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악교정 수술에서 모의 조종된 3차원 전산화 단층촬영상의 응용
Application of Simulated Three Dimensional CT Image in Orthognathic Surgery

치과방사선 1998년 28권 2호 p.363 ~ 385

김형돈, 유선국, 이경상, 박창서,

소속 상세정보

김형돈 (  ) - 연세대학교 치과대학 치과방사선학
유선국 (  ) - 연세대학교 의과대학 의용공학
이경상 (  ) - 연세대학교 의과대학 의용공학
박창서 (  ) - 연세대학교 치과대학 치과방사선학

KMID : 0378219980280020363

Abstract

저자는 악교정 수술 전후의 후전방 및 측방 두부규격 방사선사진에서의 변화를 악교정 수
술전의 3차원 전산화 단층상에 적용하여 모의 조종된 3차원 상을 얻는 새로운 방법을 만들
어 보았고 이 방법을 검증하고자 악교정 수술을 가상하여 하악골의 위치를 변화시킨 건조
두개골의 4가지 경우와 악교정 수술을 받은 4명의 환자에 적용하여 보아 다음과 같은 결과
를 얻었다.
1.하악골의 위치를 달리하고 시행된 건조 두개골의 4가지 경우에서 하악골의 위치 변화
전 후의 후전방 및 측방 두부규격 방사선사진에서의 변화를 하악골의 위치 변화 전의 3차원
상에 적용하여 컴퓨터로 모의 조종된 3차원상과 하악골의 위치 변화 후에 실제 촬영된 3차
원 상 간의 좌표값의 변위 범위는 -1.8 ㎜에서 1.8 ㎜ 까지 였고 모든 변위값의 94%가 1.4
㎜에서 1.4 ㎜까지였으며 또한 두 상간에 유의차는 없었다(p>0.05).
2. 악교정 수술을 받은 4 명에서 수술 전후의 후 전방 및 측방 두부규격 방사선사진에서
의 변화를 수술 전의 3차원 상에 적용하여 컴퓨터로 모의 조종된 3차원 상과 수술 후에 실
제 촬영된 3차원 상 간의 좌표값의 변위 범위는 - 6.7 ㎜에서 7.7 ㎜까지였고 모든 변위값
의 90%가 -4.0 ㎜에서 4.0 ㎜까지였으며 또한 두 상 간에 유의차는 없었다(p>0.05).
결론적으로 수술 전의 3차원 전산화 단층사진과 수술 전후의 후전방 및 측방 두부규격
방사선사진을 이용하여 컴퓨터로 모의 조종된 3차원 상을 얻어 건조 두개골과 악교정 수술
환자에 각각 적용한 결과 앞으로 수술 후에 3차원 전산화 단층촬영을 하지 않고도 수술 후
의 3차원 상을 얻을 수 있는 가능성이 제시되었다.
#초록#
In orthodontics and orthognathic surgery, cephalogram has been routine Practice in
diagnosis and treatment evaluation of craniofacial deformity. But its inherent distortion
of actual length and angles during projecting three dimensional object to two
dimensional plane might cause errors in quantitative analysis of shape and size.
Therefore, it is desirable that three dimensional object is diagnosed and evaluated three
dimensionally and three dimensional CT image is best for three dimensional analysis.
Development of clinic necessitates evaluation of result of treatment and comparison
before and after surgery. It is desirable that patient that was diagnosed and planned by
three dimensional computed tomography before surgery is evaluated by three
dimensional computed topography after surgery, too. But Because there is no
standardized normal values in three dimension now and three dimensional Computed
Tamography needs expensive equipments and because of its expenses and amount of
exposure to radiation, limitations still remain to be solved
in its application to routine practice. If postoperative three dimensional image is
constricted by pre and postoperative lateral and postero-anterior cephalograms and
preoperative three dimensional computed tomogram, pre and postoperative image will be
compared and evaluated three dimensionally without three dimensional computed
nomography after surgery and that will contribute to standardize normal values in three
dimension.
This study introduced new method that compute~simulated three dimensional image
was constructed by preoperative three dimensional computed tomogram and pre and
postoperative lateral and postero-anterior cephalograms, and for validation of new
method, in four cases of dry skull that position of mandible was displaced and four
patients of orthognathic surgery, computer simulated three dimensional image and actual
postoperative three dimensional image were compared. The results were as follows.
1. In flour cases of dry skull that position of mandible was displaced, range of
displacement between computer-simulated three dimensional images and actual
postoperative three dimensional images in co-ordinates values was from -1.8 ㎜ to 1,8
mm and 94% in displacement of all co-ordinates values was from -1.0 ㎜ to 1.0 ㎜ and
no significant difference between computer-simulated three dimensional images and
actual postoperative three dimensional images was noticed(p>0.05).
2. In four cases of orthognathic surgery patients, range of displacement between
computer-simulated three dimensional images and actual postoperative three dimensional
images in co-ordinates values was from -6.7 ㎜ to 7.7 ㎜ and 90% in displacement of
all co-ordinates values was from -4.0 to 4.0 ㎜ and no significant difference between
computer-simulated three dimensional images and actual postoperative three dimensional
images was noticed(p>0.05).
Conclusively, computer-simulated three dimensional image was constricted by
preoperative three dimensional computed tomogram and pre and postoperative lateral and
postero-anterior cephalograms. Therefore, potentiality that can construct postoperative
three dimensional image without three dimensional computed tomography after surgery
was presented.