WO2024027724A1

WO2024027724A1 - Digital three-dimensional measurement and evaluation method for temporomandibular joints

Info

Publication number: WO2024027724A1
Application number: PCT/CN2023/110626
Authority: WO
Inventors: 赵颖; 郝泽良; 孙焕焕
Original assignee: 首都医科大学宣武医院
Priority date: 2022-08-04
Filing date: 2023-08-01
Publication date: 2024-02-08
Also published as: CN114998349B; CN114998349A

Abstract

A digital three-dimensional measurement and evaluation method for temporomandibular joints, comprising: (1) establishing a standardized measurement and evaluation procedure: acquiring cone beam (CT) image data of a patient; performing head position correction to obtain three-dimensional image data of a standard head position; generating a plurality of temporomandibular joint two-dimensional measurement films by using the three-dimensional image data of the standard head position and a specific method; respectively measuring and evaluating joints and surrounding structures and position relationships thereof by using the two-dimensional measurement films; and generating a measurement report and a display image to provide data for clinical diagnosis and treatment; (2) performing a standard measurement method: completing the measurement of line distance and angle indexes by determining mark points and reference lines; and (3) performing a standard measurement report and customized display of the image. According to the present solution, the three-dimensional measurement and evaluation procedure is standard and has good reliability; the two-dimensional measurement film generation method is scientific and has good repeatability; the measurement items are complete and rich, such that the representativeness and the longitudinal comparability are good; digital measurement achieves an accurate result; and the measurement report and the image display are visual and clear.

Description

Digital three-dimensional measurement and evaluation method of temporomandibular joint

Cross-references to related applications

This application claims priority for the Chinese patent application submitted to the China Patent Office on August 4, 2022, with application number 2022109300595 and the invention name "Digital three-dimensional measurement and evaluation method of temporomandibular joint", the entire content of which is incorporated into this application by reference. middle.

Technical field

The present application relates to the field of oral medicine, and more specifically, the present application relates to a digital three-dimensional measurement and evaluation method of the temporomandibular joint.

Background technique

As the only joint structure in the craniofacial structure, the temporomandibular joint plays an important role in oral chewing, pronunciation and other functions. Temporomandibular joint disease is a common oral disease with a high incidence rate in the population. In addition to clinical symptoms and signs, the diagnosis of TMJ disease often relies on imaging evidence. Traditional imaging diagnosis of temporomandibular joint is mostly qualitative diagnosis. For measurement research on the temporomandibular joint and surrounding anatomical structures, manual measurement is often used for evaluation. Measurement is time-consuming and laborious, and there is no unified measurement index and normal value range. The temporomandibular joint morphology and structure among patients, before and after treatment, and during long-term follow-up The reproducibility of the evaluation of the relationship with position is poor and lacks comparability.

Digital cephalometric technology refers to the clinical use of three-dimensional cone beam CT (CBCT) to capture cranial and maxillofacial images, and digital cephalometric measurement (including three-dimensional calibration, fixed point, line distance measurement and angle measurement) after three-dimensional reconstruction. It is An effective quantitative assessment method for assessing craniofacial soft and hard tissue structures. However, there is currently no three-dimensional systematic digital measurement and evaluation method and system for the temporomandibular joint and its surrounding structures. Since the image data of the patient's natural head position obtained by conventional three-dimensional pyramidal beam CT are inconsistent with the standard head position, the heterogeneity of temporomandibular joint imaging is large. If the head position of the same patient cannot be consistent before and after treatment, it is difficult to ensure the accuracy of each measurement plane. Consistent, the measurement results lack horizontal and vertical comparability, and precise evaluation conclusions cannot be drawn. Therefore, head position correction through three-dimensional registration and generation of standard two-dimensional measurement films are very important in this process.

In addition, there are currently no standardized normal values for measurements of healthy temporomandibular joint structure and symmetry in a large sample of people without temporomandibular joint disease. There are three reasons: ① The anatomy of the temporomandibular joint structure of different people has great variation and measurement heterogeneity, which requires classified measurement and statistics. ② There is no recognized measurement index for the evaluation of the three-dimensional structure of the temporomandibular joint based on three-dimensional pyramidal beam CT data. ③ There is no complete system of measurement tools to measure it accurately and with good repeatability.

For example, Chinese patent application publication CN107080554A discloses a temporomandibular joint measurement method, in which a patient's oral cavity model is obtained; the patient's target image is determined through the oral cavity model, and the maxilla and mandible are separated based on the target image to free the mandible. This program matches and overlaps the dental crown images in different jaw positions with the corresponding dental crown images, and guides the free mandible to the corresponding jaw position to determine the temporomandibular joint image.

However, the technical solution disclosed in the above-mentioned patent application performs measurement through dental crown image matching, and does not perform direct and accurate measurement.

Therefore, based on three-dimensional pyramidal beam CT image data, a three-dimensional digital measurement and evaluation system and method for the temporomandibular joint and its surrounding anatomical structures and positional relationships should be established that is accurate, repeatable, and has good longitudinal comparability. It can provide more effective tools for scientific research and clinical diagnosis.

Contents of the invention

The technical problem to be solved by this application is to provide a digital three-dimensional measurement and evaluation method of the temporomandibular joint with high measurement accuracy, repeatability and longitudinal comparability in view of the above-mentioned defects in the existing technology.

According to this application, a digital three-dimensional measurement and evaluation method of the temporomandibular joint is provided, including:

1) Establish standardized measurement and evaluation procedures:

The first step: Obtain the patient's three-dimensional cone beam CT image data;

The second step: perform head position correction based on three-dimensional cone beam CT image data to obtain standard head position three-dimensional image data;

The third step: Use standard head position three-dimensional image data to generate multiple two-dimensional measurement films of the temporomandibular joint using a specific method;

Step 4: Use multiple two-dimensional measurement films of the temporomandibular joint to measure and evaluate the bilateral temporomandibular joints and their surrounding anatomical structures and positional relationships;

Step 5: Output the measurement and evaluation results, generate measurement reports and display images, and provide data for clinical diagnosis and treatment.

