Mandibular Growth Changes and
下颌生长变化与

KEY WORDS: - Cervical vertebrae - Growth - Skeletal age -
关键词：- 颈椎 - 生长 - 骨骼年龄 -

Treatment during periods of accelerated or intensive growth can contribute significantly to correction of dentofacial deviations and improvement of facial appearance (Sassouni 1972, Pearson 1978 and 1986, Pancherz 1985). The use of biological measurements such as skeletal age or ossification stages to evaluate the individual timetable of development, although criticized by Houston (1979 and 1980), has been advocated by many investigators (Tofani 1972, Bowden 1976, Hägg and Taranger 1980, Grave 1978, Chapman 1972, Fishman 1979).
在加速或密集生长期间进行治疗可以显著有助于纠正牙颌面畸形和改善面部外观（Sassouni 1972，Pearson 1978 年和 1986 年，Pancherz 1985 年）。虽然 Houston（1979 年和 1980 年）批评了使用骨骼年龄或骨化阶段等生物测量来评估个体发育时间表的做法，但许多研究人员（Tofani 1972，Bowden 1976，Hägg 和 Taranger 1980，Grave 1978，Chapman 1972，Fishman 1979）提倡这样做。

The hand and wrist are the part of the skeleton used most frequently to assess a patient’s progress toward maturity, but other bpnes have also been used.
手腕是骨骼中最常用于评估患者成熟度进展的部分，但其他部位也被使用。
Several human growth studies have shown that the timing of the pubertal growth of the mandible is closely related to specific ossification events and stages observed in the hand-wrist area of skeleton (Hunter 1966, Bergersen 1972, Bambha 1963, Tofani 1972). With the same objective, Leite and O’Reilly (1987) showed that three fingers of the hand can also provide clinically significant information on skeletal maturation. The method consists of simultaneously exposing the first three fingers along with the craniofacial structures in the lateral cephalometric radiograph as recommended by Thurow (1970, 1977).
多项人类生长研究表明，下颌骨的青春期生长时间与骨骼手部腕部区域观察到的特定骨化事件和阶段密切相关（Hunter 1966，Bergersen 1972，Bambha 1963，Tofani 1972）。为了同样的目的，Leite 和 O’Reilly（1987）表明，手部的三个手指也可以提供有关骨骼成熟度的临床重要信息。该方法包括在 Thurow（1970，1977）推荐的侧位头颅测量放射照片中同时暴露前三个手指以及颅面结构。

Dr. Maria T. O’Reilly  玛丽亚·T·奥莱利博士
School of Dental Medicine University of Pittsburgh 3501 Terrace St. Pittsburgh, PA 15261
牙科医学院 匹兹堡大学 3501 露台街 匹兹堡，PA 15261

Dr. O’Reilly is Associate Professor of Orthodontics at the University of Pittsburgh. She is a dental graduate of the University of Pittsburgh, and also holds M.D.S. and Ph.D. degrees from that institution. She is a Diplomate of the American Board of Orthodontics.
奥里利博士是匹兹堡大学的正畸学副教授。她是匹兹堡大学的牙科毕业生，并且还持有该机构的 M.D.S. 和 Ph.D. 学位。她是美国正畸委员会的专家。
Dr. Yaniello is in the private practice of Orthodontics in Pittsburgh, Pennsylvania. He is a dental graduate (D.M.D.) of the University of Pittsburgh, and hold a Certificate in Orthodontics from the same institution.
约尼洛博士在宾夕法尼亚州匹兹堡从事正畸学私人执业。他是匹兹堡大学的牙科毕业生（D.M.D.），并持有该机构的正畸学证书。

Lamparski (1972) utilized the cervical vertebrae and found them to be as reliable and as valid as the hand-wrist area for assessing skeletal age. He developed a series of standards for assessment of skeletal age for both males and females. This method has the advantage of eliminating the need for an additional radiographic exposure since the vertebrae are already recorded on the lateral cephalometric radiograph.
兰帕尔斯基（1972 年）利用颈椎，发现它们与手腕区域一样可靠和有效，用于评估骨骼年龄。他制定了一系列标准和评估方法，用于评估男性和女性的骨骼年龄。这种方法的优势在于无需额外的放射线曝光，因为颈椎已经在侧位头影测量照片中记录。

Evaluation of the individual biologic timetable and the identification of periods of accelerated and intense growth provide, along with other clinical data, valuable information on treatment planning and retention procedures. The purpose of this study is to investigate the relationship of the stages of cervical vertebral maturation to growth changes in the mandible.
评估个体生物时间表以及识别加速和强烈生长的时期，结合其他临床数据，为治疗计划和保留程序提供有价值的信息。本研究的目的是探讨颈椎成熟阶段与下颌骨生长变化的关系。

The sample was obtained from the files of the Bolton-Broadbent growth study in Cleveland, and had been part of earlier studies Tofani 1972, Dermaut and Tofani 1978). It consisted of yearly lateral cephalometric radiographs of 13 caucasian females with ages ranging from 9 to 15 years. The measurements of mandibular length, corpus length and ramus height were previously made by one of the authors.
样本来自克利夫兰的波尔顿-布罗德本特生长研究档案，并曾参与早期研究（Tofani 1972 年，Dermaut 和 Tofani 1978 年）。它由 13 名年龄在 9 至 15 岁的白人女性每年的侧位头影测量放射照片组成。下颌骨长度、体长和髁突高度的测量先前由一位作者进行。

