正颌手术对骨性下颌后缩颞下颌关节生物力学影响的三维有限元研究  

Three-dimensional finite element study on biomechanical effects of orthognathic surgery on the temporomandibular joint of skeletal mandibular retrusion

作　　者：田涛 王为 郑维银 李焰[3] 任凯歌 Tian Tao;Wang Wei;Zheng Wei-yin;Li Yan;Ren Kai-ge(Southwest Medical University, Luzhou 646000 Sichuan Province, China;Urumqi DW Innovation InfoTech Co., Ltd., Urumqi 830001, Xinjiang Uygur Autonomous Region, China;Chengdu Military General Hospital of Chinese PLA, Chengdu 610000, Sichuan Province, China)

机构地区：[1]西南医科大学,四川省泸州市646000 [2]乌鲁木齐大为创新信息科技有限公司,新疆维吾尔自治区乌鲁木齐市830001 [3]中国人民解放军成都军区总医院,四川省成都市610000

出　　处：《中国组织工程研究》2017年第28期4486-4492,共7页Chinese Journal of Tissue Engineering Research

基　　金：中国人民解放军成都军区总医院资助项目(15QNP034)~~

摘　　要：背景:骨性下颌后缩一般需通过正颌手术治疗。下颌作为颞下颌关节受咀嚼力载荷的支点,使下颌正颌手术与颞下颌关节密切相关,但正颌手术对颞下颌关节的影响至今未形成统一结论。近年来有限元法在口腔医学的研究中得到了大量应用。目的:建立骨性下颌后缩正颌手术前后颞下颌关节与下颌咀嚼肌系统的有限元模型,利用有限元法基本明确正颌手术对其颞下颌关节生物力学的远期影响。方法:在三维重建软件中对骨性下颌后缩患者的CT平扫+三维重建数据模拟下颌支矢状劈开前徙术,前徙距离分别为4,8,10 mm。利用限元法获得正颌前后其髁突、颞下颌关节窝的Von Mises应力。结果与结论:(1)成功建立了骨性下颌后缩正颌前后颞下颌关节与下颌咀嚼肌系统的有限元模型,获得了其髁突与颞下颌关节窝的应力云图及各区域的最大Von Mises应力值;(2)结果显示,综合运用Mimics、Geomagic Studio、Unigraphics NX、Workbench可建立具有较高相似性的骨性下颌后缩正颌前后颞下颌关节与下颌咀嚼肌系统的有限元模型;(3)从远期来看,规范的正颌手术一般不会对骨性下颌后缩患者的髁突与颞下颌关节窝产生不良影响。BACKGROUND:Generally,orthognathic surgery is used for skeletal mandibular retrusion.As the fulcrum of the masticatory loads on the temporomandibular joint,the mandible connects orthognathic surgery on itself with temporomandibular joint closely.However,the influence of orthognathic surgery on temporomandibular joint has not yet been fully unified.Finite element method has been widely used in the research concerning stomatology in recent years.OBJECTIVE:To establish a finite element model of temporomandibular joint and mandible with masticatory muscles before and after orthognathic surgery on the mandible and to investigate the long-term influence of orthognathic surgery on the biomechanics of temporomandibular joint.METHODS:The data of CT scan and three-dimensional reconstruction of a patient with skeletal mandibular retrusion were used to simulate surgical mandibular advancement with sagittal split ramus osteotomy,and the distance of advancement was4,8and10mm,respectively.The Von Mises stress of the condyles and articular fossae were obtained based on finite element method.RESULTS AND CONCLUSION:The finite element models of temporomandibular joint and mandible with masticatory muscles before and after orthognathic surgery of the patient with skeletal mandibular retrusion were established successfully,the stress nephograms and maximum Von Mises stress in each region of the condyles and articular fossae were obtained.To conclude,the finite element models are successfully established by Mimics,Geomagic Studio,Unigraphics NX and Workbench synthetically.The standard orthognathic surgery generally does not affect the condyle and glenoid fossa of the patient with skeletal mandibular retrusion negatively in the long-term.

关 键 词：组织构建 骨组织工程 骨性下颌后缩 正颌手术 颞下颌关节 有限元 VonMises应力 

分 类 号：R318[医药卫生—生物医学工程]