不完全性腭裂患者咽腔三维分析

摘要

目的：探讨不完全性腭裂患者咽腔三维结构与正常人之间的差异。方法应用Mimics三维重建与分析软件对不完全性腭裂患者及同龄正常人的咽腔CBCT扫描数据进行分析,比较两组之间骨性咽腔前份高( Ho-PNS/PNSc)、骨性咽腔后份高(Ho-Ba)、骨性咽腔总深度(Ba-PNS/PNSc)、咽腔顶角(∠Ba-Ho-PNS/PNSc)、骨性鼻咽底长(C1-PNS/PNSc)、第二颈椎平面骨性咽腔深度(C2-T1)、第三颈椎平面骨性咽腔深度(C3-T2)、气性咽腔横径(D t p,D t c2,D t c3)、气性咽腔前后径(D pa p,D pa c2,D pa c3)、气性咽腔横截面积(A p,A c2,A c3)以及气性咽腔体积(V t,V p,V p-c2,V c2-c3)等的差异。同时通过皮尔森相关系数一致性检验验证咽腔三维分析的信度。结果共入组32例未经手术治疗的成年不完全性腭裂患者及30例同龄正常人。组内一致性检验皮尔森相关系数介于0．994至0．999之间,组间一致性检验皮尔森相关系数介于0．992至0．999之间。腭裂患者Ho-PNS/PNSc、Ba-PNS/PNSc、C1-PNS/PNSc及D pa p大于正常组(P=0．000,P =0．003,P =0．034,P =0．000)。 A p、V t、V p及V p-c2大于正常组(P=0．000,P=0．031,P=0．024,P=0．022)。结论腭裂患者咽腔的改变主要在鼻咽部,且鼻咽部的变化以矢状向等比例放大所带来的鼻咽面积、体积增加为主。%Objective To carry out 3D evaluation of pharynx in adult patients with unrepaired isolated cleft palate(ICP). Methods CBCT of patients with isolated cleft palate and normal individuals was acquired and analyzed by Mimics. Linear (Ho-PNS/PNSc, Ho-Ba, Ba-PNS/PNSc, angle Ba-Ho-PNS/PNSc, C1-PNS/PNSc, C2-T1, C3-T2, Dtp, Dtc2, Dtc3;Dpap, Dpac2, Dpac3), planar(Ap, Ac2, Ac3), andvolumetric(Vt, Vp, Vp-c2, Vc2-c3)between ICP and control were compared. Interobserver and intraobserver reliability of 3-dimensional pharyngeal analysis was determined by Pearson correlation coefficient. Results Thirty-two patients with unrepaired non-syndromic isolated cleft palate and 30 normal controls were selected in this study. Pearson correlation coefficients ranged from 0.994 to 0.999 for intraobserver, and from 0.992 to 0.999 for interobserver measurements. Anterior height, length of the floor, total depth of bony nasopharynx, posteroanterior distance and sectional area of pharyngeal airway at palatal plane and total volume, volume above palatal plane and volume between palatal plane and C2 plane of pharyngeal airway in ICP patients were all greater than those in controls(P<0.05). Conclusion The pharynx, especially the nasopharynx, was enlarged in adult patients with unrepaired isolated cleft palate.