A Study of the Anatomical Structure of the Mandibular Canal in the Mandible by Cone-beam Computed Tomography
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摘要:
目的 利用锥形束CT（cone-beam computed tomography，CBCT）观测下颌管在下颌骨内的解剖结构，为口腔医师开展牙种植术及牙槽外科手术等提供理论依据。 方法 按照纳入和排除标准收集昆明医科大学附属口腔医院的CBCT影像资料共339例，根据不同的年龄及性别进行分组，测量分析下颌管在下颌骨内的解剖结构和位置走行。 结果 下颌管距牙槽嵴顶、颊侧骨板、舌侧骨板及牙根根尖的距离在年龄和性别上的差异具有统计学意义（P < 0.05），下颌管距下颌骨下缘的距离在年龄上的差异有统计学意义（P < 0.05），在性别上差异无统计学意义（P > 0.05）。 结论 下颌管的解剖结构变异较大，在下颌骨中从远中向近中由舌侧向颊侧并逐渐靠近牙槽嵴顶走行；运用CBCT能够清晰的观测到下颌管在下颌骨内三维位置，对下颌骨外科手术及种植手术方案的制定具有重大的临床指导和参考价值。 Abstract:Objective Cone-beam computed tomography（CBCT）was used to observe the anatomical structure of the mandibular canal in the mandible, providing theoretical basis for dental implants and alveolar surgery. Methods According to the inclusion and exclusion criteria, a total of 339 cases of CBCT imaging data were collected; all the cases were divided into groups on the basis of age and gender; and the anatomy and position of the mandibular canal was measured and analyzed. Results The lengths from mandibular canal to alveolar ridge crest, buccal bone plate, the lingual bone plate and the root apex were statistically significant among the different age and gender groups（P < 0.05）; the lengths from mandibular canal and the inferior margin of the mandible was statistically significant among age groups（P < 0.05）, but there was no statistical significance in gender groups（P > 0.05）. Conclusion The location of the mandibular canal are highly variable. The mandibular canal runs in the mandible from the distal to the medial, from the tongue to the buccal side and gradually approaches the alveolar crest. The use of CBCT can clearly demonstrate the three-dimensional location of the mandibular canal in the mandible, which has great clinical guidance and reference value for the mandibular surgery and implant surgery. -
表 1 研究对象基本信息统计表（n）
Table 1. Demographic data of research objects（n）
民族 性别 年龄段 总计 青年组 中年组 老年组 汉族组 男 20 22 18 60 女 19 21 13 53 傣族组 男 24 20 20 64 女 18 18 13 49 哈尼族组 男 19 25 14 58 女 22 20 13 55 总计 122 126 91 339 
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表 2 不同年龄段颏孔上缘及下颌管上壁内缘到牙槽嵴顶的距离[（
