X线头影测量分析.ppt

X线头影测量分析线头影测量分析Cephalometrics Analysis Company LogoCompany Logo简介简介简介简介n n 1934年Hofrath and Broadbent 提出n n 我国于20世纪60年代初运用于临床Company LogoCompany Logo 通过测量通过测量通过测量通过测量X X 线头颅定位照相所得的影像线头颅定位照相所得的影像线头颅定位照相所得的影像线头颅定位照相所得的影像,对牙颌、颅面对牙颌、颅面对牙颌、颅面对牙颌、颅面各标志点描绘出一定的线角进行测量分析各标志点描绘出一定的线角进行测量分析各标志点描绘出一定的线角进行测量分析各标志点描绘出一定的线角进行测量分析,从而了解牙颌、从而了解牙颌、从而了解牙颌、从而了解牙颌、颅面软硬组织的结构颅面软硬组织的结构颅面软硬组织的结构颅面软硬组织的结构,使对牙颌、颅面的检查诊断由表面使对牙颌、颅面的检查诊断由表面使对牙颌、颅面的检查诊断由表面使对牙颌、颅面的检查诊断由表面形态深入到内部的骨骼结构中去形态深入到内部的骨骼结构中去形态深入到内部的骨骼结构中去形态深入到内部的骨骼结构中去,它是正畸临床诊断及治它是正畸临床诊断及治它是正畸临床诊断及治它是正畸临床诊断及治疗设计的一种重要手段疗设计的一种重要手段疗设计的一种重要手段疗设计的一种重要手段.X X线头影测量分析线头影测量分析简言之：通过对X片进行分析、测量，从而了解牙颌、颅面骨骼及软组织发育状况及相互关系。Company LogoCompany Logo一、主要应用一、主要应用一、主要应用一、主要应用n n研究颅面生长发育n n牙颌、颅面畸形的诊断分析n n确定错牙合牙合畸形的矫治计划n n研究矫治中，矫治后的变化n n外科正畸的诊断和矫治设计n n下颌功能分析Company LogoCompany Logo1.研究颅面生长发育研究颅面生长发育n n不同个体同一年龄段横向研究颅面发育n n同一个体各年龄段-纵向研究颅面发育 明确了颅面生长发育机制，快速生长期的年龄、及对颅面生长发育的预测。-“颅面生长发育”章节Company LogoCompany Logo通过通过X线对线对正常牙合正常牙合人人的颅面结构进行分析的颅面结构进行分析得出正常牙合的各得出正常牙合的各项测量参考标准项测量参考标准作为诊断分析作为诊断分析的基础的基础2.牙颌、颅面畸形的诊断分析牙颌、颅面畸形的诊断分析Company LogoCompany Logo3.3.确定错确定错确定错确定错牙合牙合牙合牙合畸形的矫治计划畸形的矫治计划畸形的矫治计划畸形的矫治计划对比对比分析出错牙合畸形的机制正常牙颌正常牙颌颅面关系颅面关系个体牙颌个体牙颌颅面结构颅面结构确定牙和颌位的理想位置，制定可行的矫治方案Company LogoCompany Logo4.研究矫治中及矫治后牙颌、颅面的变化研究矫治中及矫治后牙颌、颅面的变化治疗前治疗前正畸治疗正畸治疗治疗中治疗中,矫治后矫治后对比对比Company LogoCompany Logo5.5.外科正畸的诊断和矫治设计外科正畸的诊断和矫治设计外科正畸的诊断和矫治设计外科正畸的诊断和矫治设计n n通过X线对颅面畸形患者进行分析n n得出畸形的机制n n确定手术部位、方法及需要移动或切除的部位Company LogoCompany Logo局限性局限性局限性局限性n n标记点的定位都是相对n n标记时存在个体差异n n存在种族、性别的差异Company LogoCompany Logo1.头颅头颅定位定位X线要求：线要求：n n头颅定位的关键在于：定位仪上左右耳塞与眶点指针，三者构成一与地面平行的恒定平面。定位定位Company LogoCompany Logo2.头影图的描绘头影图的描绘n nX线头影图像上，因头颅本身厚度或个体两侧结构不完全对称而出现的左右影像不完全重合按其平均中点来作描绘Company LogoCompany Logo传统传统X线片线片数字化数字化X线片线片Company LogoCompany Logo 传统手描图传统手描图 数字化描图数字化描图Company LogoCompany Logo常用头影测量标志点常用头影测量标志点n n标志点：用来构成一些平面及测量内容的点1.解剖的，真正代表颅骨的解剖结构2.引伸的，如两测量平面相交的一个标志点定点准确才能获得相应准确的头影测量分析结果！Company LogoCompany Logo标志点标志点 硬组织测量标志点 软组织测量标志点Company LogoCompany Logo1.硬组织测量标志点硬组织测量标志点颅部颅部蝶鞍点（蝶鞍点（S S）鼻根点（鼻根点（N N）机械耳点机械耳点(P)(P)上颌骨上颌骨前鼻棘前鼻棘(ANS)(ANS)上齿槽座点（上齿槽座点（A A）上中切牙点（上中切牙点（U1U1）下颌骨下颌骨下齿槽座点（下齿槽座点（B）下中切牙点（下中切牙点（L1）颏前点（颏前点（Pg）颏下点颏下点(Me)颏顶点颏顶点(Gn)Company LogoCompany Logo额点（额点（G G）鼻小柱点（鼻小柱点（CmCm）鼻下点（鼻下点（SnSn）上唇缘点（上唇缘点（ULUL）下唇缘点（下唇缘点（LLLL）软组织颏前点软组织颏前点(Pgs)(Pgs)软组织颏下点软组织颏下点(Mes)(Mes)颈点（颈点（C C）2.