双侧下颌骨牵引成骨术不同牵引方向对颞下颌关节影响的三维有限元分析  

Biomechanical study on the effect of different traction directions on temporomandibular joint in mandible distraction osteogenesis

作　　者：崔颖秋 张娜 周思茵 张云燕 赵树蕃 毛喆 Cui Yingqiu;Zhang Na;Zhou Siyin;Zhang Yunyan;Zhao Shufan;Mao Zhe(Oral and Maxillofacial Surgery,Guangzhou Women and Children’s Medical Center,Guangzhou 510000,China;Anesthesiology Department,Guangzhou Women and Children’s Medical Center,Guangzhou 510000,China;Imaging Department,Guangzhou Women and Children’s Medical Center,Guangzhou 510000,China)

机构地区：[1]广州市妇女儿童医疗中心口腔颌面外科,510000 [2]广州市妇女儿童医疗中心麻醉科,510000 [3]广州市妇女儿童医疗中心影像科,510000

出　　处：《中华整形外科杂志》2021年第5期476-485,共10页Chinese Journal of Plastic Surgery

基　　金：广州市科技计划项目(202102080002)。

摘　　要：目的确定行双侧下颌骨牵引成骨术(MDO)时对颞下颌关节影响最小的牵引力方向。方法(1)利用锥形束CT获取1例15岁男性健康志愿者的颌面部DICOM格式数据,采用Mimics 10.01、Geomagic studio 12.0、Workbench 16.2软件建立颞下颌关节三维有限元模型,并对模型的有效性进行验证。(2)在验证后的三维有限元模型上模拟进行MDO,荷载6种不同方向的牵引力:沿髁突中点至下颌颏点连线,平行于颌骨体部表面;沿髁突中点至下颌颏点连线,平行于矢状面;沿下颌体方向,平行于颌骨体部表面;沿下颌体方向且平行于矢状面;沿下颌升支方向且平行于颌骨表面;沿下颌升支方向且平行于矢状面。牵引力大小均设定为100 N。(3)测量不同方向牵引力对关节盘应力、截骨面位移、颞骨应力、髁突压力的影响。结果(1)在关节盘最薄区域,关节盘上、下表面所受应力最小的牵引力方向为"沿下颌体方向,平行于颌骨体部表面"。(2)在相同大小牵引力作用下,各截骨面沿牵引方向位移差距不大,效果基本一致。(3)施以"沿下颌体方向,平行于颌骨体部表面"与"沿下颌体方向且平行于矢状面"2个方向的牵引力时,颞骨的应力(0.42416、0.46697 MPa)小于其他4种情况(0.64387~0.98117 MPa),且这2种牵引力均为沿下颌体方向,力分解之后对髁突的压力(59.712、60.470 N)亦小于其他4种情况(80.098~99.769 N)。结论采用DICOM数据建模法可以获得满意的颞下颌关节三维有限元模型。"沿下颌体方向,平行于颌骨体部表面"及"沿下颌体方向且平行于矢状面"方向的牵引力对颞下颌关节影响最小。在设计MDO牵引方向时,除要考虑手术对颌骨和上呼吸道形态的影响之外,还应权衡牵引力方向对颞下颌关节的影响,以保证行MDO时对颞下颌关节影响最小。Objective To determine the direction of traction that has the least influence on temporomandibular joint(TMJ)during mandibular distraction osteogenesis(MDO).Methods(1)The three-dimensional finite element model was established after the mandible data were obtained by cone beam computed tomography(CBCT)scanning,and the validity of the model was verified.(2)Based on the verified three-dimensional finite element model,the distraction osteogenesis of mandible was carried out with six different directions.(3)The effects of different traction directions on disc pressure,osteotomy displacement,temporal bone pressure and condylar pressure were measured.Results(1)In the thinnest area of the articular disc,the direction of the minimum stress on the upper and lower surfaces of the disc was"along the direction of the mandible,parallel to the surface of the mandible".(2)Under the same load,the displacement of each osteotomy surface along the traction direction was different,but the difference was not big,and the effect was basically the same.(3)"Along the direction of the mandible,parallel to the surface of the mandible"and"along the direction of the mandible and parallel to the sagittal plane"had less pressure on the temporal bone than other situations,and the two directions of traction were parallel to the mandible.After the force decomposition,the direction of the condyle was the smallest,so the pressure on the condyle was smaller.Conclusions A satisfactory TMJ model can be obtained by DICOM.The traction force of"along the direction of the mandible body,parallel to the surface of the mandible body"and"along the direction of the mandible body and parallel to the sagittal plane"had the least effect on the TMJ.When designing the traction direction of MDO,we should not only consider the influence of surgery on the shape of jaw and upper respiratory tract,but also weigh in the influence of traction direction on the TMJ,and determine the direction of traction which has the least influence on the TMJ.

关 键 词：颞下颌关节 有限元分析 骨生成 牵张 下颌骨 牵引成骨方向 

分 类 号：R782.6[医药卫生—口腔医学]