石家庄地区正常（牙合）人X线头影测量McNamara 分析
|
摘要
目的：用McNamara X线头影测量分析法对石家庄地区正常牙合人牙、颌、颅面形态结构和特征进行分析；初步建立石家庄地区正常牙合人McNamara分析法的正常值和标准差，补充和完善石家庄地区正常牙合资料，为正畸和正颌外科临床应用McNamara分析法进行诊断、矫治设计和疗效评估提供重要的理论依据。
方法：1. 样本来源：对河北医科大学和石家庄二十七中的学生进行普查，从中挑选出正常牙合汉族人136名，按不同年龄和性别分为恒牙初期男性、恒牙初期女性、恒牙期男性、恒牙期女性四组。2. 研究方法：对每个正常牙合个体拍摄X线头影测位片，由作者本人对头影测量片进行描绘、定点，把描绘定点的图形输入计算机用专用软件对其进行测量，所有测量数据输入SPSS 10.0统计软件进行统计分析。3. 将石家庄地区正常牙合资料男女之间、恒牙期与恒牙早期之间分别进行两样本的t检验。4. 将石家庄地区正常牙合资料与其它地区的正常牙合资料进行比较。
结果：1. 石家庄地区正常牙合人的性别差异：有效上颌长度、有效下颌长度和前下面高均为男性大于女性，此外恒牙期男性上切牙突距较大，女性下颌平面角较大。2. 石家庄地区正常牙合人的年龄差异：女性有效上颌长度、有效下颌长度、上切牙突距、上咽腔宽和下颌平面角具有
统计学差异，除下颌平面角恒牙期小于恒牙初期外，其余均为恒牙期大于恒牙初期。男性恒牙初期与恒牙期测量结果比较：上颌突度、下颌突度、有效上颌长度、有效下颌长度、上下颌差、前下面高、上切牙突距、上咽腔宽、下颌平面角具有统计学差异，除下颌平面角恒牙期小于恒牙初期外，其余均为恒牙期大于恒牙初期。3. 石家庄地区正常牙合人 颅颌线距相关分析及回归方程的建立：上颌突度与下颌突度正相关，有效上颌长度与有效下颌长度正相关，前下面高与有效下颌长度正相关，并按年龄和性别分别建立了回归方程。4. 石家庄人与上海人比较：女性面型相似；男性恒牙初期组上颌突度、有效下颌长度、前下面高、上切牙突距、下切牙突距有统计学差异除上颌突度石家庄小于上海，其余均为石家庄大于上海；恒牙期组有效上颌长度、有效下颌长度、上切牙突距、上咽腔宽有统计学差异，除上咽腔宽石家庄小于上海，其余均为石家庄大于上海。5. 石家庄人与成都人比较：男性上颌突度、有效上颌长度、有效下颌长度有统计学差异，上颌突度石家庄小于成都，其余两项石家庄大于成都；女性有效上颌长度、有效下颌长度、前下面高有统计学差异，石家庄大于成都。
结论：1. McNamara分析法以线距测量为主，测量项目较少，直观简便。采用FH平面作为水平参考平面、鼻根点垂线作为垂直参考线，避免了由于SN平面的旋转而造成的诊断误差。2. 该方法的上下颌突度结合SNA、SNB角对颌骨与颅骨的关系进行分析会更加全面。3. 该方法以有效上颌长度、有效下颌长度及前下面高定量地反映颌
骨间矢状和垂直关系，并且线距测量具有充分的可比性。4. 上下咽腔宽度的测量用于帮助检查气道问题。5. 用该方法对石家庄地区正常牙合人的颅面结构比例及骨骼结构大小进行分析，初步建立了石家庄地区正常牙合人McNamara分析法的正常值和标准差；通过对颅、颌线距的相关分析建立了回归方程。6. 用此方法与中国南方人比较，石家庄地区正常牙合人的颅面特征与以往研究结论一致，进一步证明了该方法的可使用性。
Objective: To study the teeth,jaws and craniofacial structures of Shijiazhuang adolescents and adults with normal occlusion using McNamara Analysis. To establish the norms with Standard Derivation of cephalometric roentgenometry of adolescents and adults with normal occlusion in Shijiazhuang,and to complement the data of Shijiazhuang people with normal occlusion .To provide the theoretical basis for clinical diagnosis,design and treatment evaluation of orthodontic and orthognathic surgery patients.