软组织测量标志点软组织测量标志点Company LogoCompany LogoLandmark（定点）Company LogoCompany Logo1.颅部标志点Company LogoCompany Logo定点S(Sella 蝶鞍中心点蝶鞍中心点)Company LogoCompany Logo定点N(Nasion 鼻根点鼻根点)：鼻额缝最前点：鼻额缝最前点Company LogoCompany Logo定点P(Porion耳点耳点）：机械耳点）：机械耳点Company LogoCompany Logo定点颅底点颅底点(Ba,basion）枕骨大孔前缘中点）枕骨大孔前缘中点Company LogoCompany Logo定点Bolton点：枕骨髁突后切迹最凹点点：枕骨髁突后切迹最凹点Company LogoCompany Logo2.上颌标志点Company LogoCompany Logo定点Or(orbitale 眶点眶点)Company LogoCompany Logo翼上颌裂点（翼上颌裂点（Ptm）：翼上颌裂轮廓最下点）：翼上颌裂轮廓最下点Company LogoCompany Logo前鼻棘（前鼻棘（ANS）：前鼻棘之尖）：前鼻棘之尖Company LogoCompany LogoA(Subspinale上齿槽座点上齿槽座点)Company LogoCompany Logo定点UI(Upper incisor上中切牙切端上中切牙切端)Company LogoCompany Logo3.下颌标志点Company LogoCompany Logo定点髁顶点髁顶点(Co):髁突最上点髁突最上点Company LogoCompany Logo定点关节点（关节点（Ar):颅底下缘与下颌髁突颈后缘之交点颅底下缘与下颌髁突颈后缘之交点Company LogoCompany Logo定点Go(Gonion下颌角点下颌角点)：下颌支平面与下颌角下颌支平面与下颌角平面交角之分角线与下颌角的交点平面交角之分角线与下颌角的交点Company LogoCompany LogoB(Supramental下齿槽座点下齿槽座点)Company LogoCompany LogoLI(Lower incisor下中切牙切下中切牙切端端)Company LogoCompany Logo定点Po(Pogonion颏前点颏前点)：颏部最突点：颏部最突点Company LogoCompany Logo定点Me(Menton颏下点颏下点)Company LogoCompany LogoGn(Gnathion 颏顶点颏顶点):颏前点与颏下点之中点颏前点与颏下点之中点Company LogoCompany LogoD点点:下颌体骨性联合部之中心点下颌体骨性联合部之中心点Company LogoCompany Logon第二次实验Company LogoCompany Logo头影测量平面头影测量平面Company LogoCompany Logo1.基准平面(Reference line)：头影测量中相对稳定的平面Company LogoCompany Logon nSN 平面 前颅底平面n nFH 平面Frankfort 平面n nBolton平面 Bolton点与鼻根点连线1.基准平面基准平面Company LogoCompany Logo基准平面基准平面SN plane前颅底平面Company LogoCompany Logo基准平面基准平面FH plane眶耳平面Company LogoCompany Logo基准平面基准平面Bolton平面平面Company LogoCompany Logo基准平面基准平面基准平面基准平面Company LogoCompany Logo测量平面Company LogoCompany Logo测量平面测量平面腭平面(ANS-PNS)Company LogoCompany Logo测量平面测量平面全颅底平面（Ba-N):颅底点与鼻根点连线Company LogoCompany Logo全颅底平面全颅底平面Company LogoCompany Logo测量平面测量平面牙合平面(OP)1:第一磨牙咬合中点于上下切牙间中点连线。2:功能牙合平面：第一恒磨牙及第一乳磨牙或第一前磨牙的牙合接触点Company LogoCompany Logo测量平面测量平面下颌平面（MP）1:通过颏下点于下颌角下缘相切的线Company LogoCompany Logo测量平面测量平面下颌平面（MP）2:下颌下缘最低点的切线Company LogoCompany Logo测量平面测量平面下颌平面（MP）3:下颌角点与下颌颏顶点间连线Company LogoCompany Logo测量平面测量平面下颌支平面(RP):下颌升支及髁突后缘的切线Company LogoCompany Logo测量平面测量平面面平面（面平面（NP)：鼻根点与颏前点连线：鼻根点与颏前点连线Company LogoCompany