Optionally, a standardized measurement and evaluation procedure is established in the digital three-dimensional measurement and evaluation method of the temporomandibular joint, which is characterized in that the second step of correcting the three-dimensional cone beam CT image data to the standard head position specifically includes but is not limited to: three-dimensional coordinate system Registration method, natural head position registration method.

Optionally, a standardized measurement and evaluation procedure is established in the digital three-dimensional measurement and evaluation method of the temporomandibular joint, which is characterized in that in the second step, after the three-dimensional cone beam CT image data is corrected for the head position by the natural head position registration method, the orbital ear position in the sitting position is The line connecting the two sides is parallel to the ground plane, the line connecting the bilateral zygomaticofrontal sutures is parallel to the ground plane, and the line connecting the bilateral zygomaticofrontal sutures is also parallel to the ground plane in the supine position.

Optionally, first determine the maximum axial surface of the condyle, that is, parallel to the orbital plane, scan layer by layer from the top of the condyle to the sigmoid notch, select the axial layer section of the condyle with the largest internal and external diameter of the condyle, and generate ① condyle Maximum axial radiograph (bilateral);

Among the continuous sections perpendicular to the maximum internal and external diameter of the condyle, select the section passing through the midpoint of the maximum internal and external diameter of the condyle as the condyle center oblique sagittal plane to generate ② condyle center oblique sagittal view (bilateral);

Among the continuous sections perpendicular to the maximum axial plane of the condyle and the oblique sagittal plane of the condyle center, select the section passing through the maximum internal and external diameter of the condyle as the condyle center oblique coronal plane, and generate ③ condyle center oblique coronal film (bilateral ).

2) Establish standard measurement methods:

In the fourth step mentioned above, multiple two-dimensional measurement films of the temporomandibular joint are used to separately measure and evaluate the bilateral temporomandibular joints and their surrounding anatomical structures and positional relationships. The landmark points, reference lines, and reference lines on each two-dimensional measurement film are specified. The line distance between points, the distance between points and lines, and the intersection angle between lines are used as measurement indicators. Follow the principle of first determining the point, then the line, and then measuring the line distance and angle. These indicators are used to evaluate the structure and positional relationship of the bilateral temporomandibular joints to form a set of standard measurement methods.

Optionally, a standard measurement method is established in the digital three-dimensional measurement and evaluation method of the temporomandibular joint, which is characterized in that the landmark points determined on different two-dimensional measurement films include but are not limited to: ① The maximum axial film of the condyle: within the axial condyle point, axial condylar outer point, condylar geometric center point; ② condylar center oblique sagittal film: condylar center point, condylar apex, glenoid apex, condylar anterior point, glenoid anterior point, condylar process Posterior point, posterior point of the glenoid fossa, bottom point of the articular tubercle, bottom point of the glenoid fossa, and the lowest point of the sigmoid notch of the mandible; ③ oblique coronal radiograph of the center of the condyle: inner point of the coronal condyle, outer point of the coronal condyle , the medial point of the condyle top, the middle point of the condyle top, the lateral point of the condyle top, the medial point of the glenoid fossa, the middle point of the glenoid fossa, and the lateral point of the glenoid fossa.

Optionally, a standard measurement method is established in the digital three-dimensional measurement and evaluation method of the temporomandibular joint, which is characterized in that determining the reference line on different two-dimensional measurement films specifically includes but is not limited to: ① Maximum axial film of the condyle: axial condylar length axis, midsagittal line. ② Oblique sagittal radiograph of the condylar center: the optimal line of the anterior slope of the glenoid fossa, the top and bottom lines of the anterior slope of the glenoid fossa, the optimal line of the posterior slope of the glenoid, the long axis of the condyle, and the posterior tangent line of the ramus of the mandible. ③ Oblique coronal radiograph of the center of the condyle: external tangent line of the ramus of the mandible and coronal long axis of the condyle.

Optionally, a standard measurement method is established in the digital three-dimensional measurement and evaluation method of the temporomandibular joint, which is characterized in that the measurement indicators determined on different two-dimensional measurement films include but are not limited to: ① The maximum axial film of the condyle: the inside and outside of the axial condyle diameter, horizontal distance from the geometric center point of the condyle, sagittal distance from the geometric center point of the condyle, vertical distance from the geometric center point of the condyle, and long axis angle of the condyle. ② Condyle center oblique sagittal radiograph: condylar anteroposterior diameter, condylar height, condylar sagittal inclination angle, mandibular ramus posterior inclination angle, pre-articular space, post-articular space, supra-articular space, length of posterior slope of articular tubercle , articular tubercle inclination, glenoid fossa width, glenoid fossa depth, and glenoid fossa opening angle. ③ Oblique coronal radiograph of the condylar center: coronal internal and external diameter of the condyle, intra-articular space, extra-articular space, mid-articular space, coronal inclination angle of the condyle, and external inclination angle of the ramus of the mandible.

3) Standard measurement reports and customized display images:

The measurement data of the left and right temporomandibular joints are displayed correspondingly in the measurement report, making it easy to evaluate the structure of the bilateral joints as well as the symmetry of the shape and position; the display image of each two-dimensional measurement piece includes landmark points, reference lines, line distance and angle measurement data Information, and the display range and content can be customized.

Optionally, the standard measurement report and customized display image in the digital three-dimensional measurement and evaluation method of temporomandibular joint, when outputting the measurement results, the measurement report table and display image are displayed correspondingly with the left and right joint measurement indicators. The customized display content specifically includes But not limited to: image display, landmark point display, reference line display, line distance indicator display or angle indicator display, and comprehensive display, etc. It is illustrated with pictures and texts to facilitate comprehensive analysis and understanding by clinicians.