$\bar{x} \pm s$ ），mm]Table 2. The length from the upper edge of the mental foramen and the inner edge of the upper wall of the mandibular canal to the alveolar ridge crest in different age groups[（
$\bar{x}\pm s$ ），mm]测量截面分区 年龄 F P 青年 中年 老年 左侧 Ⅰ区 15.3 ± 1.3 16.0 ± 1.5 13.9 ± 1.2 61.647 < 0.001 Ⅱ区 17.1 ± 1.4 17.6 ± 1.3 16.0 ± 1.2 21.570 < 0.001 Ⅲ区 16.8 ± 1.5 17.0 ± 1.6 15.2 ± 1.2 43.935 < 0.001 Ⅳ区 15.4 ± 1.3 16.2 ± 1.6 14.4 ± 1.1 43.593 < 0.001 Ⅴ区 14.8 ± 1.4 15.4 ± 1.5 13.9 ± 1.1 30.310 < 0.001 右侧 Ⅰ区 15.4 ± 1.3 16.1 ± 1.5 14.0 ± 1.2 66.188 < 0.001 Ⅱ区 17.3 ± 1.4 17.5 ± 1.4 15.9 ± 1.1 22.273 < 0.001 Ⅲ区 16.8 ± 1.4 16.9 ± 1.7 15.2 ± 1.1 42.923 < 0.001 Ⅳ区 15.5 ± 1.4 16.1 ± 1.7 14.4 ± 1.1 37.096 < 0.001 Ⅴ区 14.8 ± 1.6 15.5 ± 1.5 13.9 ± 1.0 30.905 < 0.001
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表 3 不同性别颏孔上缘及下颌管上壁内缘到牙槽嵴顶的距离[（
$ \bar{x}\pm s $ ），mm]Table 3. The length from the upper edge of the mental foramen and the inner edge of the upper wall of the mandibular canal to the alveolar ridge crest in different gender groups[（
$ \bar{x} \pm s$ ），mm]测量截面分区 性别 t P 男性 女性 左侧 Ⅰ区 15.7 ± 1.6 14.6 ± 1.4 6.848 < 0.001 Ⅱ区 17.4 ± 1.4 16.6 ± 1.4 4.147 < 0.001 Ⅲ区 16.9 ± 1.8 16.0 ± 1.4 5.270 < 0.001 Ⅳ区 15.8 ± 1.6 15.0 ± 1.3 4.591 < 0.001 Ⅴ区 15.1 ± 1.6 14.4 ± 1.2 4.291 < 0.001 右侧 Ⅰ区 15.7 ± 1.6 14.8 ± 1.5 5.369 < 0.001 Ⅱ区 17.4 ± 1.3 16.6 ± 1.4 4.223 < 0.001 Ⅲ区 16.8 ± 1.7 15.9 ± 1.4 5.671 < 0.001 Ⅳ区 15.8 ± 1.7 15.0 ± 1.4 4.690 < 0.001 Ⅴ区 15.1 ± 1.8 14.5 ± 1.1 3.929 < 0.001
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表 4 不同年龄段下颌管下壁内缘到下颌骨下缘骨皮质外侧壁的距离[（
$ \bar{x} \pm s$ ），mm]Table 4. The length from the inner edge of the inferior wall of the mandibular canal to the lateral wall of the lower edge of the mandible in different age groups[（
$ \bar{x} \pm s$ ），mm]测量截面分区 年龄 F P 青年 中年 老年 左侧 Ⅱ区 9.2 ± 1.1 9.8 ± 1.0 9.5 ± 1.3 4.087 0.018 Ⅲ区 9.0 ± 1.0 9.6 ± 0.9 9.4 ± 1.1 11.271 < 0.001 Ⅳ区 9.6 ± 1.1 9.8 ± 0.9 10.0 ± 1.1 3.789 0.024 Ⅴ区 11.2 ± 1.4 10.7 ± 1.1 10.5 ± 1.3 9.892 < 0.001 Ⅱ区 9.2 ± 1.1 9.8 ± 1.1 9.6 ± 1.2 5.763 0.004 右侧 Ⅲ区 9.0 ± 1.1 9.7 ± 1.0 9.4 ± 1.1 13.781 < 0.001 Ⅳ区 9.5 ± 1.2 9.9 ± 1.0 10.0 ± 1.1 5.428 < 0.001 Ⅴ区 10.9 ± 1.6 10.7 ± 1.2 10.5 ± 1.3 2.856 0.059
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表 5 不同性别下颌管下壁内缘到下颌骨下缘骨皮质外侧壁的距离[（
