本文選題：動物模型　切入點：髁突游離端　出處：《寧夏醫(yī)科大學》2016年碩士論文

【摘要】：目的模擬“M”型無下頜升支高度下降SFMC臨床特點,構建羊的SFMC模型,以明確脫位型髁突游離端復位內固定對TMJ形態(tài)、功能及組織病理學指標的影響。方法1、構建右側髁突SFMC動物模型:全麻下,常規(guī)消毒鋪巾;由耳屏前切口入路,切開皮膚、皮下組織后翻瓣;暴露TMJ關節(jié)囊和顴弓后份;沿髁突長軸縱形切開關節(jié)囊,再沿顴弓根部下緣橫形切開關節(jié)囊,形成一角形切口,暴露右側髁突;由髁突關節(jié)面中點至髁頸髁突翼肌窩下方斜向中線方向縱形切開髁突;將髁突骨折片向前向方推移至關節(jié)結節(jié)前下方,保持髁突殘端位置不變,形成下頜升支高度無下降的SFMC模型。2、下頜升支無下降型SFMC模型制備完成后,保留髁突游離端于關節(jié)結節(jié)的前下方,分層縫合切口,常規(guī)飼養(yǎng),即為保守治療組;下頜升支無下降型SFMC建模完成后,立即將脫位的髁突骨折片解剖復位,并以髁突把持鉗保持髁突骨折片與髁突殘端緊密接觸。再以側向拉力螺釘從髁突殘端處釘入,橫穿骨折斷端,使髁突骨折片與髁突殘端達到解剖位及堅固內固定,即為手術治療組。3、按照術后4w、8w、12w的時間點,以TMJ結構及功能、影像資料及組織病理學方法等評價髁突游離端復位內固定對SFMC堅固內固定術后,骨折愈合、髁突改建、TMJ形態(tài)功能影響。結果本研究成功構建了綿羊脫位型下頜升支無下降型SFMC動物模型。通過保守治療及手術治療分組,在不同時間點,與術前相比,保守治療組最大開口度、前伸和左側向運動度顯著減少,手術治療組下頜的運動度無顯著性變化,但咬合關系無明顯差異。平均放射學評分,手術治療組顯著低于保守治療組。從病理觀察可見,在治療4w時,髁突表面有不規(guī)則新骨形成,保守治療組動物手術側髁突新骨形成較手術治療組明顯。12w時,保守治療組動物手術側髁突形態(tài)改變較以前更明顯,甚至骨贅形成,髁突出現畸形。相比之下,手術治療組動物手術側髁突形態(tài)趨于正常。所有動物非手術側髁突形態(tài)沒有改變。結論1.本研究成功構建了綿羊無下頜升支高度降低型SFMC的模型。2.手術治療組實驗動物被動張口度、下頜前伸及側向運動度較保守治療組改善良好,有利于恢復下頜運動功能。3.對2組實驗動物進行CBCT檢查及TMJ形態(tài)改變的放射學評分后的結果顯示,所有手術側髁突前后徑、內外徑均有增大。因保守治療組髁突內外徑、前后徑明顯增大,隨著時間的推移,這種變化更加明顯,實驗組髁突內外徑及前后徑的改變并不明顯。實驗組即手術治療組的放射學評分低于對照組。因此,保守治療較手術治療的髁突增生改建明顯,不利于TMJ形態(tài)及功能的恢復。4.保守治療組在術后12w時髁突形態(tài)出現畸形,而手術治療組術后12w時髁突形態(tài)基本恢復正常。因此,手術治療髁突形態(tài)較保守治療恢復更佳,有利于TMJ形態(tài)及功能的恢復。5.從組織細胞學角度驗證,保守治療組較手術治療組有較多新骨形成,髁突形態(tài)結構畸形嚴重,不利于TMJ形態(tài)及功能的恢復。
[Abstract]:Objective to simulate the "M" type without clinical features of mandibular branch height decreased SFMC, build the SFMC model of sheep, to clear the dislocation of condyle distal fixation on TMJ morphology, function and influence of histopathologic parameters. Methods 1, build the right condyle SFMC animal model: under general anesthesia, routine disinfection shop towels pretragal; by incision, cut the skin, subcutaneous tissue after exposure of TMJ flap; joint capsule and zygomatic arch; along the long axis of condyle longitudinal incision of the joint capsule, and then along the lower edge of the root of the zygomatic arch transverse incision of the joint capsule, which forms an angular incision to expose right condyle by condylar joint; face to the midpoint of the condylar neck of condyle fossa pterygoid muscle below the diagonal line direction of longitudinal incision of the condyle; the condylar fracture piece forward side passage to the articular tubercle below before, keep the condylar stump position unchanged, the formation of the mandibular.2 SFMC model with high free fall, ramus no decrease in SFMC model system The preparation is completed, before the bottom end in retention of free condyle articular tubercle, suture the incision, conventional breeding, the conservative treatment group; no descending ramus complete type SFMC immediately after modeling, anatomical reduction of fracture and dislocation of the condylar plate, and the condylar pliers maintain close contact sheet and condyle the stump of condylar fractures. The lateral condylar screw from the stump at the nail across the broken end of the fracture, the condylar fracture and condylar stump anatomic and rigid internal fixation, the surgical treatment group.3, according to 4W after operation, 8W, 12W time points, to TMJ the structure and function of imaging data and histological evaluation methods of condylar free end fixation on the healing of fracture SFMC internal fixation, and condylar reconstruction, effect of morphology of TMJ function. The results of this study successfully constructed sheep dislocation of mandibular ramus no decrease in type SFMC animal model. Through conservative treatment And the surgical treatment group at different time points, compared with the preoperative, conservative treatment group maximum opening, protrusion and left lateral movement of the surgical treatment group was significantly reduced, the degree of mandibular movement had no significant difference, but no significant difference between the occlusal relationship. The average score of Radiology, surgery in the treatment group were significantly lower than conservative treatment group. From the pathological observation showed that in the treatment of 4W, condylar surface with irregular new bone formation, conservative treatment group animal surgery condylar bone formation than the surgical treatment group was.12w, the conservative treatment group animal surgery condylar morphology changes than before even more obvious, osteophyte formation, condyle deformity. In contrast, the surgical treatment group animal surgery condylar morphology tended to be normal. All animal non operative condylar morphology did not change in 1.. Conclusion this study successfully constructed sheep without mandibular ramus height reduction model for surgical treatment of.2. type SFMC Experimental animal passive mouth opening, mandibular protrusive and lateral movement of the conservative treatment group improved better, is conducive to the recovery of mandibular movement.3. radiological score change CBCT examination and TMJ on the morphology of the 2 groups after the animal experiment results showed that after all the surgical side condyle diameter, inner and outer diameter increased. Because of the conservative treatment condylar internal diameter, anteroposterior diameter increased significantly, with the passage of time, the more obvious changes, the experimental group of condylar change in diameter and diameter is not obvious. The experimental group before and after the operation of Radiology score in treatment group than the control group. Therefore, conservative treatment is surgical treatment of condylar hyperplasia reconstruction was not conducive to TMJ morphology and functional recovery of.4. conservative treatment group in the postoperative 12W condylar morphology abnormalities, and the surgical treatment group postoperative 12W condylar morphology returned to normal. Therefore, surgical treatment of the condylar shape is Paul Conservative treatment and better recovery are beneficial to the recovery of morphology and function of TMJ..5. is verified from the perspective of histology and cytology. The conservative treatment group has more new bone formation than the operative group, and the condyle structure is malformed, which is not conducive to the recovery of TMJ morphology and function.

【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R782.4
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本文編號：1672700