翼外肌在创伤性颞下颌关节骨强直中的病理性作用  

Pathological Effect of Lateral Pterygoid Muscle in Traumatic Temporomandibular Joint Bony Ankylosis

作　　者：邓天阁[1] 刘平[1] 刘昌奎 张林林[1] 吴丽更[3] 周宏志[1] 丁宇翔[1] 胡开进[1] DENG Tiange;LIU Ping;LIU Changkui;ZHANG Linlin;WU Ligeng;ZHOU Hongzhi;DING Yuxiang;HU Kaijin(State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Surgery, School of Stomatology, the Fourth Military Medical University, Xi'an 710032, China;Department of Oral Surgery, School of Stomatology, Xi'an Medical University, Xi'an 710021, China;Department of Endodontics and Restorative Dentistry, School of Stomatology, Tianjin Medical University, Tianjin 300070, China)

机构地区：[1]军事口腔医学国家重点实验室&国家口腔疾病临床医学研究中心&陕西省口腔疾病临床医学研究中心,第四军医大学口腔医学院颌面外科,陕西西安710032 [2]西安医学院口腔医学院口腔外科,陕西西安710021 [3]天津医科大学口腔医学院牙体牙髓科,天津300070

出　　处：《口腔医学研究》2021年第5期442-447,共6页Journal of Oral Science Research

基　　金：国家自然科学基金面上项目(编号:81970954、81271103)。

摘　　要：目的:创伤性颞下颌关节强直病理学机制仍不清楚,本研究目的是验证翼外肌在创伤性颞下颌关节骨性强直病理学机制中的作用。方法:7只6个月大的雄性绵羊,双侧颞下颌关节模拟髁突矢状骨折,关节盘外侧1/3切除建立创伤性颞下颌关节骨强直绵羊动物模型。左侧颞下颌关节作为实验组,切断左侧翼外肌;右侧关节作为对照组,保留右侧翼外肌。所有绵羊均在术后12周实施安乐死。所有颞下颌关节复合体通过大体解剖、螺旋CT、显微CT、组织病理学等检查进行评估。结果:大体解剖发现,对照组颞下颌关节发生了骨强直,而实验组颞下颌关节只发生纤维粘连;螺旋CT和显微CT检查发现,与实验组比较,对照组颞下颌关节间隙可见钙化影像,上下关节面可见新骨长入关节间隙的不规则钙化影像,对照组的髁突最大内外径及最大前后径明显大于实验组;显微CT显示,两组所有显微结构参数均有统计学差异(P<0.05),对照组髁突新生骨小梁总体表达方向与翼外肌的牵拉方向一致,而实验组髁突骨折区新生骨小梁的主要方向与翼外肌的牵拉方向不一致;组织病理学检查发现,对照组关节发生了骨强直,但实验组无骨强直发生。结论:当髁突发生矢状骨折时,翼外肌对骨折块有牵拉(类似牵张成骨)的病理性作用是创伤性颞下颌关节骨强直发生的重要因素。Objective:To verify the effect of lateral pterygoid muscle(LPM)in the pathogenesis of traumatic TMJ bone ankylosis.Methods:Animal model of TMJ bone ankylosis was established in 76-month-old male sheeps with bilateral TMJs simulating sagittal fracture of condyle and lateral 1/3 articular disc resection.Left TMJ was used as the experimental group to block the LPM function.Right TMJ was used as the control group to maintain the LPM function.All sheep were euthanized 12 weeks after surgery.All TMJ complexes were evaluated by gross anatomy,helical-CT,micro-CT,and histopathological examination.Results:Gross anatomy showed that the control TMJ complexes developed bone ankylosis,while the experimental TMJ complexes only developed fibrous adhesion.Helical-CT and micro-CT showed that,compared with the experimental group,calcification callus images were observed in the joint space of control TMJ complexes,and irregular calcification images of new bone were observed in the upper and lower articular surfaces.The maximum mediolateral and anteroposterior diameters of control condyles were significantly larger than those of experimental condyles.Micro-CT showed that there were significant differences with all microstructural parameters between two groups(P<0.05).In the control group,the main growth orientation of new trabecular bone in the condylar fracture area was consistent with the LPM contraction direction,but not in the experimental condylar fracture area.Histopathological examination revealed that fibro-osseous ankylosis occurred in the control TMJ complexes,but not in the experimental TMJ complexes.Conclusion:Effect(similar to distraction osteogenesis)of LPM was an important and pathological cause of traumatic TMJ bone ankylosis after the sagittal fracture of condyle.

关 键 词：翼外肌 动物模型 髁突矢状骨折 颞下颌关节强直 牵张成骨 

分 类 号：R782.61[医药卫生—口腔医学]