Logo测量平面测量平面Y轴：蝶鞍中心与颏顶点连线轴：蝶鞍中心与颏顶点连线Company LogoCompany Logo常用硬组织测量项目Company LogoCompany LogoX线头影测量线头影测量 常用于临床对错牙合畸形机制进行分析明确牙齿、牙弓、颌骨、颅面间的关系不调明确牙齿、牙弓、颌骨、颅面间的关系不调测量上、下颌各自的形态、大小和相互间的位测量上、下颌各自的形态、大小和相互间的位置关系及牙齿位置或倾斜度置关系及牙齿位置或倾斜度得出相应诊断得出相应诊断Company LogoCompany Logo通过通过X线对线对正常牙合正常牙合人人的颅面结构进行分析的颅面结构进行分析得出正常牙合的各得出正常牙合的各项测量参考标准项测量参考标准作为诊断分析作为诊断分析的基础的基础前提：前提：正常值的确定Company LogoCompany Logo头影测量分析目的头影测量分析目的头影测量分析目的头影测量分析目的:对比对比分析出错牙合畸形的机制正常牙颌正常牙颌颅面关系颅面关系个体牙颌个体牙颌颅面结构颅面结构确定牙和颌位的理想位置，制定可行的矫治方案Company LogoCompany Logo每一个项目有特定意义说明相应结构的特征或生长变化趋势！每一个项目有特定意义说明相应结构的特征或生长变化趋势！n n必须综合的评价各项测量指标，才能明确畸形机制，作出正确诊断!颅面颅面牙齿、牙弓牙齿、牙弓颌骨颌骨 相互不调，相互不调，产生牙颌畸形产生牙颌畸形互相补偿产生互相补偿产生正常颅面形态正常颅面形态Company LogoCompany Logo n上下颌骨的常用测量项目Company LogoCompany Logo测量内容测量内容SNA angle：反映上颌相对颅骨的前后位置Company LogoCompany Logo测量内容测量内容SNB angle：反映上颌相对颅骨的前后位置Company LogoCompany Logo测量内容测量内容ANB angle：反映上颌相对颅骨的前后位置Company LogoCompany Logo基准平面基准平面NP FH（面角）:反映下颌的突缩程度。此角越大则下颌？相对突度越大Company LogoCompany Logo测量内容测量内容NAPA(颌凸角)：反映上颌相对整个侧面的关系此角越大则上颌？相对突度越大Company LogoCompany Logo测量内容测量内容Y轴角:反映颏部的突缩，也代表面部生长发育方向此角越大则颏部？此角越大则颏部？生长发育方向生长发育方向?颏部后缩颏部后缩垂直生长型垂直生长型Company LogoCompany Logo测量内容测量内容MPFH 下颌平面角：反映1.下颌体陡度2.下颌角大小 3.面高度：短面型/长面型Company LogoCompany Logo 测量内容测量内容ANS-Ptm（上颌长）Company LogoCompany Logo 测量内容测量内容S-Ptm（上颌位置）Company LogoCompany Logo 测量内容测量内容Co-Pog（下颌长）Company LogoCompany Logo 测量内容测量内容S-Co（下颌位置）Company LogoCompany Logo上下前牙常用测量项目Company LogoCompany Logo测量内容测量内容UISN angleCompany LogoCompany Logo测量内容测量内容LI MP angle此角越大则下前牙？唇倾度大Company LogoCompany Logo测量内容测量内容U1NA:上切牙对于前颅底的相对倾斜度Company LogoCompany Logo测量内容测量内容U1NA distance (U1-NA距)Company LogoCompany Logo测量内容测量内容L1NB angleCompany LogoCompany Logo测量内容测量内容L1NB distanceCompany LogoCompany Logo测量内容测量内容U1L1 angle：反映上下前部牙弓的突度。Company LogoCompany Logo测量内容测量内容MPSN angle：与下颌平面角类似Company LogoCompany Logon n头影测量分析方法很多n n针对不同种族、人群研究课题的各测量项目均依据不同的分析内容而定。Company LogoCompany Logon n华西医科大学头影测量分析法头头影影测测量分析表量分析表头头影影测测量量 项项目目Specificity 不同个体不同个体 Adults成人成人Female 女女Male男男 Children儿童儿童Female女女Male男男Company LogoCompany Logo头头影影测测量量项项目目Specificity个体个体AdultsFemale Male SNA83 84SNB80 80ANB3 4MP-FH28 29PP-FH5 5Yaxis64 65Npg-FH83 85U1-SN75 73L1-MP95 100U1-L1127 121Ptm-A42 44Ptm-S17 18S-Go69 71Go-Co51 52Go-Pg68 68N-ANS50 51ANS-Me57 58U1-PP26 