以有限元法仿真分析闭合式上颌窦提升的黏膜形变  

Finite element analysis on the deformation of maxillary sinus mucosa after closed maxillary sinus augmentation

作　　者：刘晓芳[1] 胡玲玲[2] 宋光保[1] 邵龙泉[3] 柳大烈[4] 章锦才[1] 

机构地区：[1]广东省口腔医院.南方医科大学附属口腔医院,广东省广州市510280 [2]中山大学工学院应用力学与工程系,广东省广州市510275 [3]南方医科大学,广东省广州市510280 [4]南方医科大学珠江医院,广东省广州市510280

出　　处：《中国组织工程研究》2013年第50期8678-8684,共7页Chinese Journal of Tissue Engineering Research

基　　金：广东省医学科研课题资助项目(A2009095);课题名称:骨挤压式上颌窦提升术的计算机力学分析研究~~

摘　　要：背景:如何避免闭合式上颌窦提升种植治疗中医源性上颌窦黏膜穿孔等并发症成为近年研究的热点。目的:以有限元法比较闭合式上颌窦提升种植治疗中不同上颌窦黏膜厚度对黏膜穿孔的影响。方法:在ANSYS有限元分析软件的SHELL63单元中分别建立0.3,0.5,0.8 mm厚度上颌窦黏膜与4.2 mm直径种植体的有限元模型,模拟闭合式上颌窦提升手术抬高黏膜,根据大变形非线性理论计算3种厚度上颌窦黏膜中心Von Mises最大应力值,并进行统计学分析。结果与结论:通过对3种厚度上颌窦黏膜提升1-5 mm的形变与应力分析,发现上颌窦黏膜高变形区发生在黏膜顶端中心,在黏膜提升1-4 mm时,最大应变值曲线变化温和,在大于4 mm高度后曲线斜率明显增加;在上颌窦黏膜提升5 mm之内,0.3,0.5,0.8 mm 3种厚度黏膜中心最大Von Mises应力值差异无显著性意义(P>0.05)。提示上颌窦黏膜提升高度大于4 mm之后,黏膜弹性拉伸大幅增加,增大了穿孔的概率;对于上颌窦黏膜厚度为0.3-0.8 mm需要进行闭合式上颌窦提升治疗的患者,其所面对的黏膜穿孔风险是无差别的;而上颌窦黏膜厚度小于0.3 mm的患者,要更加慎重地选择上颌窦提升方案以防止黏膜穿孔的发生。BACKGROUND： How to avoid iatrogenic maxillary sinus mucosal perforation after closed maxillary sinus augmentation. OBJECTIVE： To compare the influence of maxillary sinus mucosa at different thicknesses on the mucosal perforation in closed maxillary sinus augmentation operation by using finite element analysis. METHODS： Three finite element models of maxillary sinus mucosa at different thicknesses of 0.3 mm, 0.5 mm 0.8 rnm respectively and implant with 4.2 mm diameter were established in the SHELL63 units. ANSYS finite element analysis software was used to evaluate maxillary sinus mucosal deformation by the simulated closed maxillary sinus augmentation surgery. Differences of Yon Mises maximum stress values of mucosa surface were calculated according to the non-linear large-deformation theory. RESULTS AND CONCLUSION： When maxillary sinus mucosa height was increased from 1 mm to 5 mm, the large deformation was observed in the center of mucosa center. The maximum stress curve slope was shifted mild between 1 4 mm deformation, while shifted abruptly after 4 mm. There was no difference in the value of Von Mises maximum stress values between three maxillary sinus mucosa at 0.3 mm, 0.5 mm, 0.8 mm thickness, when the lift height was increased from 1 mm to 5 mm （P 〉 0.05）. Maxillary sinus mucosa are faced with a higher risk of mucosal perforation and elastic elongation when maxillary sinus height is increased more than 4 mm. Maxillary sinus mucosa at 0.3-0.8 mm thickness are faced the similar risk of mucosal perforation in closed maxillary sinus augmentation operation within 5 mm. While more considerations should be paid on patients with less than 0.3 mm maxillary sinus mucosa thickness.

关 键 词：组织构建 口腔组织构建 上颌窦提升 有限元分析 牙种植体 上颌窦黏膜 Von Mises应力 应变 省级基金 

分 类 号：R318[医药卫生—生物医学工程]