Method: 1. Source of samples: 136 people of Han nationality with normal occlusion were selected from Hebei Medical University and the No.27 Middle School,and were divided into four groups: male early permanent dentition stage,female early permanent dentition stage, male
permanent dentition stage and female permanent dentition stage. 2. Laterial cephalometric radiographs from each subject were taken,traced and measured by the special soft ware.The data was input into computer and SPSS 10.0 soft ware was used in this study. 3. Compare the norms between male and female,between early permanent dentition stage and permanent dentition stage in Shijiazhuang respectively. 4. Compare the Shijiazhuang norms with those of other regions.
Results: 1. The comparative results between male and female in Shijiazhuang: The effective maxillary length, the effective mandibular length and the lower anterior facial height of male were larger than those of female.In addition,in permament dentition stage the upper incisor to point A vertical in male was larger and the angle of mandibular plane in female was larger. 2 . The comparative results between adolescents and adults in Shijiazhuang: In female the angle of mandibular plane of adolescents was larger than that of adults.while the effective maxillary length ,the effective mandibular length, the upper incisor to point A vertical and the upper pharynx of adults were larger than those of adolescents;In male the angle of mandibular plane of adolescents was larger than that of adults, while the Nasion
perpendicular to point A,the Pogonion to Nasion perpendicular, the effective maxillary length ,the effective mandibular length, the upper incisor to point A vertical and the upper pharynx of adults were larger than those of adolescents. 3. Pearson correlation analysis showed that there were positive correlations between effective maxillary length and effective mandibular length,between Nasion perpendicular to point A and Pogonion to Nasion perpendicular and between effective mandibular length and lower anterior facial height.The above mentioned correlations were significant difference(P<0.01).The regression equations were presented respectively. 4. The comparative results between Shijiazhuang and Shanghai people by McNamara analysis:In male adolescent group,the Nasion perpendicular to point A of Shijiazhuang was smaller than that of Shanghai;the effective mandibular length,the lower anterior facial height ,the upper incisor to point A vertical and the lower incisor to A-Po line of Shijiazhuang were larger than those of Shanghai.In male adult group,the upper pharynx of Shijiazhuang was smaller than that of Shanghai;the effective maxillary length,the effective mandibular length,the upper incisor to point A vertical of Shijiazhuang were larger than those of Shanghai.On the whole, there was no significant difference between Shijiazhuang and Shanghai female. 5. The comparative results between
Shijiazhuang and Chengdu adolescents by McNamara analysis:In male, the Nasion perpendicular to point A vertical of Shijiazhuang was smaller than that of Chengdu;the effective maxillary length,the effective mandibular length,the lower anterior facial height of Shijiazhuang were larger than those of Chengdu.In female,the effective maxillary length,the effective mandibular length,the lower anterior facial height of Shijiazhuang were larger than those of Chengdu.
Conclusion: 1. McNamara analysis depends primarily upon linear measurements and it contains fewer parameters ,so that it
方法：1. 样本来源：对河北医科大学和石家庄二十七中的学生进行普查，从中挑选出正常牙合汉族人136名，按不同年龄和性别分为恒牙初期男性、恒牙初期女性、恒牙期男性、恒牙期女性四组。2. 研究方法：对每个正常牙合个体拍摄X线头影测位片，由作者本人对头影测量片进行描绘、定点，把描绘定点的图形输入计算机用专用软件对其进行测量，所有测量数据输入SPSS 10.0统计软件进行统计分析。3. 将石家庄地区正常牙合资料男女之间、恒牙期与恒牙早期之间分别进行两样本的t检验。4. 将石家庄地区正常牙合资料与其它地区的正常牙合资料进行比较。
结果：1. 石家庄地区正常牙合人的性别差异：有效上颌长度、有效下颌长度和前下面高均为男性大于女性，此外恒牙期男性上切牙突距较大，女性下颌平面角较大。2. 石家庄地区正常牙合人的年龄差异：女性有效上颌长度、有效下颌长度、上切牙突距、上咽腔宽和下颌平面角具有
统计学差异，除下颌平面角恒牙期小于恒牙初期外，其余均为恒牙期大于恒牙初期。男性恒牙初期与恒牙期测量结果比较：上颌突度、下颌突度、有效上颌长度、有效下颌长度、上下颌差、前下面高、上切牙突距、上咽腔宽、下颌平面角具有统计学差异，除下颌平面角恒牙期小于恒牙初期外，其余均为恒牙期大于恒牙初期。3. 石家庄地区正常牙合人 颅颌线距相关分析及回归方程的建立：上颌突度与下颌突度正相关，有效上颌长度与有效下颌长度正相关，前下面高与有效下颌长度正相关，并按年龄和性别分别建立了回归方程。4. 石家庄人与上海人比较：女性面型相似；男性恒牙初期组上颌突度、有效下颌长度、前下面高、上切牙突距、下切牙突距有统计学差异除上颌突度石家庄小于上海，其余均为石家庄大于上海；恒牙期组有效上颌长度、有效下颌长度、上切牙突距、上咽腔宽有统计学差异，除上咽腔宽石家庄小于上海，其余均为石家庄大于上海。5. 石家庄人与成都人比较：男性上颌突度、有效上颌长度、有效下颌长度有统计学差异，上颌突度石家庄小于成都，其余两项石家庄大于成都；女性有效上颌长度、有效下颌长度、前下面高有统计学差异，石家庄大于成都。
