一种基于榫卯结构的腓骨重建下颌骨固定方法的生物力学分析研究  

Biomechanical analysis of mandibular reconstruction with a fibular flap by fixation based on mortise and tenon joint structure

作　　者：魏文卿 韩婧[2] 胡俊磊 刘剑楠[2] Wei Wenqing;Han Jing;Hu Junlei;Liu Jiannan(University of Shanghai for Science and Technology,School of Medical Instrument and Food Engineering,Shanghai 200093,China;Department of Oral Maxillofacial Head and Neck Oncology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology&Shanghai Research Institute of Stomatology,Shanghai 200011,China)

机构地区：[1]上海理工大学医疗器械与食品学院,200093 [2]上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,200011

出　　处：《中华整形外科杂志》2021年第5期520-527,共8页Chinese Journal of Plastic Surgery

基　　金：国家重点研发计划项目(2018YFC0807303);上海交通大学医工交叉重点项目(ZH20182DA15)。

摘　　要：目的探讨下颌骨重建时应用腓骨榫卯结构设计结合拉力螺钉固位的应力及位移特点。方法选取2020年8月上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科收治的1例66岁男性下颌骨无骨折及畸形的患者作为志愿者。通过CT扫描获取患者下颌骨及腓骨影像学数据,应用Mimics 17.0、GeomagicWrap 2017软件进行三维重建、逆向重建获取下颌骨与腓骨三维模型。经过Solidworks 2017与Geomagic Design X 64软件最终获得腓骨重建下颌骨模型。采用布尔运算分割皮质骨与松质骨。应用三维有限元分析,模拟垂直咬合状态(载荷条件为在中切牙沿轴线向下125 N,第2、3磨牙沿轴线向下250 N),对比分析榫卯结构结合拉力螺钉与传统钛板两种固定方式在骨断端愈合前、后,下颌骨及内固定物的应力与位移分布特点。在榫卯固定模式中优化下颌骨边界条件,再次测量未愈合时应力条件下榫卯固定模式内固定物的应力分布及下颌骨的移位情况。结果在应力分布方面:骨断端未愈合条件下,榫卯结构固定的内固定物应力峰值分布于骨断面与内固定物的交界处,为304.07 MPa;钛板固定方式的应力峰值位于后端骨断端处,为345.39 MPa。骨愈合后,榫卯结构固定的内固定物应力峰值分布不变,为58.47 MPa;钛板固定方式内固定物的应力集中在钛钉与钛板的接触点,为92.06 MPa;此外,榫卯固定模式优化边界条件后,在骨未愈合条件下,骨两端应力分布均匀,内固定物应力峰值为88.56 MPa,显著低于钛的最大屈服强度860 MPa。在位移方面:在骨未愈合条件下,两种固定方式的位移峰值均分布于下颌骨下缘正中部偏右侧颏孔区,累及前端截骨面。榫卯固定方式的下颌骨位移峰值(1.307 mm)略小于钛板固定方式的下颌骨位移峰值(1.447 mm);在骨愈合后,两种固定方式的主要位移位置均靠近下颌骨下缘正中部,不累及截骨面。钛板固�Objective To analyze the stress and displacement distribution of mandibular reconstruction with fibular flap by fixation based on mortise and tenon joint structure with three-dimensional finite element analysis.Methods A 66-year-old male patient with no fracture or deformity of the mandible was admitted to the Department of Oral and Maxillofacial Head and Neck Oncology of the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine in August 2020.The imaging data of the mandible and fibula of the patients were obtained with CT scan.Three-dimensional reconstruction and reverse reconstruction were performed with software Mimics 17.0 and GeomagicWrap 2017 to obtain the three-dimensional models of the mandible and fibula.The model of mandibular reconstruction with fibular flap was obtained by software Solidworks 2017 and Geomagic Design X 64.The cortical bone and cancellous bone were segmented by Boolean operation.The vertical occlusal state was simulated(the loading condition was 125 N downward along the axis of the central incisor and 250 N downward along the axis of the second and third molars).Three dimensional finite element analysis was used to compare and analyze the stress and displacement distribution characteristics of the mandible and internal fixation before and after bone healing with the mortise and tenon joint structure combined with lag screws and traditional titanium plates.After optimized the boundary conditions of the mandible based on the mortise and tenon joint structure,the stress and displacement distribution of the internal fixation and mandible were measured.Results In terms of stress distribution,under the condition of bone non-union,the stress peak of the internal fixator fixed by mortise and tenon structure was distributed at the junction of bone section and internal fixator,which was 304.07 MPa.The peak stress of the titanium plate fixation was 345.39 MPa at the broken end of the posterior bone.After bone healing,the stress peak distributions of the internal fixator fixe

关 键 词：下颌骨重建术 有限元分析 成像 三维 榫卯结构 

分 类 号：R687.3[医药卫生—骨科学] R318.01[医药卫生—外科学]