27U6-PP19 19L1-MP38 38L6-MP30 30Company LogoCompany Logo测量内容测量内容SNA angle：反映上颌相对颅骨的前后位置Company LogoCompany Logo测量内容测量内容SNB angleCompany LogoCompany Logo测量内容测量内容ANB angleCompany LogoCompany Logo测量内容测量内容MPFH angle（下颌平面角）Company LogoCompany Logo 测量内容测量内容PPFH Company LogoCompany Logo测量内容测量内容Y轴角:反映颏部的突缩，也代表面部生长发育方向Company LogoCompany Logo 测量内容测量内容Npg-FH(面角)Company LogoCompany Logo测量内容测量内容U1SN angleCompany LogoCompany Logo测量内容测量内容L1 MP angleCompany LogoCompany Logo测量内容测量内容U1L1 angle：反映上下前部牙弓的突度。Company LogoCompany Logo 测量内容测量内容Ptm-A（上颌长）Company LogoCompany Logo 测量内容测量内容Ptm-S（上颌位置）Company LogoCompany Logo 测量内容测量内容S-Go后面高Company LogoCompany Logo 测量内容测量内容Go-Co下颌支长Company LogoCompany Logo 测量内容测量内容Go-Pg（下颌体长）Company LogoCompany Logo 测量内容测量内容N-ANS上面高Company LogoCompany Logo 测量内容测量内容ANS-Me下面高Company LogoCompany Logo测量内容测量内容U1PP距Company LogoCompany Logo测量内容测量内容U6PP距Company LogoCompany Logo测量内容测量内容L1 MP distanseCompany LogoCompany Logo测量内容测量内容L6 MP distanseCompany LogoCompany LogoWits分析法BOAOBOAOCompany LogoCompany LogoTweed三角（FMA,IMPA,FMIA）FMAFMAFMIAFMIAIMPAFMIATweed应用此三角分析得出美国白种正常牙合儿童，FMIA均值为65，此角是建立良好面型的良好条件。Company LogoCompany Logon nLandmark （定点）n nReference line（基准平面）n nCephalometric measurement （测量内容）Company LogoCompany Logo常用的分析方法常用的分析方法常用的分析方法常用的分析方法n nDowns analysis Downs analysis n nTweed analysisTweed analysisn nSteiner analysisSteiner analysisn nWylie analysisWylie analysisn nRickettes analysisRickettes analysisn nNJMU analysisNJMU analysisCompany LogoCompany Logo3.常用平面常用平面眶耳平面（眶耳平面（FHFH）前颅底平面（前颅底平面（SNSN）审美平面（审美平面（EPEP）下颌平面（下颌平面（MPMP）Company LogoCompany Logo4.常用角度常用角度颅底颅底-上齿槽座角（上齿槽座角（SNASNA）：）：上颌对颅底位置关系上颌对颅底位置关系 82821 1颅底颅底-下齿槽座角（下齿槽座角（SNBSNB）：）：下颌对颅底位置关系下颌对颅底位置关系 79791 1上下齿槽座角（上下齿槽座角（ANBANB）：）：上下颌位置关系上下颌位置关系 3 3 1 1 Company LogoCompany Logo5.常用线距常用线距全面高（全面高（N NMeMe）上面高（上面高（N NANSANS）下面高（下面高（ANSANSMeMe）上面高上面高/全面高全面高下面高下面高/全面高全面高Company LogoCompany Logo测量平面测量平面下颌支平面(RP):下颌升支及髁突后缘的切线Company LogoCompany LogoContentsClick to add Title1Click to add Title2Click to add Title3Click to add Title4Company LogoCompany LogoHot Tipn nHow do I incorporate my logo to a slide that will apply to all the other slides?On the On the ViewView menu,point to menu,point to Master,Master,and then click