结论：1. McNamara分析法以线距测量为主，测量项目较少，直观简便。采用FH平面作为水平参考平面、鼻根点垂线作为垂直参考线，避免了由于SN平面的旋转而造成的诊断误差。2. 该方法的上下颌突度结合SNA、SNB角对颌骨与颅骨的关系进行分析会更加全面。3. 该方法以有效上颌长度、有效下颌长度及前下面高定量地反映颌
骨间矢状和垂直关系，并且线距测量具有充分的可比性。4. 上下咽腔宽度的测量用于帮助检查气道问题。5. 用该方法对石家庄地区正常牙合人的颅面结构比例及骨骼结构大小进行分析，初步建立了石家庄地区正常牙合人McNamara分析法的正常值和标准差；通过对颅、颌线距的相关分析建立了回归方程。6. 用此方法与中国南方人比较，石家庄地区正常牙合人的颅面特征与以往研究结论一致，进一步证明了该方法的可使用性。
Objective: To study the teeth,jaws and craniofacial structures of Shijiazhuang adolescents and adults with normal occlusion using McNamara Analysis. To establish the norms with Standard Derivation of cephalometric roentgenometry of adolescents and adults with normal occlusion in Shijiazhuang,and to complement the data of Shijiazhuang people with normal occlusion .To provide the theoretical basis for clinical diagnosis,design and treatment evaluation of orthodontic and orthognathic surgery patients.
Method: 1. Source of samples: 136 people of Han nationality with normal occlusion were selected from Hebei Medical University and the No.27 Middle School,and were divided into four groups: male early permanent dentition stage,female early permanent dentition stage, male
permanent dentition stage and female permanent dentition stage. 2. Laterial cephalometric radiographs from each subject were taken,traced and measured by the special soft ware.The data was input into computer and SPSS 10.0 soft ware was used in this study. 3. Compare the norms between male and female,between early permanent dentition stage and permanent dentition stage in Shijiazhuang respectively. 4. Compare the Shijiazhuang norms with those of other regions.
Results: 1. The comparative results between male and female in Shijiazhuang: The effective maxillary length, the effective mandibular length and the lower anterior facial height of male were larger than those of female.In addition,in permament dentition stage the upper incisor to point A vertical in male was larger and the angle of mandibular plane in female was larger. 2 . The comparative results between adolescents and adults in Shijiazhuang: In female the angle of mandibular plane of adolescents was larger than that of adults.while the effective maxillary length ,the effective mandibular length, the upper incisor to point A vertical and the upper pharynx of adults were larger than those of adolescents;In male the angle of mandibular plane of adolescents was larger than that of adults, while the Nasion
perpendicular to point A,the Pogonion to Nasion perpendicular, the effective maxillary length ,the effective mandibular length, the upper incisor to point A vertical and the upper pharynx of adults were larger than those of adolescents. 3. Pearson correlation analysis showed that there were positive correlations between effective maxillary length and effective mandibular length,between Nasion perpendicular to point A and Pogonion to Nasion perpendicular and between effective mandibular length and lower anterior facial height.The above mentioned correlations were significant difference(P<0.01).The regression equations were presented respectively. 4. The comparative results between Shijiazhuang and Shanghai people by McNamara analysis:In male adolescent group,the Nasion perpendicular to point A of Shijiazhuang was smaller than that of Shanghai;the effective mandibular length,the lower anterior facial height ,the upper incisor to point A vertical and the lower incisor to A-Po line of Shijiazhuang were larger than those of Shanghai.In male adult group,the upper pharynx of Shijiazhuang was smaller than that of Shanghai;the effective maxillary length,the effective mandibular length,the upper incisor to point A vertical of Shijiazhuang were larger than those of Shanghai.On the whole, there was no significant difference between Shijiazhuang and Shanghai female. 5. The comparative results between
Shijiazhuang and Chengdu adolescents by McNamara analysis:In male, the Nasion perpendicular to point A vertical of Shijiazhuang was smaller than that of Chengdu;the effective maxillary length,the effective mandibular length,the lower anterior facial height of Shijiazhuang were larger than those of Chengdu.In female,the effective maxillary length,the effective mandibular length,the lower anterior facial height of Shijiazhuang were larger than those of Chengdu.