In the plan of this application, a digital three-dimensional measurement plan is established based on the measurement system, from collecting cone beam CT data, to three-dimensional direction registration, to generating a two-dimensional plan view of the temporomandibular joint, as well as relevant points of each plan view, Lines, surfaces, and angles are determined and measured, and finally the measurement evaluation results are output. This application develops a complete three-dimensional measurement and evaluation system for the temporomandibular joint, including the determination of different planes in the three-dimensional structure, as well as the determination of relevant landmark points, reference lines, measurement line distances and angles on different planes.

This application has at least the following advantages:

1. This application establishes a complete and systematic three-dimensional measurement and evaluation system for the temporomandibular joint, including standardized evaluation procedures. The standardized evaluation procedure includes three-dimensional pyramidal beam CT image acquisition, head position correction of the image data through three-dimensional registration, and the completion of the generation of multiple two-dimensional measurement films of the temporomandibular joint in the three-dimensional direction under the head position correction condition, and the two-dimensional The measurement and evaluation of the anatomical structure and positional relationship of the bilateral temporomandibular joints were completed on the measurement film. This set of standardized evaluation procedures ensures high reproducibility and good longitudinal comparability, which is conducive to horizontal comparisons between different patients and between the structures of the temporomandibular joints on both sides of the same patient under the same conditions, as well as longitudinal comparisons of the same patient at different times. .

2. This application establishes a complete and systematic three-dimensional measurement and evaluation system for the temporomandibular joint, which also includes standard measurement methods. This standard measurement method measures and comprehensively evaluates the temporomandibular joints on both sides from three dimensions: the maximum axial plane of the condyle, the oblique sagittal plane of the condyle center, and the oblique coronal plane of the condyle center. This standard measurement method establishes a series of The measurement landmark points and measurement indicators of the temporomandibular joint head - condyle, temporomandibular glenoid fossa - temporal bone glenoid fossa and temporomandibular joint space can truly achieve quantitative assessment of the temporomandibular joint and surrounding three-dimensional structures.

3. This application has established a complete and systematic three-dimensional measurement and evaluation system of the temporomandibular joint, which can provide an effective tool for collecting large sample sizes of healthy temporomandibular joint image data and establishing a standard normal value range for the temporomandibular joint structure. Three-dimensional pyramidal beam CT image data brings new developments in the evaluation of the structure and positional relationships of the temporomandibular joint.

4. This application establishes a complete and systematic three-dimensional measurement and evaluation system for the temporomandibular joint, changing the current situation that the measurement of the temporomandibular joint requires manual fixation and manual measurement in the past, reducing the systematic error of manual measurement; changing the different focuses of different researchers The current status of evaluation provides a more comprehensive and powerful tool for accurate and in-depth scientific research. At the same time, it changes the current situation that accurate measurement of temporomandibular joints is only used in the field of scientific research, and provides a more effective tool for clinical diagnosis and treatment of temporomandibular joint diseases.

5. This application establishes a complete and systematic three-dimensional measurement and evaluation system for the temporomandibular joint, changing the traditional clinical qualitative evaluation method. By quantitatively evaluating the anatomical structure of the temporomandibular joint head, glenoid fossa and joint space, it provides a basis for the diagnosis and treatment of temporomandibular joint disease. Diagnosis provides a more accurate imaging basis, for example, condyle wear/joint space narrowing, specific wear amount, height reduction amount, joint space narrowing amount, and provides a scientific method for evaluating the severity of temporomandibular joint disease.

6. This application has established a complete and systematic three-dimensional measurement and evaluation system of the temporomandibular joint, which can provide longitudinal comparative assessment of the progress of organic changes, bone remodeling and joint space changes of the temporomandibular joint, and provide long-term treatment for temporomandibular joint diseases. Follow-up observation provides a scientific method.

7. This application has established a complete and systematic three-dimensional measurement and evaluation system for the temporomandibular joint, including measurement reports and customized display images that display the measurement data of the left and right temporomandibular joints symmetrically, which can provide users of this method with clear and illustrated images. The easy-to-understand display of measurement results is conducive to better analysis and understanding of the manifestations of temporomandibular diseases, and can be applied to academic communication and clinical case reports.

Description of the drawings

A more complete understanding of the present application and its attendant advantages and features will be more readily understood by reference to the following detailed description, taken in conjunction with the accompanying drawings, wherein:

Figure 1 schematically shows a flow chart of a digital three-dimensional measurement and evaluation method for the temporomandibular joint according to a preferred embodiment of the present application;

Figure 2 schematically shows the sagittal state before head position correction;

Figure 3 schematically shows the sagittal state after head position correction;

Figure 4 schematically shows the coronal state before head position correction;

Figure 5 schematically shows the coronal state after head position correction;

Figure 6 schematically shows the lateral state before head position correction;

Figure 7 schematically shows the lateral state before head position correction;

Figure 8 schematically shows a schematic diagram of the maximum axial film of the condylar process of the digital three-dimensional measurement method of the temporomandibular joint according to the preferred embodiment of the present application;

Figure 9 schematically shows the principle diagram of determining the oblique coronal film of the condylar center according to the digital three-dimensional measurement method of the temporomandibular joint according to the preferred embodiment of the present application;

Figure 10 schematically shows a schematic diagram of an oblique coronal film of the condylar center of the temporomandibular joint digital three-dimensional measurement method according to a preferred embodiment of the present application;

Figure 11 schematically shows a schematic diagram of the determination of the oblique sagittal film of the condylar center according to the digital three-dimensional measurement method of the temporomandibular joint according to the preferred embodiment of the present application;

Figure 12 schematically shows a schematic diagram of a condyle center oblique sagittal film of the digital three-dimensional measurement method of the temporomandibular joint according to the preferred embodiment of the present application;

Figures 13 to 57 schematically show examples of setting mark points, setting reference lines, and measurement items.

It should be noted that the drawings are used to illustrate the present application, rather than to limit the present application. Note that drawings showing structures may not be drawn to scale. Moreover, in the drawings, the same or similar elements are labeled with the same or similar numbers.

Detailed ways

In order to make the contents of this application clearer and easier to understand, the contents of this application will be described in detail below with reference to specific embodiments and drawings.

