基于CBCT三维形态分析的中国青少年颈椎骨成熟度定量方法研究

doi:10.13591/j.cnki.kqyx.2024.05.001

摘要/Abstract

摘要：

目的通过锥形束CT(CBCT)影像探究颈椎三维形态与骨骼成熟度之间的相关性,并建立基于颈椎三维形态的颈椎骨成熟度(CVM)定量评估模型。方法共收集358例(男175例,女183例)中国青少年患者的颅颌面CBCT影像,随机分为模型建立组(277例)及验证组(81例)。定义并测量了21个颈椎三维形态学参数,纳入颈椎全部部位,包括颈椎椎体、横突、棘突、椎弓根、锥板、关节突。颈椎骨成熟指数(CVMI)由有经验的正畸医师测定并作为参考标准。采用Spearman等级相关系数和多元线性逐步分析确定相关性并构建回归模型。使用验证组数据检验各模型的评估可靠性并应用配对样本Wilcoxon符号秩检验比较模型评估值与参考标准。结果颈椎各部位的三维形态学变化与CVMI相关(P<0.05)。男性和女性模型各包括6个三维形态参数,其中3个相同。男性模型和女性模型校正R²分别为0.899和0.902,评估准确率分别为85.0%和85.4%。配对样本Wilcoxon符号秩检验结果显示两个回归模型与参考标准间均无统计学差异(P>0.05)。结论颈椎三维形态与骨骼成熟度相关,本研究建立的CVM三维形态学评估方法及相应的回归模型具有良好的可信度,与专家的一致性较高。

关键词: 骨骼成熟度, 颈椎骨成熟指数, 三维形态, CBCT

Abstract:

Objective To investigate associations between three-dimensional(3D) morphology of cervical vertebrae and skeletal maturation by cone-beam computed tomography(CBCT) and establish corresponding regression models for quantitatively evaluating cervical vertebral maturation(CVM). Methods The analyzed sample consisted of 358 CBCT images (175 male, 183 female), of which 277 images were randomly selected as the model development group and 81 as the performance test group. Twenty-one 3D morphological parameters were defined and measured, incorporating all parts of the cervical vertebrae, including the cervical vertebral bodies, transverse processes, spinous processes, pedicles, lamina, and articular processes. The cervical vertebral maturation index (CVMI) was determined by experienced orthodontists as reference standard. Spearman’s rank correlation coefficient and multivariable stepwise regression analysis were used to identify the associations and build regression models. The performance test group was employed to examine each model’s reliability. Paired-samples Wilcoxon signed-rank test compared the CVMI of the model prediction with the reference standard. Results Three-dimensional morphological changes in various parts of the cervical vertebrae correlated with CVMI (P<0.05). Six 3D morphometric parameters were each recognized for male and female models, three of which were identical. The adjusted R² was 0.899 for males and 0.902 for females, with corresponding accuracies of 85.0% and 85.4%, respectively. These models showed no difference as compared with the reference standard (P>0.05). Conclusion New associations were found between 3D morphology of cervical vertebrae and skeletal maturation. The 3D-driven morphometric CVM assessment method and corresponding regression models exhibited good credibility and high consistency with experts.

Key words: skeletal maturation, cervical vertebrae maturation index, three-dimensional morphology, cone-beam computed tomography

中图分类号:

R783.5

吴玥, 唐雯, 张语嫣然, 袁玮煜, 潘逸菲, 陈新宇, 徐海洋, 吕云帆, IZADIKHAH Iman, 曹丹, 谢理哲, 严斌. 基于CBCT三维形态分析的中国青少年颈椎骨成熟度定量方法研究[J]. 口腔医学, 2024, 44(5): 321-328.

WU Yue, TANG Wen, ZHANG Yuyanran, YUAN Weiyu, PAN Yifei, CHEN Xinyu, XU Haiyang, LYU Yunfan, IZADIKHAH Iman, CAO Dan, XIE Lizhe, YAN Bin. Quantitative analysis of cervical vertebral maturation in Chinese adolescents based on three-dimensional morphology of cervical vertebrae[J]. Stomatology, 2024, 44(5): 321-328.

