下颌骨双侧升支矢状劈开坚强内固定的生物力学研究  

Biomechanical Study of Mandibular Bilateral Sagittal Split Ramus Osteotomy with Rigid Internal Fixation

作　　者：周健[1] 孙庚林[1] 吴炜[1] 许崇涛[1] 李滨飞[1] 王鹏林[2] 

机构地区：[1]天津医科大学总医院口腔科,天津300052 [2]天津理工大学 CAE 中心,天津300052

出　　处：《口腔颌面外科杂志》2007年第4期306-311,共6页Journal of Oral and Maxillofacial Surgery

基　　金：天津市卫生局课题资助项目(03KZ23)

摘　　要：目的:研究下颌骨升支矢状劈开小型钛板和双皮质固位螺钉内同定生物力学特性,为临床提供理论上的指导。方法:用螺旋CT断层扫描技术及ANSYS有限元软件在计算机上建立下颌骨升支矢状劈开小型钛板及3种双皮质同位螺钉内固定的三维有限元模型;计算4种固定方法在三种咬合情况下颌骨的应力、内固定系统的应力以及骨劈开处的位移,对比这些固定方式的固定效果以及不同咬合情况对固定稳定性的影响。结果:在相同咬合情况下,颌骨的应力、劈开处的位移从大到小排列顺序为:2mm双皮质同位螺钉直线形内固定、小型钛板内固定、2mm双皮质同位螺钉倒"L"形内固定、2.7mm双皮质固位螺钉倒"L"形内固定。相同固定方式情况下,颌骨的应力、内固定系统的应力以及劈开处的位移从大到小排列顺序为:前牙咬合、前磨牙咬合、磨牙咬合。结论:下颌骨双侧升支矢状劈开双皮质固位螺钉倒"L"形内固定的固定稳定性要强于小型钛板内固定;直线形内固定固定稳定性相对较差。前牙咬合对同定的不良影响很大,应尽量避免。Objective： To study the biomechanical characteristic about the mandibular bilateral sagittal split ramus osteotomy （BSSRO） with miniplates or bicortical screws rigid internal fixation（RIF）, and give directions for clinic practice. Methods： CT scanned technology and the finite element software （Ansys） were used to establish the three-dimensional finite element model of BSSRO with miniplates and bicortical screws RIF. Calculate the stress distribution of the mandible and the RIF and the displacement of split mandible under three kinds of occlusion position. Result： When under the same occlusion, the decreasing order of stress of the mandible and the displacement of split mandible is 2.0 mm straight line bicortical screws fixation, miniplates fixation, 2.0 mm and 2.7 mm reverse ＂L＂ bicortical screws fixation. When under the same fixation method, the decreasing order of stress of the mandible and the RIF and the displacement of split mandible is incisor occlusion, premolar and molar occlusion. Conclusion： The stability of BSSRO fixed with reverse ＂L＂ bicortical screws is better than fixed with miniplates. The patient should avoid the incisor occlusion after surgery.

关 键 词：双侧升支矢状劈开术 有限元 坚强内固定 生物力学 

分 类 号：R782.2[医药卫生—口腔医学]