This application provides a three-dimensional digital measurement and evaluation method for the temporomandibular joint, which imports the three-dimensional image data of the temporomandibular joint taken by cone beam CT, corrects the head position, generates a two-dimensional measurement film of the temporomandibular joint, and completes the temporomandibular joint and its Measure and evaluate surrounding structures and locations, and output measurement and evaluation results to provide data for clinical diagnosis and treatment. This program has standard measurement and evaluation procedures and good reliability; the method of generating two-dimensional measurement sheets is scientific and has good repeatability; the measurement items are complete and rich, with good representativeness and longitudinal comparability; digital measurement is used, and the results are accurate; measurement reports and image display Visual and clear.

The present application will be described in detail below.

Figure 1 schematically shows a flow chart of a digital three-dimensional evaluation method of the temporomandibular joint according to a preferred embodiment of the present application.

As shown in Figure 1, the digital three-dimensional evaluation method of the temporomandibular joint according to the preferred embodiment of the present application includes:

1) Establish standardized measurement and evaluation procedures:

The first step S1: Obtain the patient's three-dimensional cone beam CT image data;

Second step S2: Perform head position correction based on three-dimensional cone beam CT image data to obtain standard head position three-dimensional image data;

Head position correction refers to converting the natural head position during CBCT shooting into a standard head position with good repeatability. The following uses the natural head position registration method as an example to correct the head position (as shown in Figure 2, slightly bowed, orbital (the line connecting the ears is not parallel to the ground), rotate the head to the standard head position through a straight line parallel or vertical operation (as shown in Figure 3). After the head position is corrected, the line connecting the orbit and the ear is parallel to the ground, so that the head position changes from the original position. The lowered head becomes the standard head position). The three-dimensional directions include sagittal rotation, coronal rotation, and transverse rotation.

Optionally, when performing head position correction, the orbit-auricular line is parallel to the ground plane when the sitting position is performed, the bilateral zygomaticofrontal suture line is parallel to the ground plane, and the bilateral zygomaticofrontal suture line is parallel to the ground plane when the supine position is performed. . For example, the registration operation includes: determining two points, forming a connection line, making the connection line parallel to the ground or perpendicular to the ground, so that the skull can follow this connection line to rotate and adjust the head position, and finally become straight.

Figure 4 schematically shows the coronal state before head position correction. At this time, the head is slightly tilted, and the bilateral zygomaticofrontal suture line is not parallel to the ground. Figure 5 schematically shows the coronal forward state after head position correction. After head position correction, the bilateral zygomaticofrontal suture line is parallel to the ground, so that the head position changes from the original deviated head position to the positive standard head position. .

Figure 6 schematically shows the lateral state before head position correction, the horizontal plane from the feet to the head, or the cross section, that is, the supine position. The previous head position was slightly tilted to the right, and the line between the bilateral zygomatic and frontal sutures was not parallel to the ground. Figure 7 schematically shows the lateral state before head position correction. After head position correction, the line connecting the bilateral zygomaticofrontal sutures is parallel to the ground in the supine position. In this way, the head position changes from the original rightward to the positive standard head position.

In this way, the head position is calibrated from three directions and becomes the standard head position. This is one method of head position correction.

The standard head position is obtained after head position correction. For example, when the patient takes a cone beam CT scan, the patient's head turns slightly to the right, one high and one low. The head position is re-corrected from this "natural but incorrect" position to the "standard horizontal and vertical" position through three directions: horizontal, vertical and transverse. head position. Accurate films can be produced in this head position. There are other ways to correct the head position, which are not listed here.

The third step S3: Use standard head position three-dimensional image data to generate multiple two-dimensional measurement films of the temporomandibular joint using a specific method;

For example, the third step of generating two-dimensional measurement slices of the temporomandibular joint specifically includes:

First, parallel to the orbital plane, scan layer by layer from the top of the condyle to the sigmoid notch, and select the axial slice of the condyle with the largest internal and external diameters of the left and right condyles to generate ① the largest axial film of the condyle (bilateral) ( As shown in Figure 8);

In the continuous section perpendicular to the maximum internal and external diameter of the condyle, the section passing through the midpoint of the maximum internal and external diameter of the condyle is selected as the condyle center oblique sagittal plane (the drawing principle is shown in Figure 9), and ② the condyle center oblique sagittal plane is generated Sagittal radiograph (bilateral) (Figure 10 shows an oblique sagittal radiograph of the left or right condylar center)

Among the continuous sections perpendicular to the maximum axial plane of the condyle and the oblique sagittal plane of the condyle center, select the section passing through the maximum internal and external diameter of the condyle as the oblique coronal plane of the condyle center (the drawing principle is shown in Figure 11), and generate ③ Condylar center oblique coronal radiograph (bilateral) (Figure 12 shows a left or right condylar center oblique sagittal radiograph).

From this, multiple two-dimensional measurement films of the temporomandibular joint are generated, including but not limited to the maximum axial film of the left condyle, the oblique sagittal film of the center of the left condyle, the oblique coronal film of the center of the left condyle, the right The maximum axial film of the condyle, the oblique sagittal film of the center of the right condyle, and the oblique coronal film of the center of the right condyle.

The fourth step S4: Use multiple two-dimensional measurement films of the temporomandibular joint to measure and evaluate the bilateral temporomandibular joints and their surrounding anatomical structures and positional relationships;

Optionally, in the fourth step to measure and evaluate the three-dimensional shape and position of the temporomandibular joint, first determine the landmark point, then determine the reference line, and then measure the line distance between points, the distance between points and lines, and the distance between lines. Intersection angle and other numerical values.

The fifth step S5: Output the measurement evaluation results, generate measurement reports and display images, and provide data for clinical diagnosis and treatment.

