下颌骨缺损腓骨瓣修复不同固定方式的有限元分析  

Finite element analysis of different fixation methods for mandibular defects reconstructing with fibula flaps

作　　者：嵇海虹 董强[1,2] Ji Haihong;Dong Qiang(Guizhou Medical University,Guiyang 550004,Guizhou Province,China;School of Stomatology/Stomatological Hospital of Guizhou Medical University,Guiyang 550004,Guizhou Province,China;The Second People’s Hospital of Guiyang(Jinyang Hospital),Guiyang 550002,Guizhou Province,China)

机构地区：[1]贵州医科大学,贵州省贵阳市550004 [2]贵州医科大学口腔医学院/附属口腔医院,贵州省贵阳市550004 [3]贵阳市第二人民医院(金阳医院),贵州省贵阳市550002

出　　处：《中国组织工程研究》2020年第24期3821-3827,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:肿瘤、外伤等原因常常造成下颌骨节段性缺损,血管化腓骨瓣同期重建下颌骨缺损是目前最主要的修复方式。目前在临床上既有用重建钛板进行固定,又有用小型钛板固定,有临床回顾性研究表明重建钛板和小型钛板固定方式患者术后并发症率无明显差异,但目前仍缺少固定稳定性相关的生物力学研究。目的:试验用三维有限元法分析下颌骨节段性缺损腓骨瓣修复时用重建钛板和小型钛板固定后的应力分布和稳定性。方法:选择1例牙列完整的成年男性进行CT扫描,并将数据录入计算机之后重建下颌骨及牙列模型,根据下颌骨缺损的Jewer分类,建立H(一侧下颌体、下颌角、下颌升支和髁突的缺失),L(一侧下颌体缺失)和C(双侧下颌骨颏部缺失)3类缺损三维模型,利用三维有限元分析法,对这3种下颌骨缺损腓骨修复后重建板和小型板固定的力学分布特点和稳定性进行对比研究。结果与结论:①从应力云图可以大致判断,正常下颌骨应力较大值主要发生在髁突、髁颈、下颌角、磨牙、钛板钛钉等周围区域处,尤其以下颌角附近处应力最大;②H类缺损在重建钛板修复下颌骨时将对下颌角附近产生较大应力,局部应力集中达185MPa,在H类小型钛板、L类小型钛板及重建钛板修复条件下,钛板的应力为117-135 MPa,腓骨块的应力最大值基本在30.4 MPa以下,钛钉应力最大值为56.2 MPa;③H及L类缺损小型钛板、重建钛板修复后骨断端相对位移变化为15-18μm,C类缺损下颌骨钛板修复后骨断端基本不产生相对位移;④结果证实,重建钛板和小型钛板均能满足这3种缺损腓骨修复的生物力学要求。BACKGROUND:Segmental defect of mandible is often caused by tumor,trauma and other reasons.Simultaneous mandibular defect by vascularized fibular flap is the most important repair method at present.It is not only useful for the reconstruction with titanium plates,but also useful for small titanium plates for fixation.Clinical retrospective studies have shown that there is no significant difference in postoperative complication rate between patients with the two fixation methods,but relevant biomechanics studies are still lacking at present.OBJECTIVE:The three-dimensional finite element analysis was used to analyze the stress distribution and stability on mandibular segmental defects simulated fibular flaps grafted with reconstruction plates and miniplates fixation.METHODS:A healthy adult male with complete dentition was selected for CT scan and data were input into the computer to reconstruct the mandible and dentition model.Three types of 3D models were built for mandibular defects dependent on Jewer’s classification,including models H(loss of lateral mandible,mandibular angle,ascending branch of mandible,and condyles),L(loss of unilateral mandible)and C(loss of bilateral mandible chin).Mechanical distribution features and stability of fixation with reconstruction plates and miniplates were comparatively studied after fibular repair of mandibular segmental defects.RESULTS AND CONCLUSION:(1)The stress graphs showed that stress was mostly higher in surrounding areas of normal mandibles such as condyle,condylar neck,mandibular angle,molar and titanium screws.In particular,the stress was highest near mandibular angles.(2)For type-H defect,the great stress was generated near the mandibular angles when mandible was reconstructed with reconstruction plate,and the stress value was 185 MPa.The stress values approximately ranged from 117 to 135 MPa on type-H and type-L defects with miniplates.The maximum stress of fibula block was less than 30.4 MPa,and the maximum stress of titanium nail was 56.2 MPa.(3)The relative dis

关 键 词：下颌骨缺损 下颌骨重建 腓骨瓣 有限元分析 生物力学 重建钛板 小型钛板 应力 稳定性 相对位移 

分 类 号：R459.9[医药卫生—治疗学] R363[医药卫生—临床医学]