To assess the maturational changes of the cervical vertebrae, Lamparski’s standards for females were utilized. On each individual lateral cephalometric radiograph the cervical vertebrae were matched to a standard and assigned the stage which they most closely resembled (Fig. 1).
为了评估颈椎的成熟变化，使用了 Lamparski 的女性标准。在每个个体的侧位头影测量放射照片上，颈椎与标准匹配，并分配最相似的阶段（图 1）。

Individual incremental curves were plotted for each of the 13 subjects and for each mandibular dimension, with increments in millimeters along the $Y$$Y$YY axis and stages of cervical vertebral
对每个受试者以及每个下颌尺寸，绘制了个体增量曲线，沿 $Y$$Y$YY 轴的增量以毫米为单位，沿 X 轴为颈椎椎体的成熟阶段。
maturation along the X axis. The midyear stages of cervical vertebral ossification were recorded, and average curves were then derived by superimposing the individual curves on peak growth velocity.
记录了颈椎椎体骨化的年中阶段，并通过将个体曲线叠加在峰值生长速度上，推导出平均曲线。

To determine the relationship of the stages of vertebral maturation to mandibular growth, an analysis of variance for repeated measurements was performed on each of the dependent variables. For significant $F$$F$FF ratios, Scheffee’s test was performed to find out exactly where the significant differences lay.
为了确定椎体成熟阶段与下颌生长的关系，对每个因变量进行了重复测量的方差分析。对于显著的 $F$$F$FF 比率，进行了 Scheffee 检验，以确定显著差异的具体位置。

Significant increases were found in corpus length, ramus height and mandibular length during the stages of cervical vertebrae maturation, as indicated by the significant $F$$F$FF ratios ( $P\le 0.0001$$P\le 0.0001$P <= 0.0001P \leq 0.0001 ) (Tables 1-3).
在颈椎椎体成熟阶段，下颌体长度、下颌支高度和下颌长度均显著增加，如表 1-3 所示，这表明了显著的 $F$$F$FF 比率（ $P\le 0.0001$$P\le 0.0001$P <= 0.0001P \leq 0.0001 ）。

Scheffee’s test demonstrated that the significant increases in mandibular length occurred between stages 1-2, 2-3, and $3-4$$3-4$3-43-4; for corpus length between 1-2 and 2-3; and for ramus height between 1-2.
Scheffee 测试表明，下颌长度显著增加发生在阶段 1-2、2-3 和 $3-4$$3-4$3-43-4 ；下颌体长度发生在 1-2 和 2-3 之间；下颌支高度发生在 1-2 之间。

Stages 1 through 3 were generally observed prior to peak velocity for all the mandibular dimensions, with stages 2 and 3 occurring in the year immediately preceeding peak. However, individual variability was present.
阶段 1 至 3 通常在所有下颌尺寸的峰值速度之前观察到，阶段 2 和 3 发生在峰值速度前一年。然而，存在个体差异。

Stages 2 and 3 were observed in the year immediately preceeding the maximum increment for corpus length in twelve subjects, and in one subject peak velocity occurred before stage 3. Stage 4 also occurred prior to peak in three subjects, and in the other ten subjects stages 4 through 6 occurred after peak velocity.
在十二个受试者中观察到阶段 2 和 3 发生在下颌体长度最大增量前一年，在一个受试者中峰值速度发生在阶段 3 之前。在三个受试者中阶段 4 也发生在峰值之前，在其余十个受试者中阶段 4 至 6 发生在峰值速度之后。

The same general trend was observed for ramus height. Stages 1 through 3 were observed prior to peak velocity in ten of the thirteen subjects. Stage 3 occurred after peak in one subject, and stage 4
下颌骨高度的变化也呈现出相同的总体趋势。在十三名受试者中有十名在峰值速度之前观察到 1 至 3 阶段。一名受试者的 3 阶段发生在峰值之后，4 阶段

Figure 1  图 1
Stages of cervical vertebral maturation.
颈椎椎骨成熟阶段。

Stage 1: All inferior borders of the bodies are flat. The superior borders are strongly tapered from posterior to anterior.
第一阶段：所有椎体下缘都是平坦的。上缘从后向前强烈收窄。

Stage 2: A concavity has developed in the inferior border of the 2nd vertebra. The anterior vertical heights of the bodies have increased.
第二阶段：第二椎体下缘出现凹陷。椎体前缘的垂直高度增加。

Stage 3: A concavity has developed in the inferior border of the 3rd vertebra. The other inferior borders are still flat.
第三阶段：第三椎体下缘出现凹陷。其他椎体下缘仍然是平坦的。

Stage 4: All bodies are now rectangular in shape. The concavity of the 3rd vertebra has increased, and a distinct concavity has developed on the 4 th vertebra. Concavities on 5 and 6 are just beginning to form.
第四阶段：所有椎体现在都是矩形形状。第三椎体的凹陷增加，第四椎体上出现明显的凹陷。第五和第六椎体上的凹陷刚刚开始形成。

Stage 5: The bodies have become nearly square in shape, and the spaces between the bodies are visibly smaller. Concavities are well defined on all 6 bodies.
第五阶段：椎体几乎呈方形，椎体之间的间隙明显变小。所有 6 个椎体的凹陷都很清晰。

Stage 6: All bodies have increased in vertical height and are higher than they are wide. All concavities have deepened.
第六阶段：所有椎体在垂直高度上都有所增加，并且比宽。所有凹陷都加深了。