Optionally, in the fifth step S5, while outputting the measurement evaluation results, the effect is displayed in a left-right symmetrical display manner. For example, output is performed based on different locations such as the joint head, glenoid fossa, joint space, and joint tubercle; or output is performed based on different planes such as the oblique sagittal plane of the condyle center, the oblique coronal plane of the condyle center, and the maximum axial plane of the condyle. ; Or output according to line distance and angle respectively. This standardized measurement and evaluation procedure and standardized measurement methods improve the accuracy and completeness of temporomandibular joint measurement and evaluation.

In the plan of this application, a digital three-dimensional measurement plan is established based on the measurement system, from collecting cone beam CT data, to head position correction, to generating each two-dimensional measurement slice of the temporomandibular joint, as well as the relevant points of each plan view. , lines, surfaces, and angles are determined and measured, and finally the measurement evaluation results are output. This application develops a complete three-dimensional measurement and evaluation system for the temporomandibular joint, including the determination of different planes in the three-dimensional structure, as well as the determination of relevant landmark points, reference planes, measurement line distances and angles on different planes.

2) Establish standard measurement methods:

For example, as mentioned above, the measurement items include: the maximum axial radiograph of the condyle, the oblique sagittal radiograph of the center of the condyle, and the oblique coronal radiograph of the center of the condyle.

For example, fixed points include:

For example, for the maximum axial film of the condyle: (Take one side as an example)

①M: The most medial point of condylar process on the axial plane, the inner point of the axial condylar process (Figure 13).

②L: The most lateral points of condylar process on the axial plane, axial condylar outer point (Figure 14).

③G: Geometric center of condylar process, the geometric center point of the condylar process, the midpoint of the long axis of the condylar process (The mediolateral axis of condylar process on the axial plane, the long axis of the condylar process) (Figure 15).

For example, for the oblique sagittal radiograph of the condylar center (taking one side as an example):

①COc: Condyle center, the center point of the condyle, the center of the largest circle suitable for the condyle and passing through COs. (Figure 16)

②COs: Superior condyle, condyle apex (as shown in Figure 17).

③R: Maximum point of the fossa, the vertex of the glenoid fossa (as shown in Figure 18).

④COa: Anterior Condyle, the anterior point of the condylar process (as shown in Figure 19). Take the tangent line to the anterior edge of the condylar process through point R, and the tangent point is COa.

⑤FOa: Anterior Fossa, the anterior point of the glenoid fossa (as shown in Figure 20), pass the COa point and draw the R-COa vertical line to intersect the posterior slope of the articular tubercle at the FOa point. After the COa point is determined, a vertical line R-COa needs to be drawn through the COa point.

⑥COp: Posterior Condyle, the posterior point of the condyle (as shown in Figure 21). The tangent line to the posterior edge of the condyle is drawn through point R, and the tangent point is COp.

⑦FOp: Posterior Fossa, the posterior point of the glenoid fossa (as shown in Figure 22), pass the COp point and draw a vertical line R-COp to intersect the posterior slope of the articular tuberosity fossa at the FOp point. After the COp point is determined, a vertical line of R-COp needs to be drawn through the COp point.

⑧T: Minimum point of the articular tubercle, the bottom point of the articular tubercle (as shown in Figure 23).

⑨FOl: Last point of posterior Fossa, the bottom point of the glenoid fossa (as shown in Figure 24), the lowest point of the posterior slope of the glenoid fossa.

⑩Sg: Sigmoid notch, the lowest point of the sigmoid notch of the mandible (as shown in Figure 25).

For example, for the oblique coronal radiograph of the condylar center (taking one side as an example):

①COm: Medial Condyle on the coronal plane, the inner point of the coronal condyle (as shown in Figure 26).

②COl: Lateral Condyle on the coronal plane, the outer point of the coronal condyle (as shown in Figure 27).

③m1': Intersection between perpendicular line of ML which pass through m1 and condyle top, the medial point of the condyle top, perpendicular to ML and passing through the m1 point, and the intersection with the top of the condyle (Figure 28).

m1: Medial 1/8 point, 1/8 point within COm-COl, the first equal point within the eight equal points of the long axis of the condyle, and the first equal point within the eight equal points of the line connecting COm and COl.

④m4': Intersection between perpendicular line of M-L which pass through m4and condyle top, the middle point of the condyle top, perpendicular to M-L and passing through the m4 point, and the intersection with the top of the condyle (Figure 28).

m4: Medial 1/2point, the midpoint of COm-COl, the fourth equal point within the eight equal points of the long axis of the condyle, and the fourth equal point (midpoint) within the eight equal points of the line connecting COm and COl.

⑤m7': Intersection between perpendicular line of M-L which pass through m7and condyle top, the lateral point of the condyle top, perpendicular to M-L and passing through the m7 point, and the intersection with the top of the condyle (Figure 28).

m7: Medial 7/8point, 7/8 point within COm-COl, seventh equal point within eight equal points of the long axis of the condyle, seventh equal point within the eight equal points of the line connecting COm and COl (outer third) first decile point).

⑥m1”: Intersection between perpendicular line of condyle top which pass through m1’and fossa, the medial point of the glenoid fossa, perpendicular to the upper surface of the condyle and passing through the m1’ point, and the intersection with the lower surface of the glenoid fossa (Figure 28).

⑦m4”: Intersection between perpendicular line of condyle top which pass through m4’and fossa, the middle point of the glenoid fossa, perpendicular to the upper surface of the condyle and passing through the m4’ point, and the intersection with the lower surface of the glenoid fossa (Figure 28).

⑧m7”: Intersection between perpendicular line of condyle top which pass through m7’and fossa, the lateral point of the glenoid fossa, perpendicular to the upper surface of the condyle and passing through the m7’ point, and the intersection with the lower surface of the glenoid fossa (Figure 28).

For example, alignment includes:

For example, for the maximum axial radiograph of the condyle

①MLa: The mediolateral axis of condylar process on the axial plane, the long axis of the condyle in the axial position (Figure 29).

②MS: Middle saggital line, median sagittal line (Figure 30).

