【作者】 余乔立；

【导师】 王洪涛；

【作者基本信息】 广州医学院 ， 外科学， 2011， 硕士

【摘要】 唇(腭)裂治疗效果的评价一直以来都是唇(腭)裂研究的热点,但对适宜的评价方法、标准和体系却至今没有定论。随着各种三维成像技术的出现和发展,三维成像和测量被认为是唇(腭)裂评价中最有前景的评价手段和方法。本研究应用国内自行研发生产的手持式三维扫描仪对18例单侧唇裂患者颌面部进行三维扫描测量分析,探讨三维扫描测量的有效性和重复性以及它在唇裂定量评价中的应用。用手持式三维扫描仪对18例单侧唇裂患儿在术前1天和术后1个月分别进行颌面部三维扫描,对所获取三维图像的鼻唇部测量标志点进行定点、测量并记录数据。同时,在术前对所有患儿同一鼻唇部标志点进行直接测量并记录数据。所有测得的数据用SPSS13.0统计软件进行统计分析。以准确性和误差两个指标评价三维扫描测量的有效性;以可靠性和精确性两个指标评价三维扫描测量的重复性。并以术前、术后各测量指标健患侧比值的差异及术后各测量指标的非对称率评价唇裂修复手术的效果。应用手持式三维扫描仪进行三维扫描测量,所有测量指标的测量值与直接测量值高度相关,各相关系数的均数为0.92;三维扫描测量和直接测量各测量指标结果间的差异无统计学意义;三维扫描测量具有很高的可靠性和精确性,重复测量值间相关系数的均数为0.95,而重复测量值间的差异则均在0.1mm以内。18例唇裂患儿所有测量指标中,除鼻翼口角距外,其余各测量指标术前、术后健患侧比值的差异均有统计学意义,而除鼻小柱高度外,各测量指标的非对称率也均在正常人颌面部非对称率范围内。本研究结果表明,用手持式三维扫描仪进行三维扫描测量,与直接测量相比,有效性高、重复性强,可随时进行反复、精确的测量,对于唇(腭)裂术前、术后的对照研究及颌面部畸形的形态学研究有重大意义,并可在低年龄组患儿中应用。而手持式三维扫描仪也可应用在唇(腭)裂术后定量评价中,评价测量值是否处于正常参考值范围内以及左右侧结构是否对称,并由此对手术效果做出判断。而手持式三维扫描仪由于其成像快速、清晰,测量精确等特点,将来还可应用于人类颌面部特征数据库的建立以及颌面部畸形的模拟手术等领域中。更多还原

【Abstract】 The assessment of treatment outcome of cleft lip and palate repair has been the focused topic of cleft lip (and palate) research for such a long time. However, no agreement has been reached on the issue of evaluation method, standard and system. With the development of three-dimensional imaging technology, three-dimensional image and measurement have been considered as the most promising method in cleft lip and palate assessment. This research use the three-dimensional hand-held scanner to analyze the facial morphology of 18 patients with unilateral cleft lip in order to study the validity and reproducibility of three-dimensional scanning measurement and its application in quantitative study of cleft lip patients.18 patients with unilateral cleft lip were scanned by a three-dimensional hand-held scanner in a day before surgery and a month after surgery accordingly. Anthropometric landmarks both in the cleft and noncleft sides were identified and measured on the three-dimensional images. Direct measurement on the same anthropometric landmarks was done before surgery as well. All the collected data was analyzed by SPSS13.0 statistic software. Validity was defined by accuracy and bias. Reproducibility was defined by reliability and precision. The evaluation of cleft lip repair was defined by the difference between measurements before and after surgery and the asymmetry ratio of all measurement.Using the three-dimensional hand-held scanner to do three-dimensional scanning measurement, all the digital values correlated highly with direct measurement, the mean correlation coefficient was 0.92. The difference between digital values and direct measurement had no statistical significance. Both of the reliability and precision of three-dimensional scanning measurement were high. The mean correlation coefficient of test and re-test measurement was 0.95 and the overall precision of all digital measurement was less than 0.1mm. There were significant differences between all measurements before and after surgery except the height of lateral upper lip. The asymmetry ratios of all measurement were within the normal range except the asymmetry ratio of columella length.The following conclusion can be reached from the result of this research. First, compared with direct measurement, the validity and reproducibility of three-dimensional scanning measurement using a three-dimensional hand-held scanner is high and comparable. It can be applied in the study of facial morphology of congenital defects. And it can even be applied to infants with cleft lip (and palate). Second, three-dimensional hand-held scanner can also be applied in quantitative study of cleft lip (and palate) patients to evaluate if the measurement is within normal range and the symmetry of both sides, so that the assessment of treatment outcome can be concluded. Because of the ability of quick imaging and precise measurement, three-dimensional hand-held scanner can even be applied in the data-base establishment of craniofacial characterization and animation of cleft repair surgery in the future.更多还原