Conclusion: 1. McNamara analysis depends primarily upon linear measurements and it contains fewer parameters ,so that it
引文
1 傅民魁，田乃学. 口腔X线头影测量理论与实践. 人民卫生出版社出版发行, 1992，6
2 McNamara JA.A method of cephalometric evaluation. Am J Orthod，1984，86(6)：449~469
3 马文盛. 石家庄市正常牙合人X线头影测量研究.河北医科大学硕士研究生毕业论文.
4 潘晓岗，刘鸿虎，曹惠菊.上海地区101名正常牙合人群X线头影测量McNamara分析.上海口腔医学， 1996，5（4）：195~197
5 王艳民，周力，高辉. 成都地区67名正常牙合青少年头影测量McNamara分析. 华西口腔医学杂志， 2002，2（20）：45~47
6 贾培增译. 正常牙合的六项标准. 口腔正畸学，1998，5（4）：175~178
7 王建国，傅民魁. 正常牙合藏族人软组织侧貌分析. 口腔正畸学，1998，5（4）：163~165
8 兰泽栋，林珠，孙新华等. 长春市正常牙合少年儿童X线头影测量研究. 实用口腔医学杂志，2001，17（1）：47~49
9 杨山，皮长生. 鼓腮咬合牙合定牙合关系. 中华口腔医学杂志，1988，23（2）：6
10 Burstone CJ. Lip posture and its significance in treatment planning. Am J Orthod，1967，53（4）：262
11 Ricketts RM. Perspectives in the clinical appliance of cephalometrics. Angle Orthod，1981，51：115~105
12 罗颂椒主编. 当代实用口腔正畸技术与理论. 北京 北京医科大学·中国协和医科大学联合出版社, 1996：71~85
13 Downs WB. Variation in facial relationships：their significance in treatnent and prognosis. Am J Orthod， 1948，34：812~840
14 Ricketts RM，Schulhof RJ，Bagha L. Orientation-sella-nasion or Frankfort horizontal. Am J Orthod， 1976，69：648~654
15 Edward Ellis III. Cephalometric reference planes-sella nasion vs Frankfort horizontal. Int J Adult Orthod and Orthog Surg，1988，2：81~87
16 傅真，梁宏，赵兰芳. Wits值与ANB角在评价颌骨矢状位置关系中的价值. 口腔正畸学，1995，2（4）：159~160
17 高晓辉，纪昌蓉，周传丽. APDI 的正畸临床评价. 现代口腔医学杂志，2000，14（2）：94~96
18 Jarvinea S.Floating norms for the ANB angle as guidence for clinical considerations. Am J Orthod，1986，90：383
Jarvinea S. An analysis of the variation of the ANB
19 angle:A statistical appeaisal. Am J Orthod，1982，87:144
20 Luzi V. The CV value (combined variation) in the analysis of sagittal malocclusions. Am J Orthod，1982，88：478
21 Hussels WH. Analysis of factors affecting angle ANB. Am J Orthod，1984，85：411
22金宜霖，周洁珉，祖彬彬. ANB角的可信度研究. 口腔正畸学，1995，2（2）：52
23 Taylor CM. Changes in the relationships of nasion,point A,point B and the effect upon ANB. Am J Orthod，1973，64：414
24 Jacobson A. The Wits appraisal of Jaw disharmony. Am J Orthod, 1975,67:125
25 Jacobson A. Application of the "Wits" appraisal. Am J Orthod，1976，70： 179
26 Kim YH. Anterposterior dysplasia indicator：An adjwnct to cephalometric differential diagnosis. Am J Orthod ，1978，73：619
27 潘晓岗.上海地区正常牙合青少年颅颌线距相关性研究. 上海第二医科大学学报，1997，17（6）：445~447
28 傅民魁，许江彦.正常牙合颅面结构中的补偿机制.口腔医学纵横，1988，4（1）：1
29 邵金陵，陈华，张巧余. 一种X线头影测量项目优选法. 中华口腔医学杂志，1992，27（3）：140
30 范莉，陈蔚，沈刚. 上海地区正常牙合Ricketts X线头影测量分析. 上海口腔医学，2001，10（4）：309~312
31 范莉，蔡中，张国华. 上海地区正常牙合Tweed-Merrifield法X线头影分析. 华夏医学，1999，12（2）：130~131
32 傅民魁主编. 口腔正畸学. 人民卫生出版社，2000：20
2 McNamara JA.A method of cephalometric evaluation. Am J Orthod，1984，86(6)：449~469
3 马文盛. 石家庄市正常牙合人X线头影测量研究.河北医科大学硕士研究生毕业论文.