For example, for a condylar center oblique sagittal radiograph

①ATp: Best-fit line of the articular tubercle's posterior oblique, the optimal line of the anterior slope of the glenoid fossa. A tangent line passing through point FOa and cutting into the anterior slope of the glenoid fossa (Fig. 31).

②RT: Top-roof line of articular tubercle, the top and bottom line of the anterior slope of the glenoid fossa, the line connecting the vertex R of the glenoid fossa and the bottom point T of the articular tubercle (Figure 32).

③MFp: Best-fit line of the mandibular fossa's posterior oblique, the optimal line of the posterior slope of the glenoid fossa, the line that passes through FOp and cuts into the posterior wall of the glenoid fossa (Figure 33).

④COH: Long axis of the condylar head, the long axis of the condylar process, the line connecting the highest point COs of the condylar process to the center point COc of the condylar process is regarded as the long axis of the condylar process (Figure 34).

⑤RMs: Long axis of the mandible ramus on the sagittal plane, the posterior tangent line of the mandibular ramus, as the long axis of the mandibular ramus (as shown in Figure 35).

For example, for a central oblique coronal radiograph of the condyle

①RMc: Long axis of the mandible ramus on the coronal plane, the outer tangent line of the mandibular ramus, as the long axis of the mandibular ramus (Figure 36).

②MLc: Mediolateral axis of condyle on the coronal plane, the long axis of the coronal condyle, the long axis passing through COm and COl (Figure 37).

For example, measurement items include:

For example, for the maximum axial radiograph of the condyle

①M-L (mm): Length of condyle process (LCP) on the axial plane, axial inner and outer diameter of the condyle, distance between two points M and L (Figure 38)

②G-MS (mm): Distance from geometric center of the condylar to the MS, the horizontal distance from the geometric center of the condylar process, the vertical distance from the geometric center point G of the condylar process to the midsagittal line, the distance between the two points G and F (Figure 39) .

F: Foot point from G to MS, the vertical foot of the mid-sagittal plane of the condyle is drawn through the geometric center point G of the condylar process and the vertical line of the mid-sagittal plane is drawn, and the vertical foot is F.

③Fr-Fls(mm): Anteroposterior distance between the geometric centers of both condylar, sagittal distance between the geometric center points of the condyle, the anteroposterior distance between the two points Fr and Fl projected on the sagittal plane, Fr is in front, it is positive, otherwise it is Negative (Figure 40).

④Fr-Flc (mm): Superiorinferior distance between the geometric centers of both condylar, the vertical distance between the geometric center points of the condyle, the upper and lower distance between the two points Fr and Fl projected on the coronal plane, Fr is positive if it is above, and negative if it is not

⑤MLa-MS(°): Inclinition of mediolateral axis of condyle, condyle long axis angle, the angle between the condyle long axis and the midsagittal line (medial anterior angle) (Figure 41).

For example, for a condylar center oblique sagittal radiograph

(1) COa-COp (mm): Width of condylar process, the anteroposterior diameter of the condyle, the distance between COa and COp (Figure 42).

(2) HCP (mm): Height of condylar process, condylar process height, the vertical distance between the condylar process apex COs and the lowest point Sg of the mandibular sigmoid notch (Figure 43).

(3) COH-RMs (°): Condylar head angle, angle between condylar head and mandibular ramus, condylar sagittal inclination angle, condylar long axis COH and mandibular ramus posterior tangent line RMs angle (upper and lower angle) (Figure 44 ).

(4) RMs-FH (°): Inclination of the mandibular ramus The posterior inclination angle of the mandibular ramus, the angle between the posterior tangent line RMs of the mandibular ramus and the horizontal line FH (as shown in Figure 45) (anterior-superior angle).

(5) COa-FOa (mm): Anterior joint space (Ajs), the distance between the two points of COa and FOa (Figure 46).

(6) COp-FOp (mm): Posterior joint space (Pjs), the distance between the two points COp and FOp (Figure 47).

(7) COs-R (mm): Superior joint space (Sjs), the gap on the joint, the distance between COs and R (Figure 48).

(8) R-T (mm): Length of the articular tubercle's posterior oblique, the length of the posterior slope of the articular tubercle, and the distance between the two points R-T (Figure 49).

(9) RT-FH (°): Inclination of articular tubercle (IRT), inclination of articular tubercle (top-bottom method), anteroinferior intersection angle between RT line and horizontal line FH (Figure 50).

(10) WMF (mm): Width of the mandibular fossa, the width of the glenoid fossa, the distance between the two points F01 and T (Figure 51).

(11) DMF (mm): Depth of the mandibular fossa, the depth of the glenoid fossa, is equal to the height of the articular tubercle, and the vertical distance from the uppermost point of the glenoid fossa R to FO1-T (Figure 52).

(12)ATp-MFp(°): Glenoid fossa divergence angle, glenoid fossa opening angle, also known as glenoid fossa expansion angle, glenoid fossa divergence angle. The angle between the optimal line ATp of the anterior glenoid slope and the optimal line MFp of the posterior glenoid slope (Fig. 53).

For example, for a central oblique coronal radiograph of the condyle

①COm-COl (mm): Length of condyle process (LCP) on the coronal plane, the inner and outer diameter of the coronal condyle, and the distance between COm and COl (Figure 54).

②m1'-m1” (mm): Medial joint space (Mjs), the distance within the joint, the distance between the two points m1’ and m1” (Figure 55).

③m7'-m7" (mm): Lateral joint space (Ljs), extra-articular space, the distance between m7' and m7". If m7" cannot be obtained (the condyle COl point is located outside the glenoid fossa), use the maximum value of the glenoid fossa. Replace with the shortest distance from the inferior lateral point to the condyle (Fig. 55).

④m4'-m4” (mm): Middle joint space (Mis), the gap in the joint, the distance between the two points m4’ and m4” (Figure 55).

⑤MLc-FH(°): Horizontal inclinition of mediolateral axis of condyle, coronal inclination angle of the condyle, horizontal inclination of the inner and outer diameter of the condyle, the angle between the long axis MLc of the inner and outer diameter of the condyle and the horizontal line FH (the inner and outer angle, COm relative If CO1 is on top, it is positive, if it is not, it is negative) (Figure 56).