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名称椎体前缘高度	aVBH	简写椎体前表面上下缘中线垂直距离	定义线性长度
	椎体后缘高度	pVBH	椎体后表面上下缘中线垂直距离
	椎体上缘长度	sVBL	椎体上表面前后缘中线前后距离
	椎体下缘长度	iVBL	椎体下表面前后缘中线前后距离
	椎体上缘宽度	sVBW	椎体上表面最大横向距离
	椎体下缘宽度	iVBW	椎体下表面最大横向距离
	椎体下缘表面距离	iVBSL	椎体下表面前后缘最外侧点之间曲线长度
	横突宽度	TPW	横突最大横向距离
	棘突长度	SPL	棘突前缘至最末端距离
	左/右椎弓根高度	r/lPH	左/右侧椎弓根上下缘最外侧直径
	双侧椎弓根距离	BPD	双侧椎弓根上表面中心点距离
	左/右锥板横向长度	r/lLTL	棘突与上关节面外侧缘沿左/右锥板上缘距离
	左/右锥板高度	r/lLH	左/右锥板上下缘中线垂直距离
	左/右关节突下表面宽度	r/liAPW	左/右关节突下表面最大横向距离
平均长度	椎体前后缘高度均值	apVBH	(aVBH+pVBH)/2
	椎体上下缘长度均值	siVBL	(sVBL+iVBL)/2
	椎体上下缘宽度均值	siVBW	(sVBW+iVBW)/2
	椎弓根左右高度均值	rlPH	(rPH+lPH)/2
	锥板左右横向长度均值	rlLTL	(rLTL+lLTL)/2
	锥板左右高度均值	rlLH	(rLH+lLH) /2
	关节突左右下表面宽度均值	rliAPW	(riAPW+liAPW)/2

参数	相关系数		参数	相关系数		参数	相关系数		参数	相关系数
参数	男性	女性	参数	男性	女性	参数	男性	女性	参数	男性	女性
aVBH3	0.905^**	0.897^**	iVBW4	0.238^**	0.251^**	siVBW3	0.097	-0.148	aVBH4/iVBL4	0.810^**	0.849^**
aVBH4	0.886^**	0.885^**	TPW2	0.693^**	0.620^**	siVBW4	0.173	0.150	iVBSL2/iVBL2	0.057	0.285^**
pVBH3	0.911^**	0.880^**	TPW3	0.644^**	0.627^**	rlPH3	0.704^**	0.468^**	iVBSL3/iVBL3	0.392^**	0.258^**
pVBH4	0.872^**	0.890^**	TPW4	0.747^**	0.616^**	rlPH4	0.738^**	0.534^**	iVBSL4/iVBL4	0.216^*	-0.211^*
sVBL3	0.350^**	0.430^**	SPL2	0.659^**	0.432^**	rlLTL2	0.140	0.243^**	rlPH3×rlLH3	0.795^**	0.657^**
sVBL4	0.451^**	0.261^**	SPL3	0.543^**	0.691^**	rlLTL3	0.123	0.368^**	rlPH4×rlLH4	0.810^**	0.733^**
iVBL2	0.462^**	0.315^**	SPL4	0.351^**	0.588^**	rlLTL4	0.111	0.301^**	rlLH₂×SPL2	0.717^**	0.575^**
iVBL3	0.519^**	0.528^**	BPD3	0.485^**	0.300^**	rlLH₂	0.587^**	0.532^**	rlLH3×SPL3	0.691^**	0.750^**
iVBL4	0.566^**	0.515^**	BPD4	0.369^**	0.336^**	rlLH3	0.757^**	0.684^**	rlLH4×SPL4	0.642^**	0.705^**
sVBW3	0.007	-0.153	apVBH3	0.924^**	0.904^**	rlLH4	0.782^**	0.760^**	TPW3/siVBW3	0.447^**	0.586^**
sVBW4	0.010	0.018	apVBH4	0.908^**	0.907^**	rliAPW3	0.441^**	0.484^**	TPW4/siVBW4	0.508^**	0.377^**
iVBW2	-0.064	-0.163	siVBL3	0.458^**	0.502^**	rliAPW4	0.398^**	0.444^**	iVBL2/iVBL3	-0.304^**	-0.113
iVBW3	0.133	-0.020	siVBL4	0.527^**	0.427^**	aVBH3/iVBL3	0.860^**	0.862^**

模型	常量与自变量	偏回归系数	标准误	t	P	调整R²	方差膨胀系数
男性	常量	3.445	0.052	66.815	0.000	0.899	—
	apVBH3	1.536	0.074	20.899	0.000		2.151
	rliAPW3	-0.307	0.066	-4.673	0.000		1.679
	TPW2	0.200	0.089	2.239	0.027		3.141
	iVBW4	-0.224	0.057	-3.922	0.000		1.285
	BPD3	0.167	0.069	2.413	0.018		1.974
	iVBSL4/iVBL4	0.152	0.067	2.260	0.026		1.029
女性	常量	3.600	0.047	77.038	0.000	0.902	—
	apVBH3	0.926	0.097	9.577	0.000		4.521
	rlLH2×SPL2	0.328	0.050	6.516	0.000		1.246
	rlLTL3	0.226	0.052	4.350	0.000		1.252
	aVBH4/iVBL4	0.410	0.090	4.572	0.000		3.676
	iVBSL4/iVBL4	-0.170	0.051	-3.299	0.001		1.167
	BPD3	-0.164	0.053	-3.123	0.002		1.284