双侧冠突切除对肋骨-肋软骨移植重建颞下颌关节受力影响的有限元分析  

Influence of bilateral coronoidectomy on temporomandibular joint stress distribution after costochondral graft reconstruction:a finite element analysis

作　　者：毛懿 陈旭卓 覃海艺[2] 甄锦泽[1] 邱亚汀[1] 霍亮[1] 张善勇[1] MAO Yi;CHEN Xu-zhuo;QIN Hai-yi;ZHEN Jin-ze;QIU Ya-ting;HUO Liang;ZHANG Shan-yong(Department of Oral Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,College of Stomatology,Shanghai Jiao Tong University,National Center for Stomatology,National Clinical Research Center for Oral Diseases,Shanghai Key Laboratory of Stomatology.Shanghai 200011;Institute of Forming Technology and Equipment,Shanghai Jiao Tong University.Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔外科,上海交通大学口腔医学院,国家口腔医学中心,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200011 [2]上海交通大学塑性成形技术与装备研究院,上海200030

出　　处：《上海口腔医学》2022年第2期126-131,共6页Shanghai Journal of Stomatology

基　　金：上海市转化医学协同创新中心项目(TM201812);上海市科委优秀技术带头人项目(21XD1431500);上海交通大学医工交叉重点项目(ZH2018ZDA13,YG2017MS04);上海交通大学医工交叉青年项目(YG2017QN08)。

摘　　要：目的:探讨双侧冠突切除对肋骨-肋软骨移植重建颞下颌关节后受力分布的影响。方法:建立双侧肋骨-肋软骨移植重建颞下颌关节同期不同程度前移(0、2、4、6、8 mm)下颌骨的三维模型,分别模拟保留冠突和切除冠突。对每一模型进行三维有限元分析,比较保留或切除冠突对关节区受力分布的影响。结果:有限元分析显示,在双侧关节重建伴下颌骨前移0~8 mm的过程中,保留冠突时,软骨发生向前形变,受剪切力依次降低,左侧由113.2 N降至26.7 N,右侧则由133.7 N降至1.9 N;切除冠突时,软骨发生向后形变,剪切力依次增加,左侧由94.6 N增加至188.5 N,右侧则由70.1 N增加至157.7 N,8 mm时肋骨颈部出现明显应力集中。结论:冠突切除术对关节区受力分布产生重要影响,保留冠突有利于维持力学平衡。双侧肋骨-肋软骨移植重建颞下颌关节伴冠突切除大幅度(≥8 mm)前移下颌骨,可导致关节区应力超过肋软骨最大承受范围并断裂。PURPOSE:To explore the effect of bilateral coronoidectomy on stress distribution after reconstruction of temporomandibular joint(TMJ)by costochondral graft.METHODS:Ten groups of models were established to simulate costochondral graft reconstruction with simultaneously different distances(0,2,4,6,8 mm)of mandibular advancement,with or without coronoidectomy.Force and stress distribution in the rib-cartilage area were analyzed by finite element analysis.RESULTS:In the process of bilateral joint reconstruction with simultaneously mandible advancement ranging from 0 mm to 8 mm,when the coronoid processes were retained,the forward deformation of the cartilage occurred and the shear force decreased in turn,from 113.2 N to 26.7 N on the left side and from 133.7 N to 1.9 N on the right side.When the coronoid processes were removed,the cartilage deformed backward and the shear force increased successively,from 94.6 N to 188.5 N on the left and 70.1 N to 157.7 N on the right.The stress in the neck was obviously concentrated when mandible ad-vanced 8 mm.CONCLUSIONS:Coronoidectomy has an important impact on stress distribution in the TMJ area,and keeping the coronoid process is beneficial to maintain the mechanical balance.Bilateral CCG reconstruction with coronoidectomy for lengthy mandible advancement(≥8 mm)may lead to prominent increase in shear force beyond CCG resistance,resulting in a costal-cartilage junction fracture.

关 键 词：颞下颌关节置换术 肋骨-肋软骨移植 有限元分析 冠突切除术 

分 类 号：R782.6[医药卫生—口腔医学]