⑥RMc-MS(°): Vertical inclination of mandible ramus, the angle of the mandibular ramus camber, the angle between the external tangent line RMc of the mandibular ramus and the midsagittal line MS (the angle between up and down, the long axis of the mandibular ramus is positive inside, No is negative) (Figure 57).

Of course, other measurement planes can also perform fixed points, alignments, measurement projects, etc.

3) Standard measurement reports and customized display images:

This application has at least the following advantages:

1. This application establishes a complete and systematic three-dimensional measurement and evaluation system for the temporomandibular joint, including standardized evaluation procedures. The standardized evaluation procedure includes three-dimensional pyramidal beam CT image acquisition, head position correction of the image data through three-dimensional registration, and the completion of the generation of multiple two-dimensional measurement films of the temporomandibular joint in the three-dimensional direction under the head position correction condition, and the two-dimensional Complete the measurement of the anatomical structure and positional relationship of the bilateral temporomandibular joints on the measurement film Quantity assessment. This set of standardized evaluation procedures ensures high reproducibility and good longitudinal comparability, which is conducive to horizontal comparisons between different patients and between the structures of the temporomandibular joints on both sides of the same patient under the same conditions, as well as longitudinal comparisons of the same patient at different times. .

2. This application establishes a complete and systematic three-dimensional measurement and evaluation system for the temporomandibular joint, which also includes standard measurement methods. This standard measurement method measures and comprehensively evaluates the temporomandibular joints on both sides from three dimensions: the maximum axial plane of the condylar process, the oblique sagittal plane of the condylar center, and the oblique coronal plane of the condylar center. This standard measurement method establishes a series of The measurement landmark points and measurement indicators of the temporomandibular joint head - condyle, temporomandibular glenoid fossa - temporal bone glenoid fossa and temporomandibular joint space can truly achieve quantitative assessment of the temporomandibular joint and surrounding three-dimensional structures.

3. This application has established a complete and systematic three-dimensional measurement and evaluation system for the temporomandibular joint, which can provide an effective tool for collecting large sample sizes of healthy temporomandibular joint image data and establishing standard normal values for the temporomandibular joint structure. Pyramid tract CT imaging data brings new developments in the assessment of temporomandibular joint structure and positional relationships.

4. This application establishes a complete and systematic three-dimensional measurement and evaluation system for the temporomandibular joint, changing the current situation that the measurement of the temporomandibular joint requires manual fixation and manual measurement in the past, reducing the systematic error of manual measurement; changing the different focuses of different researchers The current status of evaluation provides a more powerful tool for accurate and in-depth scientific research. At the same time, it changes the current situation that accurate measurement of temporomandibular joints is only used in the field of scientific research, and provides a more effective tool for clinical diagnosis and treatment of temporomandibular joint diseases.

6. This application has established a complete and systematic three-dimensional measurement and evaluation system of the temporomandibular joint, which can provide longitudinal comparative assessment of the progression of organic changes, bone remodeling and joint space changes of the temporomandibular joint, and provide guidance for the treatment of temporomandibular joint diseases. Long-term follow-up observation provides scientific methods.

In short, the establishment of the three-dimensional measurement and evaluation method of this plan is scientific and accurate, making the measurement results accurate and the measurement plan highly repeatable; this plan is based on head position correction before each measurement. The method of generating each two-dimensional measurement piece in the three-dimensional structure of the temporomandibular joint in this program is scientific and accurate, and the imaging pictures can be saved to facilitate repeated measurements. The temporomandibular joint measurement method in this program is systematic, which is reflected in: ① The measurement content is complete and rich, including the sagittal, coronal and axial measurement and evaluation of the temporomandibular joint, including the joint head, glenoid fossa, and articular tubercle , Measurement and evaluation of joint space; ② The measurement method is scientific, using first setting landmark points (mainly anatomical landmark points with good recognizability), then setting reference lines, measuring the line distance between points, the distance between points and lines, The intersection angle between lines and other numerical values. This standardized measurement procedure and standard measurement methods improve the accuracy and completeness of three-dimensional measurements of the temporomandibular joint. ③The measurement results of this program are output in the form of visual display, which is clear and clear. Although there are various measurement items, the output method is symmetrical, grouped, and clear, which facilitates clinical comparative analysis of the structure and position of the bilateral temporomandibular joints.

In addition, it should be noted that, unless otherwise specified, the terms "first", "second", "third" and other descriptions in the specification are only used to distinguish various components, elements, steps, etc. in the specification, rather than using It is used to express the logical relationship or sequential relationship between various components, elements, steps, etc.

It can be understood that although the present application has been disclosed above with preferred embodiments, the above embodiments are not intended to limit the present application. For any person familiar with the art, without departing from the scope of the technical solution of the present application, the technical content disclosed above can be used to make many possible changes and modifications to the technical solution of the present application, or modify it into equivalent changes. Example. Therefore, any simple modifications, equivalent changes and modifications made to the above embodiments based on the technical essence of the present application that do not deviate from the content of the technical solution of the present application still fall within the scope of protection of the technical solution of the present application.

