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研究生:謝靜宜
研究生(外文):HSIEH, CHING-I
論文名稱:顳顎關節結構塑性及臨床案例分析應用
論文名稱(外文):Temporomandibular Joint Structural Plasticity and Clinical Case Study
指導教授:李忠興李忠興引用關係
指導教授(外文):LI, CHUNG-HSING
口試委員:張維正莊傳宗
口試委員(外文):CHANG, WEI-JENGCHUANG, CHUAN-CHUNG
口試日期:2020-05-07
學位類別:碩士
校院名稱:國防醫學院
系所名稱:牙醫科學研究所
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:2020
畢業學年度:108
語文別:中文
論文頁數:118
中文關鍵詞:顳顎關節症候群錐狀射束電腦斷層掃描骨質密度骨結構檢測系統
外文關鍵詞:temporomandibular disorders, TMD、、、cone-beam computed tomography, CBCTBone mass density, BMDMethod and system for detection of bone structure
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目錄................................................................Ⅰ
圖目錄.............................................................Ⅲ
附錄目錄..........................................................Ⅷ
中英對照表..........................................................Ⅸ
中文摘要............................................................XV
英文摘要..........................................................XVII
第一章、 緒論........................................................1
第一節、 背景與動機...................................................1
第二節、 研究目的....................................................3
第二章、 文獻探討....................................................4
第一節、 顳顎關節的介紹...............................................4
壹、 顳顎關節解剖構造.......................................4
貳、 顳顎關節的生長.........................................7
參、 顳顎關節的結構塑性.....................................9
第二節、 顳顎關節症候群..............................................11
第三節、 咬合干擾與顳顎關節症候群.....................................13
第四節、 臨床診斷工具................................................15
第三章、 材料與方法..................................................17
第一節、 研究對象....................................................17
第二節、 研究工具....................................................18
第三節、 資料處理與分析..............................................20
第四章、 案例分析結果................................................22
第一節、 案例一......................................................22
第二節、 案例二......................................................26
第三節、 案例三......................................................29
第四節、 案例四......................................................32
第五節、 案例五......................................................35
第五章、 討論........................................................38
第一節、 錐狀射束電腦斷層掃描影像應用的可行性...........................39
第二節、 年齡與性別...................................................41
第三節、 肌肉與咬合...................................................43
第四節、 咬合干擾與髁突型態............................................45
第五節、 骨重塑與髁突型態..............................................46
第六節、 研究限制.....................................................47
第六章、 結論.......................................................49
第七章、 參考文獻....................................................50