$ \bar{x}\pm s $ ），mm]Table 5. The length from the inner edge of the inferior wall of the mandibular canal to the lateral wall of the lower edge of the mandible in different gender groups[（
$ \bar{x}\pm s $ ），mm]测量截面分区 性别 t P 男性 女性 左侧 Ⅱ区 9.5 ± 1.2 9.5 ± 1.1 0.042 0.966 Ⅲ区 9.4 ± 1.0 9.2 ± 1.0 1.066 0.287 Ⅳ区 9.8 ± 0.9 9.7 ± 1.2 0.530 0.596 Ⅴ区 10.9 ± 1.5 10.7 ± 1.0 1.264 0.207 右侧 Ⅱ区 9.5 ± 1.2 9.5 ± 1.1 0.060 0.952 Ⅲ区 9.4 ± 1.0 9.3 ± 1.1 0.524 0.600 Ⅳ区 9.8 ± 1.0 9.8 ± 1.2 0.568 0.570 Ⅴ区 10.8 ± 1.4 10.6 ± 1.3 1.028 0.304
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表 6 不同年龄段下颌管颊侧壁内缘到下颌骨颊侧骨板骨皮质外侧壁的距离[（
$ \bar{x} \pm s$ ），mm]Table 6. The length from between the inner edge of the buccal wall of the mandibular canal to the lateral cortical wall of the buccal plate of the mandible in different age groups[（
$ \bar{x} \pm s$ ），mm]测量截面分区 年龄 F P 青年 中年 老年 左侧 Ⅱ区 4.6 ± 0.7 5.0 ± 0.6 4.7 ± 0.6 5.379 0.005 Ⅲ区 6.3 ± 1.0 5.9 ± 0.7 5.4 ± 0.5 28.512 < 0.001 Ⅳ区 7.4 ± 1.0 6.8 ± 0.6 6.6 ± 0.7 27.267 < 0.001 Ⅴ区 7.0 ± 1.3 6.9 ± 1.0 7.1 ± 0.8 0.608 0.545 Ⅱ区 4.6 ± 0.5 5.1 ± 0.7 4.8 ± 0.7 11.210 < 0.001 右侧 Ⅲ区 6.2 ± 0.9 6.0 ± 0.8 5.4 ± 0.5 30.173 < 0.001 Ⅳ区 7.4 ± 0.9 7.0 ± 0.7 6.6 ± 0.7 26.071 < 0.001 Ⅴ区 7.0 ± 1.2 7.0 ± 0.9 7.1 ± 0.8 0.266 0.767
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表 7 不同性别下颌管颊侧壁内缘到下颌骨颊侧骨板骨皮质外侧壁的距离[（
$ \bar{x} \pm s$ ），mm]Table 7. The length from the inner edge of the buccal wall of the mandibular canal to the lateral cortical wall of the buccal plate of the mandible in different gender groups[（
$ \bar{x} \pm s$ ），mm]测量截面分区 性别 t P 男性 女性 左侧 Ⅱ区 4.9 ± 0.6 4.6 ± 0.6 3.728 < 0.001 Ⅲ区 6.0 ± 0.8 5.8 ± 0.8 1.971 0.049 Ⅳ区 7.1 ± 0.9 6.8 ± 0.7 2.689 0.008 Ⅴ区 7.1 ± 1.1 6.9 ± 1.0 1.624 0.105 Ⅱ区 4.9 ± 0.6 4.8 ± 0.8 1.383 0.168 右侧 Ⅲ区 6.0 ± 0.8 5.9 ± 0.9 0.763 0.446 Ⅳ区 7.1 ± 0.8 6.9 ± 0.8 2.462 0.014 Ⅴ区 7.1 ± 1.0 6.9 ± 1.0 1.773 0.077
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表 8 不同年龄段下颌管舌侧壁内缘到下颌骨舌侧骨板骨皮质外侧壁的距离[（
$ \bar{x} \pm s$ ），mm]Table 8. The length from the inner edge of the lingual wall of the mandibular canal to the lateral wall of the lingual bone plate of the mandible in different age groups[（
