素分析圖 82
圖7C&D、面罩合併或不合併腭骨擴張治療之顱底療效主應變軸張量變化圖 83
圖8A&B、面罩合併或不合併腭骨擴張治療之中臉部療效有限元素分析圖 84
圖8C&D、面罩合併或不合併腭骨擴張治療之中臉部療效主應變軸張量變化圖 85
圖9A&B、面罩合併或不合併腭骨擴張治療之下顎骨療效有限元素分析圖 86
圖9C&D、面罩合併或不合併腭骨擴張治療之下顎骨療效主應變軸張量變化圖 87
圖10A-D、單獨使用面罩組與面罩合併腭骨擴張組顱底療效的比較:有限元素分析圖 88
圖10E、單獨使用面罩組顱底療效的主應變軸張量變化圖 90
圖10F、使用面罩合併腭骨擴張組顱底療效的主應變軸張量變化圖 91
圖11A-D、單獨使用面罩組與面罩合併腭骨擴張組:中臉部療效的比較有限元素分析圖 92
圖11E、單獨使用面罩組中臉部療效的主應變軸張量變化圖 94
圖11F、使用面罩合併腭骨擴張組中臉部療效的主應變軸張量變化圖 95
圖12A-D、單獨使用面罩組與面罩合併腭骨擴張組:下顎骨療效的比較有限元素分析圖 96
圖12E、單獨使用面罩組下顎骨療效的主應變軸張量變化圖 98
圖12F、使用面罩合併腭骨擴張組下顎骨療效的主應變軸張量變化圖 99
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