国际口腔医学杂志

国际口腔医学杂志 ›› 2022, Vol. 49 ›› Issue (3): 337-342.doi: 10.7518/gjkq.2022058

• 综述 • 上一篇    下一篇

颈椎成熟法评估下颌骨骨龄的研究进展

黎静文(),周力()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医院正畸科 成都 610041
  • 收稿日期:2021-09-25 修回日期:2022-01-10 出版日期:2022-05-01 发布日期:2022-05-09
  • 通讯作者: 周力
  • 作者简介:黎静文，医师，学士，Email：975150923@qq.com

Research progress on cervical vertebra maturation in evaluating bone age of mandible

Li Jingwen(),Zhou Li.()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2021-09-25 Revised:2022-01-10 Online:2022-05-01 Published:2022-05-09
  • Contact: Li. Zhou

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摘要：

早期功能矫治及矫形治疗是改善下颌骨发育差异的重要手段，因而通过骨龄评估下颌骨生长高峰期，以此确定矫治开始时间具有重要意义。颈椎成熟（CVM）法是根据颈椎在不同生长发育阶段形状、大小有规律性的改变来预测下颌骨生长发育时期的方法。在正畸常规检查的头颅侧位片中，颈椎形态清晰可见，采用CVM法评估骨龄方便实用，相较于手腕骨法不需患者接受额外的辐射，临床应用广泛。但该方法存在主观性大、可重复性低等问题，具有一定争议。针对这些问题已有多种改进方法，包括纳入客观指标描述颈椎形态，改进试验设计及数据分析方法，使用锥形束CT影像分析颈椎形态，采用计算机辅助定点等。本文就CVM法临床应用的支持依据、相关争议以及改进方法进行综述。

关键词: 颈椎成熟法, 骨龄, 下颌骨生长发育高峰期

Abstract:

Early functional correction and orthopedic treatment are important means to improve the difference in mandibular development. Therefore, the peak growth period of the mandible by bone age must be evaluated to determine the start time of correction. The cervical vertebra maturation (CVM) method can predict the growth and development period of the mandible based on the regular changes in the shape and size of cervical vertebra at different growth and development stages. The assessment of bone age is convenient and practical. Compared with the wrist bone method, bone age assessment is widely used in clinical practice and does not require patients to receive additional radiation. However, this method is controversial because of its high subjectivity and low repeatability. In response to these problems, a variety of improved methods, including incorporation of objective indicators to describe cervical-spine morphology, improvement of experimental design and data analysis methods, the use of cone-beam computed tomography images to analyze cervical spine morphology, and the use of computer-aided positioning, have been proposed. This article reviews the supporting evidence, related controversies, and improved methods for the clinical application of CVM method.

Key words: cervical vertebrae maturation method, bone age, the peak in mandibular growth

中图分类号: 

  • R 783

图 1

颈椎分期示意图C2：第二颈椎；C3：第三颈椎；C4：第四颈椎。CS1：C2—C4底边平坦，C3、C4为梯形；CS2：C2 底边弯曲，余同 CS1；CS3：C2、C3底边弯曲，C3、C4 为梯形或水平矩形；CS4：C2、C3、C4 底边弯曲，C3、C4 均为水平矩形；CS5：C2、C3、C4 底边弯曲，C3或C4为正方形；CS6：C2、C3、C4底边明显弯曲，C3或C4为水平矩形。"

图 2

头影测量分析中使用的测量点线角A、B：颈椎高度与宽度的测量；C：第二颈椎底端曲线最高点和最低点间连线的角度@2。Cup：颈椎最上最后点；Clp：颈椎最下最后点；Cum：颈椎上边缘中点；Cd：颈椎下边缘中点；Cua：颈椎最上最前点；Cla：颈椎最下最前点；Cam：颈椎前边缘中点；UW：Cua到Cup与Clp连线的垂直距离；W：Cam到Cup与Clp连线的垂直距离；LW：Cla到Cup与Clp连线的垂直距离。PH：Cup到Clp与Cla连线的垂直距离；PD：Cup与 Clp连线；H：Cum到Clp与Cla连线的垂直距离；AH：Cua到Clp与Cla连线的垂直距离；AD：Cua与 Cla连线； C2p：第二颈椎下边缘最后点；C2a：第二颈椎下边缘最前点；C2d：第二颈椎下边缘中点；@2：C2d与C2p连线与C2p与C2a连线的夹角。"

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