$ \bar{x} \pm s$ ），mm]测量截面分区 年龄 F P 青年 中年 老年 左侧 Ⅱ区 3.9 ± 0.8 4.1 ± 0.6 4.3 ± 0.5 3.923 0.021 Ⅲ区 3.0 ± 0.6 3.3 ± 0.7 3.4 ± 0.5 12.323 < 0.001 Ⅳ区 2.4 ± 0.5 2.7 ± 0.7 2.8 ± 0.6 12.761 < 0.001 Ⅴ区 2.2 ± 0.5 2.3 ± 0.7 2.3 ± 0.7 1.937 0.146 右侧 Ⅱ区 3.9 ± 0.8 4.0 ± 0.8 4.3 ± 0.4 4.474 0.013 Ⅲ区 3.0 ± 0.7 3.2 ± 0.8 3.4 ± 0.5 9.693 < 0.001 Ⅳ区 2.4 ± 0.5 2.6 ± 0.7 2.9 ± 0.6 11.538 < 0.001 Ⅴ区 2.2 ± 0.6 2.3 ± 0.7 2.4 ± 0.8 2.163 0.117
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表 9 不同性别下颌管舌侧壁内缘到下颌骨舌侧骨板骨皮质外侧壁的距离[（
$ \bar{x} \pm s$ ），mm]Table 9. The length from the inner edge of the lingual wall of the mandibular canal to the lateral wall of the lingual bone plate of the mandible in different gender groups[（
$ \bar{x} \pm s$ ），mm]测量截面分区 性别 t P 男性 女性 左侧 Ⅱ区 4.2 ± 0.6 4.0 ± 0.7 2.139 0.034 Ⅲ区 3.3 ± 0.6 3.2 ± 0.7 2.152 0.032 Ⅳ区 2.7 ± 0.6 2.6 ± 0.7 2.091 0.037 Ⅴ区 2.3 ± 0.7 2.2 ± 0.6 1.474 0.141 Ⅱ区 4.2 ± 0.7 3.8 ± 0.8 3.240 0.001 右侧 Ⅲ区 3.3 ± 0.6 3.1 ± 0.7 2.892 0.004 Ⅳ区 2.7 ± 0.6 2.5 ± 0.7 2.759 0.006 Ⅴ区 2.4 ± 0.7 2.2 ± 0.6 1.785 0.075
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表 10 不同年龄下颌管上壁内缘到牙根根尖的距离[（
$ \bar{x} \pm s$ ），mm]Table 10. The length from the inner edge of the upper wall of the mandibular canal to the root apex in different age groups[（
$ \bar{x}\pm s $ ），mm]测量截面分区 年龄 F P 青年 中年 老年 左侧 Ⅱ区 5.1 ± 1.6 6.0 ± 1.3 4.7 ± 1.7 11.885 < 0.001 Ⅲ区 5.9 ± 1.5 6.6 ± 1.1 5.1 ± 1.6 31.522 < 0.001 Ⅳ区 4.7 ± 1.4 5.8 ± 1.4 5.1 ± 1.3 18.929 < 0.001 Ⅴ区 2.3 ± 1.3 2.6 ± 1.9 3.5 ± 1.9 13.081 < 0.001 右侧 Ⅱ区 5.2 ± 1.7 6.1 ± 1.1 4.6 ± 1.5 14.127 < 0.001 Ⅲ区 5.8 ± 1.4 6.2 ± 1.3 5.0 ± 1.3 22.384 < 0.001 Ⅳ区 4.8 ± 1.3 5.5 ± 1.8 5.0 ± 1.3 7.704 0.001 Ⅴ区 2.4 ± 1.4 2.5 ± 1.9 3.2 ± 1.5 6.406 0.002
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表 11 不同性别下颌管上壁内缘到牙根根尖的距离[（
$ \bar{x} \pm s$ ），mm]Table 11. The length from between the inner edge of the upper wall of the mandibular canal to the root apex in different gender groups[（
$ \bar{x} \pm s$ ），mm]测量截面分区 性别 t P 男性 女性 左侧 Ⅱ区 5.1 ± 1.5 5.6 ± 1.7 −2.163 0.032 Ⅲ区 5.7 ± 1.6 6.2 ± 1.4 −3.300 0.001 Ⅳ区 5.2 ± 1.5 5.2 ± 1.4 0.306 0.760 Ⅴ区 2.9 ± 1.9 2.5 ± 1.7 1.808 0.071 Ⅱ区 5.1 ± 1.5 5.7 ± 1.6 −2.577 0.011 右侧 Ⅲ区 5.6 ± 1.5 6.0 ± 1.3 −2.490 0.013 Ⅳ区 5.2 ± 1.5 5.1 ± 1.6 0.403 0.687 Ⅴ区 2.8 ± 1.7 2.4 ± 1.5 2.428 0.016
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