4 潘晓岗，刘鸿虎，曹惠菊.上海地区101名正常牙合人群X线头影测量McNamara分析.上海口腔医学， 1996，5（4）：195~197
5 王艳民，周力，高辉. 成都地区67名正常牙合青少年头影测量McNamara分析. 华西口腔医学杂志， 2002，2（20）：45~47
6 贾培增译. 正常牙合的六项标准. 口腔正畸学，1998，5（4）：175~178
7 王建国，傅民魁. 正常牙合藏族人软组织侧貌分析. 口腔正畸学，1998，5（4）：163~165
8 兰泽栋，林珠，孙新华等. 长春市正常牙合少年儿童X线头影测量研究. 实用口腔医学杂志，2001，17（1）：47~49
9 杨山，皮长生. 鼓腮咬合牙合定牙合关系. 中华口腔医学杂志，1988，23（2）：6
10 Burstone CJ. Lip posture and its significance in treatment planning. Am J Orthod，1967，53（4）：262
11 Ricketts RM. Perspectives in the clinical appliance of cephalometrics. Angle Orthod，1981，51：115~105
12 罗颂椒主编. 当代实用口腔正畸技术与理论. 北京 北京医科大学·中国协和医科大学联合出版社, 1996：71~85
13 Downs WB. Variation in facial relationships：their significance in treatnent and prognosis. Am J Orthod， 1948，34：812~840
14 Ricketts RM，Schulhof RJ，Bagha L. Orientation-sella-nasion or Frankfort horizontal. Am J Orthod， 1976，69：648~654
15 Edward Ellis III. Cephalometric reference planes-sella nasion vs Frankfort horizontal. Int J Adult Orthod and Orthog Surg，1988，2：81~87
16 傅真，梁宏，赵兰芳. Wits值与ANB角在评价颌骨矢状位置关系中的价值. 口腔正畸学，1995，2（4）：159~160
17 高晓辉，纪昌蓉，周传丽. APDI 的正畸临床评价. 现代口腔医学杂志，2000，14（2）：94~96
18 Jarvinea S.Floating norms for the ANB angle as guidence for clinical considerations. Am J Orthod，1986，90：383
Jarvinea S. An analysis of the variation of the ANB
19 angle:A statistical appeaisal. Am J Orthod，1982，87:144
20 Luzi V. The CV value (combined variation) in the analysis of sagittal malocclusions. Am J Orthod，1982，88：478
21 Hussels WH. Analysis of factors affecting angle ANB. Am J Orthod，1984，85：411
22金宜霖，周洁珉，祖彬彬. ANB角的可信度研究. 口腔正畸学，1995，2（2）：52
23 Taylor CM. Changes in the relationships of nasion,point A,point B and the effect upon ANB. Am J Orthod，1973，64：414
24 Jacobson A. The Wits appraisal of Jaw disharmony. Am J Orthod, 1975,67:125
25 Jacobson A. Application of the "Wits" appraisal. Am J Orthod，1976，70： 179
26 Kim YH. Anterposterior dysplasia indicator：An adjwnct to cephalometric differential diagnosis. Am J Orthod ，1978，73：619
27 潘晓岗.上海地区正常牙合青少年颅颌线距相关性研究. 上海第二医科大学学报，1997，17（6）：445~447
28 傅民魁，许江彦.正常牙合颅面结构中的补偿机制.口腔医学纵横，1988，4（1）：1
29 邵金陵，陈华，张巧余. 一种X线头影测量项目优选法. 中华口腔医学杂志，1992，27（3）：140
30 范莉，陈蔚，沈刚. 上海地区正常牙合Ricketts X线头影测量分析. 上海口腔医学，2001，10（4）：309~312
31 范莉，蔡中，张国华. 上海地区正常牙合Tweed-Merrifield法X线头影分析. 华夏医学，1999，12（2）：130~131
32 傅民魁主编. 口腔正畸学. 人民卫生出版社，2000：20