圖目錄
圖1:顳顎關節的前視圖.................................................57
圖2:顳顎關節構造示意圖...............................................58
圖3:下顎骨的重塑生長示意圖............................................59
圖4:Harold Frost的力學調控系統假說...................................60
圖5:Moss的功能性基質假說.............................................61
圖6:骨結構檢測系統專利概念............................................62
圖7:資料分析流程圖...................................................63
圖8:骨質密度分析步驟(A~E) ...........................................64
圖9:皮質骨AI圈選條件設定圖............................................65
圖10:人工剔除骨小樑示意圖.............................................65
圖11:骨小樑圈選示意圖.................................................65
圖12:髁突頭部投影分析結果區域示意圖....................................66
圖13:髁突頸部分析結果區域示意圖........................................67
圖14:案例一齒顎全景X光片攝影(A)、顳顎關節三維重組影像(左B1
右C1)及對應軸向視圖(左B2C3) ..........................................68
圖15:案例一顳顎關節圓心分析圖.........................................69
圖16:案例一顳顎關節矢狀分析圖.........................................70
圖17:案例一顳顎關節冠狀分析圖.........................................71
圖18:案例一下顎骨髁突頭部皮質骨經軟體演算並以全彩色層呈現骨
質密度差異之分布圖像(顏色區塊).........................................72
圖19:案例一下顎骨右側(R)及左側(L)髁突頸部皮質骨經軟體演算並
以全彩色層呈現骨質密度差異之分布圖像....................................73
圖20:案例一下顎骨右側(R)及左側(L)髁突頸部骨小樑經軟體演算並
以全彩色層呈現骨質密度差異之分布圖像....................................74
圖21:案例一下顎骨右側(R)及左側(L)髁突頸部經軟體演算並以全彩
色層呈現骨質密度差異之分布圖像.........................................75
圖22:案例二齒顎全景 X光片攝影(A)、右側顳顎關節X光影像(B)、
左側顳顎關節X光影像(C) ...............................................76
圖23:案例二顳顎關節圓心分析圖.........................................77
圖24:案例二顳顎關節矢狀分析圖......... ...............................78
圖25:案例二顳顎關節冠狀分析圖.........................................79
圖26:案例二下顎骨髁突頭部皮質骨經軟體演算並以全彩色層呈現骨
質密度差異之分布圖像(顏色區塊).........................................80
圖27:案例二下顎骨右側(R)及左側(L)髁突頸部皮質骨經軟體演算並
以全彩色層呈現骨質密度差異之分布像......................................81
圖28:案例二下顎骨右側(R)及左側(L)髁突頸部骨小樑經軟體演算並
以全彩色層呈現骨質密度差異之分布圖像................................... 82
圖29:案例二下顎骨右側(R)及左側(L)髁突頸部經軟體演算並以全彩
色層呈現骨質密度差異之分布圖像.........................................83
圖30:案例三齒顎全景X光片攝影(A)、測顱分析術的後前視圖(B)、
測顱分析術外側視圖(C)及雙側顳顎關節X光攝影(D) ..........................84
圖31:案例三右側顳顎關節X光影像(A)、左側顳顎關節X光影像(B)、
右側顳顎關節冠狀切面(C)及左側顳顎關節冠狀切面(D) .......................85
圖32:案例三顳顎關節圓心分析圖.........................................86
圖33:案例三顳顎關節矢狀分析圖.........................................87
圖34:案例三顳顎關節冠狀分析圖.........................................88
圖35:案例三下顎骨髁突頭部皮質骨經軟體演算並以全彩色層呈現骨
質密度差異之分布圖像(顏色區塊).........................................89
圖36:案例三下顎骨右側(R)及左側(L)髁突頸部皮質骨經軟體演算並
以全彩色層呈現骨質密度差異之分布圖像....................................90
圖37:案例三下顎骨右側(R)及左側(L)髁突頸部骨小樑經軟體演算並
以全彩色層呈現骨質密度差異之分布圖像....................................91
圖38:案例三下顎骨右側(R)及左側(L)髁突頸部經軟體演算並以全彩
色層呈現骨質密度差異之分布圖像.........................................92
圖39:案例四齒顎全景 X光片攝影(A)、測顱分析術的後前視圖(B)、
測顱分析術外側視圖(C) ................................................93
圖40:案例四顳顎關節圓心分析圖.........................................94
圖41:案例四顳顎關節矢狀分析圖.........................................95
圖42:案例四顳顎關節冠狀分析圖.........................................96
圖43:案例四下顎骨髁突頭部皮質骨經軟體演算並以全彩色層呈現骨
質密度差異之分布圖像(顏色區塊).........................................97
圖44:案例四下顎骨右側(R)及左側(L)髁突頸部皮質骨經軟體演算並
以全彩色層呈現骨質密度差異之分布圖像....................................98
圖45:案例四下顎骨右側(R)及左側(L)髁突頸部骨小樑經軟體演算並
以全彩色層呈現骨質密度差異之分布圖像....................................99
圖46:案例四下顎骨右側(R)及左側(L)髁突頸部經軟體演算並以全彩
色層呈現骨質密度差異之分布圖像........................................100
圖47:案例五齒顎全景 X光片攝影(A)、測顱分析術的後前視圖(B)、
測顱分析術外側視圖(C)及雙側顳顎關節 X光攝影(D).........................101
圖48:案例五右側顳顎關節X光影像(A)、左側顳顎關節X光影像(B)、
右側顳顎關節冠狀切面(C)及左側顳顎關節冠狀切面(D).......................102
圖49:案例五顳顎關節圓心分析圖........................................103
圖50:案例五顳顎關節矢狀分析圖........................................104
圖51:案例五顳顎關節冠狀分析圖........................................105
圖52:案例五下顎骨髁突頭部皮質骨經軟體演算並以全彩色層呈現骨
質密度差異之分布圖像(顏色區塊)........................................106
圖53:案例五下顎骨右側(R)及左側(L)髁突頸部皮質骨經軟體演算並
以全彩色層呈現骨質密度差異之分布圖像...................................107
圖54:案例五下顎骨右側(R)及左側(L)髁突頸部骨小樑經軟體演算並以
全彩色層呈現骨質密度差異之分布圖像.....................................108
圖55:案例五下顎骨右側(R)及左側(L)髁突頸部經軟體演算並以全彩
色層呈現骨質密度差異之分布圖像........................................109
圖56:五個案例下顎骨右側(R)及左側(L)髁突頸部皮質骨骨質密度差異
之分布圖像..........................................................110
圖57:顳顎關節活動示意圖.............................................112
圖58:五個案例下顎骨右側(R)及左側(L)髁突頸部骨小樑骨質密度差異
之分布圖像..........................................................113
圖59:五個案例下顎骨右側(R)及左側(L)髁突頭部吸收及皮質骨較厚區
域示意圖............................................................114

附錄目錄
附錄一:人體試驗計畫同意函............................................115
附錄二-1:骨結構檢測分析軟體專利證明文件(美國) ........................116
附錄二-2:骨結構檢測分析軟體專利證明文件(台灣) ........................118



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