안면비대칭과 척추 측만증의 관계 연구

Abstract

본 연구의 목적은 안면비대칭환자에서 척추 측만증을 동반하는 환자의 비율을 알아보고 비대칭이 없는 환자와 비교하여 안면비대칭과 척추 측만증의 관련성을 분석하고자 하였다. 안면 비대칭 양상과 척추 측만의 정도를 객관적인 지표로 측정하고 안면비대칭이 척추 측만증의 기여 요인이 되는지 두 요소 사이의 연관성에 대해서 객관적으로 평가하였다. 안면 비대칭의 여부는 모든 환자의 수술 전 전후방 두개방사선 사진에서 판단하였다. 양측 Latero-orbitale point를 연결한 선을 수평 기준선(H-line)과 H-line에 수직이면서 Crista Galli를 지나는 수직 기준선(V-midline)을 그린다. H-line과 V-midline이 만나는 점에서 방사선 사진상 radioacity가 증가하여 보이는 menton까지 선을 그린다. 각도를 기준으로 했을 경우, 이 선이 V-midline과 이루는 각도가 4도 이상 차이 나는 환자를 안면비대칭으로 구분하였고, 길이를 기준으로 했을 경우에는 V-midline에서 menton까지 거리가 4 mm 이상인 환자를 안면비대칭으로 구분하였다. 또한 안면 비대칭을 가지고 있는 환자의 측모 두부방사선사진에서 SNB각을 측정하였다. 남자의 경우 74.91～85.53, 여자의 경우 74.20～81.82사이를 skeletal class I으로 구분하였고, 이 범위의 각도보다 작으면 class II, 크면 class III로 구분하였다. 척추 측만 정도는 환자의 흉부 방사선 사진에서 Cobb's angle을 측정하여 구분하였다. 안면비대칭의 유무와 안면비대칭 환자를 class I, II, III로 구분하여 각각의 군에서 척추 측만증의 발생 빈도를 확인하였다. 안면비대칭과 척추 측만증의 관계를 분석하기 위하여 측정한 데이터를 바탕으로 SPSS 16.0을 이용하여 통계분석을 하였다. t-test를 사용하였으며 p값이 0.05 미만인 경우를 통계적 유의수준으로 하였다. 또한 Class I, II, III 세 그룹과 Cobb's angle, 안면비대칭 판단 기준인 길이와 각도 각각 세 항목과의 관계를 살펴보기 위해서 one-way ANOVA 분석을 시행하였다. 안면비대칭을 각도를 기준으로 측정했을 때, 안면비대칭이 없는 환자와 안면비대칭이 있는 환자들 사이의 Cobb's angle의 양상에 유의미한 차이가 있었고, 길이를 기준으로 측정했을 때에는 유의미한 차이가 없었다. 또한 class III 환자는 Cobb's angle이 작게 나타나고 안면비대칭 측정의 기준이 되는 각도와 길이 모두 작게 나타나는 경향을 보였다.

Facial asymmetry is known to occur in disharmony of growth of the jaw. A variety of factors are involved in the growth starting point of the chin, especially the musculoskeletal system of the head and neck is mutually affected by growth of the jaw. Patient of facial asymmetry usually change the position which to be inclined in one side to compensate for the asymmetry, these position may affect the spine position. It was reported that facial asymmetry patients had tendency to show inclined natural head position which a direction to compensate for the displacement of menton according to previous research. These intentional compensate action of facial asymmetry patient could affect the direction of the spine. However, there were not reported any studies that facial asymmetry directly affects scoliosis. Therefore, the purpose of this study is analyzing the relevance of scoliosis and facial asymmetry by comparing the percentage of patients with scoliosis in the facial asymmetry patients and patients without asymmetry. The presence of facial asymmetry was evaluated by all patients' Posteroanterior (PA) cephalometric radiograph before the surgery. The horizontal reference line (H-line) was determined by connecting two latero-orbitale point in the PA. Vertical reference line (V-midline) was determined by the perpendicular line to the H-line through the Crista Galli. After determining the two reference lines, drawing the line from the point of V-midline and H-line meet to menton of the lower jaw. Facial asymmetry were measured in two ways of angle and length respectively. On the basis of the angle, an angel was measured between the line from the point which V-midline and H-line meet line to menton of the lower and the V-midline. If there is a difference between 4 degrees or more, it is divided into facial asymmetry. On the basis of the length, the distance from V-midline to the menton is more than 4mm, it was divided into facial asymmetry patients. Also, we measured SNB angle in lateral cephalo radiographic view of patients who have facial asymmetry. Patients, in the case of men, from 74.91 to 85.53 and in case of women, from 74.20 to 81.82 are divided into skeletal class I. If patients SNB angle is smaller than these ranges, they are classified into class II and if patients SNB angle is larger than the angle of these range, they are classified into class III. The degree of scoliosis was classified by measuring the Cobb's angle in the patients chest X-ray. We measured Cobb's angle in patients with no asymmetry and facial asymmetry patients by using the PiView STAR soft program. If patients Cobb's angle was more than 10 degree, they are classified into scoliosis. The presence of facial asymmetry was determined and facial asymmetry patients were classified Class I, II, and III then we confirmed the frequency of scoliosis in each group. To analyze the relationship of facial asymmetry and scoliosis we implemented statistical analysis using the SPSS 16.0 based on the measured data. We used an independent t-test to compare the pattern of cobb's angle in patients with no facial asymmetry and facial asymmetry patient. We determine a statistically significant level which is less than a 0.05 p value. Also, we used one-way ANOVA to find out the relationship between class I, II, III three groups and Cobb's angle, degree and distance which is facial asymmetry criteria, respectively. The patterns of scoliosis in groups of patients with and without facial asymmetry were not significantly different. Also, class III patients presented the smallest Cobb's angle and the smallest tendency of facial asymmetry regarding both criteria of length and angle.