and then click Slide MasterSlide Master or or Notes Notes Master.Master.Change images to the one you Change images to the one you like,then it will apply to all the other like,then it will apply to all the other slides.slides.Company LogoCompany LogoDiagramThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.TitleAdd your textThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Company LogoCompany Logo Cycle DiagramTextTextTextTextTextCycle nameAdd Your TextCompany LogoCompany LogoDiagramTextTextTextAdd YourTitle TextText 1Text 2Text 3Text 4Text 5Add YourTitle TextText 1Text 2Text 3Text 4Text 5TextTextCompany LogoCompany LogoDiagramConceptAdd Your TextTextTextTextTextTextTextCompany LogoCompany LogoDiagramAdd Your TextAdd Your TextAdd Your TextAdd Your TextAdd Your TextAdd Your TextAdd Your TextAdd Your TextCompany LogoCompany LogoDiagramAdd Your TitleAdd Your TitleAdd Your TitleThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Company LogoCompany LogoThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.DiagramTextTextTextCompany LogoCompany LogoTableConceptConceptConceptConceptconceptconceptConceptConceptCompany LogoCompany LogoDiagramTitleAdd Your TextAdd Your TextAdd Your TextAdd Your TextAdd Your TextAdd Your TextCompany LogoCompany LogoDiagram1ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.2ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.3ThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Company LogoCompany LogoDiagramYour TextYour TextYour TextYour TextYour TextYour TextYour TextYour Text2001200220032004Company LogoCompany LogoDiagramTitleTitleThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.TitleTitleThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.TitleTitleThemeGallery is a Design Digital Content&Contents mall developed by Guild Design Inc.Company LogoCompany LogoBlock DiagramTEXTTEXTTEXTTEXTTEXTTEXTTEXTTEXTCompany LogoCompany LogoTableTitleTitleTitleTitleTitleTitleOOOOOTitleOOOOOTitleOOOOOTitleOOOOOTitleOOOOOTitleOXOXOCompany LogoCompany LogoText1Text2Text3Text4Text53-D Pie Chart3-D Pie ChartCompany LogoCompany LogoDiagramAdd Your TitleAdd Your TextAdd Your TextAdd Your TextAdd Your TextAdd Your TextAdd your company slogan