CT影像数据建立吞咽肌骨三维模型以及生物力学特征分析  

Three-dimensional model of swallowing musculoskeletal system based on CT image data and biomechanical characteristics analysis

作　　者：方丹丹 马睿杰[2] 黄怿 何克林[2] 吴磊 Fang Dandan;Ma Ruijie;Huang Yi;He Kelin;Wu Lei(Zhebei Branch of Affiliated Third Hospital of Zhejiang Chinese Medical University(Wuxing District Hospital of Traditional Chinese Medicine),Huzhou 313002,Zhejiang Province,China;Affiliated Third Hospital of Zhejiang Chinese Medical University,Hangzhou 310005,Zhejiang Province,China;Third School of Clinical Medicine,Zhejiang Chinese Medical University,Hangzhou 310053,Zhejiang Province,China)

机构地区：[1]浙江中医药大学附属第三医院浙北分院(湖州市吴兴区中医院),浙江省湖州市313002 [2]浙江中医药大学附属第三医院,浙江省杭州市310005 [3]浙江中医药大学第三临床医学院,浙江省杭州市310053

出　　处：《中国组织工程研究》2025年第29期6167-6173,共7页Chinese Journal of Tissue Engineering Research

基　　金：浙江省中医药科技计划项目(2022ZB198),项目负责人:吴磊;浙江省中医药现代化专项项目(2020ZX011),项目负责人:马睿杰;浙江省中医药科技计划项目(2025ZX232),项目负责人:方丹丹。

摘　　要：背景:目前对于吞咽障碍的临床研究较多,而吞咽障碍状态对骨骼及舌骨肌群应力影响的研究较少。目的:建立吞咽肌骨三维模型,探讨吞咽运动中舌骨及舌骨上肌群的应力变化。方法:选取1名健康成年男性并拍摄头颈部CT,通过影像数据提取法构建三维模型。根据舌骨的位移情况,设定舌骨的最低位置及最高位置,依次加载舌骨上肌群的肌力,观察生理状态下舌骨上肌群对舌骨的应力影响。通过改变肌肉的材料属性,模拟不同程度吞咽障碍,观察吞咽异常状态下舌骨上肌群的应力变化。结果与结论:①建立了包含C2-C4椎体、部分颞骨、下颌骨、舌骨及下颌舌骨肌-颏舌骨肌的有限元模型,可反映患者吞咽时舌骨位移情况及应力变化。②生理状态下,舌骨上肌群中下颌舌骨肌对舌骨的应力影响最大,其次是二腹肌、颏舌骨肌及茎突舌骨肌。③通过模拟不同程度的吞咽障碍,发现随着吞咽障碍严重程度增加,舌骨上肌群的应力也逐渐增加。④结果说明,舌骨上肌群中下颌舌骨肌及二腹肌对舌骨应力影响较大,提示特定肌肉刺激的重要性。吞咽障碍的加重与舌骨上肌群的应力改变呈正相关,该结果为吞咽障碍的机制研究及临床诊疗提供了生物力学参考。BACKGROUND:At present,there are many clinical studies on dysphagia,but little is known about the stress of bones and hyoid muscles caused by dysphagia.OBJECTIVE:To establish a three-dimensional model of swallowing musculoskeletal system to investigate the stress changes of hyoid and suprahyoid muscles during swallowing.METHODS:A healthy adult male was selected for head and neck CT scanning.A three-dimensional model was constructed by image extraction method.According to hyoid motion,the lowest and highest positions of hyoid were set,and the muscle strength of suprahyoid muscles was successively loaded to observe the stress influence of suprahyoid muscles on hyoid under physiological state.By changing the material properties of muscles,we simulated different degrees of dysphagia and observed the stress changes of suprahyoid muscle group under the condition of dysphagia.RESULTS AND CONCLUSION:(1)The finite element models including C2-C4 vertebrae,partial temporal bone,mandible,hyoid,and mylohyoid-geniohyoid muscle were established,which could reflect the displacement of hyoid and stress changes during swallowing.(2)Under physiological conditions,among suprahyoid muscles,mylohyoid muscle had the greatest influence on hyoid stress,followed by digastric muscle,geniohyoid muscle,and stylohyoid muscle.(3)By simulating different degrees of dysphagia,it was found that with the increase of the severity of dysphagia,the stress of suprahyoid muscles gradually increased.(4)These findings conclude that among suprahyoid muscles,mylohyoid muscle and digastric muscle have the greatest influence on hyoid stress,which suggests the importance of specific muscle stimulation.The aggravation of dysphagia was positively correlated with the stress change of suprahyoid muscles,which could provide a biomechanical reference for the mechanism study and clinical diagnosis and treatment of dysphagia.

关 键 词：舌骨 舌骨上肌群 吞咽障碍 生物力学 有限元 工程化骨组织 

分 类 号：R496[医药卫生—康复医学] R318[医药卫生—临床医学] R816.1