請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/15894
標題: | 以三維電腦斷層影像分析老化對華人眼眶及中臉骨骼的影響 3D Computed Tomographic Study in Aging of Chinese Periorbital and Midfacial Skeletons |
作者: | Chen-Hsiang Kuan 官振翔 |
指導教授: | 湯月碧 |
共同指導教授: | 陳世杰 |
關鍵字: | 顏面骨骼,老化,三維電腦斷層分析,華人, facial bone,aging,3D computed tomography,Chinese, |
出版年 : | 2012 |
學位: | 碩士 |
摘要: | 研究背景與目的
臉部老化是一個連續且動態的過程。對於臉部上三分之一及中臉方面的影響主要在眼窩及上顎骨的變化。眼窩老化成因於眼眶膈膜彈性的減弱造成內側上方的眼瞼脂肪脫疝,視覺上會讓人觀察到眉毛內側下移及眉間皺紋產生,而眼眶橫向寬度增加會造成魚尾紋及眼袋下垂加劇。骨骼形態的變化繼而影響軟組織的包附,形成了臉部上三分之一及中臉老化上常見的眼窩內陷,眼瞼下垂,眼周圍脂肪脫疝,眼袋下垂及眼溝加深等。 不論是利用手術或微創整形來使臉部年輕化逐漸被愈來愈多人所接受。目前面臨最大的困境是我們對年齡老化在臉部骨骼結構上的影響瞭解不透徹,沒有足夠客觀科學化定性定量測量的結果。理想上年輕的臉部在骨骼形態及軟組織的容量及彈性有著特定協調的比例及關係。大部分整形所根據的基礎來自於主觀上局部美學的變化及去除「老化」的徵象,舉例像是皺紋,凹陷等。因此要使臉部年輕化有效精準,透徹瞭解老化過程所造成的動態變化是重要的。 研究材料與方法 本研究蒐集自西元2005年後在台大醫院接受頭部電腦斷層掃描之華人資料庫,分組為三個年齡族群: 青年族群(20-35歲) 、中年族群(45-60歲)、老年族群(70-85歲),藉由頭部電腦斷層掃描三度空間重組及二度空間來分析顏面骨骼之變數: 眼窩體積(Bony orbit volume),眼窩寬度(Orbit aperture width),上下眼窩縱長(Orbit aperture longitudinal height),眼眶面積(Orbit aperture area),雙側額骨顴骨交界處距離(Bilateral fronto-zygomatic junction distance),中臉之鼻狀梨孔面積(Pyriform aperture area),眉間角度(Glabellar angle),鼻狀梨孔角度(Pyriform angle) ,上顎骨角度(Maxillary angle),上下眼眶角度(Orbital angle)。我們測量數值並與身高體重指數值(BMI)做矯正,比較東方人與西方人臉部老化差異。 在統計分析方面,我們排除同一測量者內(Intraobserver difference)及不同測量者間(Interobserver difference)之測量差異。以t-test比較不同測量值在不同族群間的差異。將各年齡族群之測量值與年齡做線性回歸分析。我們設定的顯著p值為<0.05。 研究結果 首先對於三維電腦斷層重組分析之測量值,同一測量者內及不同測量者間之測量差異之相關係數值很高,因此忽略隨機測量誤差,並決定測量之信度與效度。 在不同年齡族群間之顏面骨骼測量數值之比較,我們發現:在男女兩族群中,眼眶體積會隨年齡增加而有顯著增加。眼眶面積在男性族群中會隨年齡增加而有顯著增加。在上下眼眶比較分析中,上眼眶內側及下眼眶外側,在男女兩族群中皆會隨年齡而有退縮之顯著趨勢。 眼眶寬度,雙側額骨顴骨交界距離,鼻狀梨孔面積,中臉之眉間角度,鼻狀梨孔角度,上下眼眶角度則未隨不同年齡達顯著差異。僅有在女性族群中上顎骨角度,在老年族群比中年族群有顯著減少。 結論 本研究發現在華人族群中,眼眶體積,面積,上下眼眶骨骼會隨年齡老化而有變化之趨勢,臨床上可以提供骨骼老化上客觀定性定量測量的依據,伴隨著軟組織的變化,使臉部年輕化整形手術及微創整形能更科學化有效化,減少主觀的誤差及醫療併發症。 Introduction Facial aging is a continuous and dynamic process. The aging of upper third face and midface are mainly focused on the change of the orbit and the upper maxilla. Herniation of the medial upper lid fat and weakening of the orbital septum contribute to the orbital aging, which lead to the perceived descent of the medial brow and the formation of glabella skin creases. Moreover, increase in orbital aperture width may contribute to the formation of crow’s-feet and lower lid lag. Cosmetic procedures both surgical and nonsurgical to enhance or rejuvenate the appearance of one’s face are becoming more accepted by the public. The most challenging difficulties of facial rejuvenation come from inadequate scientific understanding of what happens to the facial bone and soft tissue structures in the aged face. To rejuvenate effectively the aging face, it is necessary to understand the dynamic aging process. Matertials and Methods We retrospectively reviewed the image database of facial computed tomography in National Taiwan University Hospital from the year 2005 to 2011. The patients are grouped into three age categories: young (20-30 years), middle (45-55 years), old (70-80 years). We analyze parameters with volume-rendered 3D-reconstruction: bony orbit volume, orbital aperture width, orbital aperture area, orbital aperture longitudinal height, bilateral fonto-zygomatic junction distance, midface glabellar angle, pyriform angle, maxillary angle and orbital angle. We correlate the results with body height, body weight, and body mass index (BMI). We also compare the differences of facial aging between the Chinese and the Caucasians. The student t test and linear regression were used to analyze the differences between age groups. The level of significance was set at p < 0.05. Results The intraobserver measurements and interobserver measurements yield correlation coefficient near 1, which showed good reproducibility and negliable differences. The bony orbit volume in both our male and female subjects showed a significant increase with age. The orbit aperture area would increase with age in only male gender. In both genders, we found the significant increase in longitudinal height medially in the superior orbital rim and laterally in the inferior orbital rim, suggesting the bony recession with aging. The orbital aperture width, bilateral fonto-zygomatic junction distance, midface glabellar angle, pyriform angle, and orbital angle all showed no signiciant differences between groups in both genders. But in female gender, the maxillary angle showed significant decrease between old age and middle age group. Conclusion Our study suggest the bony orbit volume, orbit aperture area would increase with age. The medial superior and lateral inferior orbital rim would showed recession with age. To rejuvenate effectively the aging face, it is necessary to understand the dynamic aging process. The results could provide scientific and objective parameters in understanding of Chinese facial aging . The results would help minimize complications in facial rejuvenation. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/15894 |
全文授權: | 未授權 |
顯示於系所單位: | 臨床醫學研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-101-1.pdf 目前未授權公開取用 | 2.6 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。