發(fā)布時間：2018-06-12 18:05

  本文選題：顳下頜關(guān)節(jié) + 關(guān)節(jié)強(qiáng)直　； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究旨在闡明不同處理方式治療髁狀突囊內(nèi)骨折與創(chuàng)傷性顳下頜關(guān)節(jié)強(qiáng)直發(fā)生的關(guān)系,初步探討髁狀突囊內(nèi)骨折繼發(fā)顳下頜關(guān)節(jié)強(qiáng)直的機(jī)理,為髁狀突囊內(nèi)骨折治療方法的選擇及預(yù)防創(chuàng)傷性顳下頜關(guān)節(jié)強(qiáng)直發(fā)生提供可靠的數(shù)據(jù)支持。方法:本研究采用手術(shù)方法模擬髁狀突囊內(nèi)骨折建立小型豬動物模型。在實(shí)驗(yàn)動物模型建立的基礎(chǔ)上進(jìn)行對照實(shí)驗(yàn),根據(jù)不同的治療方式將實(shí)驗(yàn)動物分為生理鹽水組、地塞米松組、鈦板固定組和自然愈合組。其中自然愈合組為對照組,其它三組為實(shí)驗(yàn)組。1.術(shù)后6個月,通過大體標(biāo)本觀察、影像學(xué)和組織學(xué)檢查評價各組顳下頜關(guān)節(jié)強(qiáng)直的形成。2.利用免疫組織化學(xué)染色定性檢測各組顳下頜關(guān)節(jié)中血管內(nèi)皮生長因子(Vascular endothelial growth factor,VEGF)、骨鈣素(Osteocalcin,OCN)、骨橋蛋白(Osteopontin,OPN)和骨形態(tài)發(fā)生蛋白-2(Bone morphogenetic protein 2,BMP2)的表達(dá)情況。3.利用RT-PCR和Western Blot技術(shù)相對定量檢測各組顳下頜關(guān)節(jié)中VEGF、OCN、OPN和BMP2的mRNA和蛋白表達(dá)改變。結(jié)果:1.通過大體標(biāo)本觀察、影像學(xué)和組織學(xué)檢查發(fā)現(xiàn),各實(shí)驗(yàn)組顳下頜關(guān)節(jié)強(qiáng)直發(fā)生率顯著低于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.免疫組織化學(xué)染色定性檢測發(fā)現(xiàn),各實(shí)驗(yàn)組顳下頜關(guān)節(jié)中VEGF、OCN、OPN和BMP2的平均光密度明顯低于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。3.RT-PCR實(shí)時定量分析發(fā)現(xiàn),實(shí)驗(yàn)組顳下頜關(guān)節(jié)中VEGF、OCN、OPN和BMP2的mRNA表達(dá)水平明顯低于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。4.Western Blot檢測發(fā)現(xiàn),VEGF、OCN、OPN和BMP2在實(shí)驗(yàn)組顳下頜關(guān)節(jié)中的蛋白表達(dá)明顯低于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。結(jié)論:1.小型豬髁狀突囊內(nèi)骨折實(shí)驗(yàn)動物模型的建立具有可重復(fù)性,該動物模型能為探索創(chuàng)傷性顳下頜關(guān)節(jié)強(qiáng)直的發(fā)生機(jī)制提供研究平臺。2.不同處理方式治療髁狀突囊內(nèi)骨折與創(chuàng)傷性顳下頜關(guān)節(jié)強(qiáng)直的發(fā)生率密切相關(guān)。3.將骨折復(fù)位并采用微型鈦板固定,且將移位的關(guān)節(jié)盤復(fù)位固定可以有效減少顳下頜關(guān)節(jié)強(qiáng)直的發(fā)生。4.地塞米松局部注射于關(guān)節(jié)腔內(nèi)可有效預(yù)防顳下頜關(guān)節(jié)強(qiáng)直的發(fā)生。5.清理骨創(chuàng)間血腫、減少骨創(chuàng)面的暴露及抑制新骨過度修復(fù)是預(yù)防關(guān)節(jié)強(qiáng)直發(fā)生的關(guān)鍵因素。
[Abstract]:Objective: to elucidate the relationship between intracapsular condylar fracture and traumatic temporomandibular joint ankylosis, and to explore the mechanism of temporomandibular joint ankylosis secondary to condylar intracapsular fracture. To provide reliable data support for the treatment of intracapsular condylar fracture and the prevention of traumatic temporomandibular joint ankylosis. Methods: a miniature pig model was established by surgical simulation of intracapsular condylar fracture. Based on the establishment of experimental animal model, the experimental animals were divided into normal saline group, dexamethasone group, titanium plate fixation group and natural healing group according to different treatment methods. The natural healing group was the control group, and the other three groups were the experimental group. 6 months after operation, the formation of temporomandibular joint ankylosis was evaluated by gross specimen observation, imaging and histological examination. The expressions of vascular endothelial growth factor (VEGF), osteocalcin (OC), osteopontin (OPN) and bone morphogenetic protein-bone morphogenetic protein (BMP2) in temporomandibular joint (TMJ) were detected by immunohistochemical staining. The mRNA and protein expressions of VEGF OCNOPN and BMP2 in temporomandibular joint were detected by RT-PCR and Western blot. The result is 1: 1. The incidence of temporomandibular joint ankylosis in each experimental group was significantly lower than that in the control group, and the difference was statistically significant (P 0.05). Immunohistochemical staining showed that the mean optical density of VEGF OCNOPN and BMP2 in temporomandibular joint in each experimental group was significantly lower than that in the control group, and the difference was statistically significant (P 0.01). 3. The expression of VEGFOCNOOPN and BMP2 mRNA in the temporomandibular joint of the experimental group was significantly lower than that in the control group, and the difference was statistically significant (P 0.01). 4. Western blot analysis showed that the protein expression of OCNOPN and BMP2 in the temporomandibular joint of the experimental group was significantly lower than that in the control group, and the difference was statistically significant (P 0.01). Conclusion 1. The experimental animal model of intracapsular condylar fracture in miniature pigs is repeatable. This animal model can provide a research platform for exploring the mechanism of traumatic temporomandibular joint ankylosis. The incidence of traumatic temporomandibular joint ankylosis was closely related to the treatment of intracapsular condylar fracture. Reduction of fracture and fixation with micro-titanium plate and reduction and fixation of displaced disc can effectively reduce the occurrence of temporomandibular joint ankylosis. Local injection of dexamethasone into articular cavity can effectively prevent the occurrence of temporomandibular joint ankylosis. The key factors to prevent ankylosis are to clear the hematoma of bone, reduce the exposure of bone wound and inhibit the excessive repair of new bone.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782.4

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