Claims

A digital three-dimensional measurement and evaluation method of the temporomandibular joint, which is characterized by including:

Implement standardized measurement and evaluation procedures:

The first step: Obtain the patient's three-dimensional cone beam CT image data;

The second step: perform head position correction based on three-dimensional cone beam CT image data to obtain standard head position three-dimensional image data;

The third step: Use standard head position three-dimensional image data to generate multiple two-dimensional measurement films of the temporomandibular joint using a specific method;

Step 4: Use multiple two-dimensional measurement films of the temporomandibular joint to measure and evaluate the bilateral temporomandibular joints and their surrounding anatomical structures and positional relationships;

Step 5: Output the measurement and evaluation results, generate measurement reports and display images, and provide data for clinical diagnosis and treatment.
The digital three-dimensional measurement and evaluation method of the temporomandibular joint according to claim 1, further comprising:

Perform standard measurement methods including:

In the fourth step of using multiple two-dimensional temporomandibular joint measurement films to measure and evaluate the bilateral temporomandibular joints and their surrounding anatomical structures and positional relationships, the landmark points and reference lines on each two-dimensional measurement film are specified. , stipulates the line distance between points, the distance between points and lines, and the intersection angle between lines as measurement indicators; follow the sequence of first fixing the point, then fixing the line, and then measuring the line distance and angle, and use comprehensive and rich measurement indicators to measure both sides. The structure and positional relationship of the temporomandibular joint were evaluated.
The digital three-dimensional measurement and evaluation method of the temporomandibular joint according to claim 1 or 2, further characterized by:

Perform standard measurement reports and custom image presentations including:

The measurement data of the left and right temporomandibular joints are displayed correspondingly in the measurement report, making it easy to evaluate the symmetry of the bilateral joint structure, shape and position; the display image of each two-dimensional measurement piece includes landmark points, reference lines, line distance and angle measurements Data information, and the display range and content can be customized.
The digital three-dimensional measurement and evaluation method of the temporomandibular joint according to claim 1, wherein in the establishment of a standardized measurement and evaluation program, the second step of correcting the three-dimensional cone beam CT image data to a standard head position specifically includes but not Limited to: three-dimensional coordinate system registration method and natural head position registration method.
The digital three-dimensional measurement and evaluation method of the temporomandibular joint according to claim 1, characterized in that in establishing a standardized measurement and evaluation program, the third step utilizes the standard head position three-dimensional cone beam CT image data to generate a plurality of two-dimensional images generated by a specific method. Dimensional measurement films specifically include but are not limited to: left and right condylar maximum axial films, left and right condylar center oblique sagittal films, and left and right condylar center oblique coronal films.
The digital three-dimensional measurement and evaluation method of the temporomandibular joint according to claim 1, characterized in that, in establishing a standardized measurement and evaluation program, the third step uses standard head position three-dimensional cone beam CT image data to generate a specific method of two-dimensional measurement slices for:

First, parallel to the orbital plane, scan layer by layer from the top of the condyle to the sigmoid notch, and select the axial slice of the condyle with the largest internal and external diameters of the condyle on both sides to generate the largest axial film of the left and right condyles;

Among the continuous sections perpendicular to the maximum internal and external diameter of the condyle, select the section passing through the midpoint of the maximum internal and external diameter of the condyle as the condyle center oblique sagittal plane, and generate the left and right condyle center oblique sagittal views;

Among the continuous sections perpendicular to the maximum axial plane of the condyle and the oblique sagittal plane of the condyle center, the section passing through the maximum inner and outer diameter of the condyle was selected as the oblique coronal plane of the condyle center, and the left and right condylar center oblique coronal films were generated.
The digital three-dimensional measurement and evaluation method of the temporomandibular joint according to claim 1 or 2, characterized in that in establishing the standard measurement method, landmark points are determined on different two-dimensional measurement slices, specifically including but not limited to: ① The maximum axis of the condyle Radiographs: axial condylar inner point, axial condylar outer point, condylar geometric center point; ② Condyle center oblique sagittal radiograph: condylar center point, condylar apex, glenoid apex, condylar anterior point , the anterior point of the glenoid fossa, the posterior point of the condyle, the posterior point of the glenoid fossa, the bottom point of the articular tubercle, the bottom point of the glenoid fossa, and the lowest point of the sigmoid notch of the mandible; ③ oblique coronal radiograph of the condylar center: inside the coronal condyle Point, coronal condyle outer point, condyle apex medial point, condyle apex midpoint, condyle apex lateral point, glenoid fossa medial point, glenoid fossa midpoint, glenoid fossa lateral point.
The digital three-dimensional measurement and evaluation method of the temporomandibular joint according to claim 1 or 2, characterized in that in establishing the standard measurement method, reference lines are determined on different two-dimensional measurement sheets, specifically including but not limited to: ① The maximum axis of the condyle Radiograph: axial long axis of the condyle, mid-sagittal line; ② Oblique sagittal radiograph of the center of the condyle: optimal line of the anterior slope of the glenoid fossa, top and bottom line of the anterior slope of the glenoid fossa, optimal line of posterior slope of the glenoid fossa, condyle Long axis, posterior tangent line of the ramus of the mandible; ③ Oblique coronal film of the center of the condylar process: external tangent line of the ramus of the mandible, long axis of the condyle in the coronal position.
The digital three-dimensional measurement and evaluation method of the temporomandibular joint according to claim 1 or 2, characterized in that in establishing the standard measurement method, measurement indicators are determined on different two-dimensional measurement sheets, specifically including but not limited to: ① The maximum axis of the condyle Radiographs: axial inner and outer diameter of the condyle, horizontal distance from the condylar center point, sagittal distance from the condylar center point, vertical distance from the condylar center point, condylar long axis angle; ② oblique sagittal radiograph of the condylar center: condyle Anteroposterior diameter, condylar height, condylar sagittal inclination angle, mandibular ramus retroversion angle, pre-articular space, post-articular space, supra-articular space, length of posterior slope of articular tubercle, inclination of articular tubercle, width of glenoid fossa, joint Fossa depth, glenoid fossa opening angle; ③ Condyle center oblique coronal film: coronal condyle internal and external diameter, intra-articular space, extra-articular space, mid-articular space, coronal inclination angle of the condyle, and external inclination angle of the ramus of the mandible.
The digital three-dimensional measurement and evaluation method of the temporomandibular joint according to claim 3, characterized in that in the standard measurement report and the customized image display, when the measurement results are output, the measurement report table is displayed correspondingly with the left and right temporomandibular joint measurement indicators. And display images, customized display content specifically includes but is not limited to: image display, landmark point display, reference line display, line distance indicator display or angle indicator display, as well as combined or comprehensive display.