正頜手術(shù)對(duì)骨性下頜后縮顳下頜關(guān)節(jié)生物力學(xué)影響的三維有限元研究
發(fā)布時(shí)間：2018-08-03 18:32
【摘要】：目的:骨性下頜后縮主要表現(xiàn)為Ⅱ類骨性錯(cuò)牙合,影響著患者口腔頜面部的功能和容貌。成年患者常需通過正畸—正頜聯(lián)合治療以獲得個(gè)體最佳的咬合狀態(tài)與協(xié)調(diào)的頜面部軟組織輪廓。大量研究表明正頜手術(shù)與顳下頜關(guān)節(jié)(temporomandibular joint,TMJ)關(guān)系密切,正頜手術(shù)對(duì)TMJ健康的影響一直是學(xué)術(shù)界關(guān)注的問題,但至今仍未形成統(tǒng)一的結(jié)論。有限元法(finite element method,FEM)因具有直接實(shí)驗(yàn)分析無法比擬的優(yōu)勢(shì)而在口腔生物力學(xué)的研究中得到了大量應(yīng)用。本實(shí)驗(yàn)通過利用三維建模軟件與有限元分析軟件建立骨性下頜后縮正頜手術(shù)前后TMJ與下頜及其咀嚼肌系統(tǒng)的有限元(finite element,FE)模型,利用有限元法基本明確正頜手術(shù)對(duì)TMJ生物力學(xué)的遠(yuǎn)期影響。方法:選取1例全口牙正畸去代償完成時(shí)且已診斷明確的單純骨性下頜后縮的健康成年男性患者,其頭顱經(jīng)16層X射線電子計(jì)算機(jī)斷層掃描裝置掃描獲得頜面部CT平掃+三維重建的DICOM格式數(shù)據(jù),綜合運(yùn)用Mimics、Geomagic Studio、Unigraphics NX,去除模型中除下頜骨及其上面的牙齒、雙側(cè)關(guān)節(jié)窩、顳骨以外的圖像,并將模型從正中矢狀剖開,取一側(cè)(左側(cè))進(jìn)行研究,在該半側(cè)模型各臨床牙根的表面建立0.2mm厚的牙周膜、在髁突頭與關(guān)節(jié)窩表面分別建立0.3、0.5mm厚的軟骨、根據(jù)髁突頭與關(guān)節(jié)窩之間的間隙生成關(guān)節(jié)盤,將模型中的髁突劃分為前斜面、橫嵴、后斜面、髁突頸4個(gè)區(qū)域、將關(guān)節(jié)窩劃分為前、后、中央、內(nèi)側(cè)、外側(cè)5個(gè)區(qū)域,在模型上標(biāo)記出咬肌、顳肌、翼內(nèi)肌、翼外肌的附著區(qū)并確定的肌力方向,將此模型記為術(shù)前模型。在以上軟件中,將術(shù)前模型模擬下頜支矢狀劈開前徙術(shù)且取出接骨板、螺釘后骨不連續(xù)區(qū)完全愈合時(shí)的狀態(tài),下頜前徙距離設(shè)定為臨床常用的4、8、10mm,保持肌肉附著區(qū)不變,原肌力的方向隨肌肉附著區(qū)位置的變化而變化并成為最終的肌力方向,并根據(jù)髁突頭與關(guān)節(jié)窩之間的間隙重新生成新的關(guān)節(jié)盤,其對(duì)應(yīng)的模型分別為術(shù)后模型1、2、3。在workbench中對(duì)術(shù)前模型與術(shù)后模型1、2、3各結(jié)構(gòu)的接觸類型、界面類型、摩擦系數(shù)進(jìn)行設(shè)定并完成四面體網(wǎng)格劃分,設(shè)置固定約束、部件材料屬性后,按最大咀嚼肌力狀態(tài)設(shè)置咀嚼肌力的大小及其作用于模型的區(qū)域。結(jié)果:1.成功建立了術(shù)前與下頜前徙4、8、10mm且取出接骨板、螺釘后不連續(xù)區(qū)完全愈合時(shí)的tmj、下頜及其咀嚼肌系統(tǒng)的fe模型,與真實(shí)的tmj與下頜具有較好的幾何相似性,網(wǎng)格劃分比較細(xì)致,更能反映其受力時(shí)的真實(shí)狀態(tài)。2.成功獲得骨性下頜后縮正頜術(shù)前與下頜前徙4、8、10mm且取出接骨板、螺釘后不連續(xù)區(qū)已完全愈合時(shí)在最大咀嚼肌力狀態(tài)下tmj的vonmises應(yīng)力分布云圖與各結(jié)構(gòu)各區(qū)域的最大vonmises應(yīng)力值。術(shù)前術(shù)后髁突vonmises應(yīng)力最大區(qū)均位于髁突頸部后內(nèi)側(cè),當(dāng)下頜前徙4mm時(shí),最大vonmises應(yīng)力最大,為106.26mpa。在髁突頭vonmises應(yīng)力最大區(qū)位于前斜面與頸部交界的外側(cè),當(dāng)下頜前徙8mm時(shí),其最大vonmises應(yīng)力最大,為21.898mpa。正頜手術(shù)前后關(guān)節(jié)窩最大vonmises應(yīng)力均位于前區(qū),當(dāng)下頜前徙10mm時(shí),最大Von Mises應(yīng)力最大,為15.729MPa。隨著下頜前徙距離的增加,關(guān)節(jié)窩后區(qū)與外側(cè)區(qū)Von Mises應(yīng)力有明顯的增加。在下頜前徙過程中,橫嵴、髁突后斜面、關(guān)節(jié)窩中央?yún)^(qū)最大Von Mises應(yīng)力變化幅度較小。關(guān)節(jié)窩內(nèi)側(cè)區(qū)在下頜前徙從4mm到8mm時(shí)最大Von Mises應(yīng)力增加的幅度較大。下頜前徙距離從8mm到10mm時(shí),髁突頸部的最大Von Mises應(yīng)力減小幅度較大。髁突總體Von Mises應(yīng)力值明顯大于關(guān)節(jié)窩。結(jié)論:綜合運(yùn)用Mimics、Geomagic Studio、Unigraphics NX、Workbench可建立具有較好幾何與力學(xué)相似性的骨性下頜后縮正頜手術(shù)前后TMJ與下頜咀嚼肌系統(tǒng)的FE模型。骨性下頜后縮及其正頜術(shù)后髁突頸一直是TMJ應(yīng)力最集中的部位,髁突前斜面均是髁突的主要功能面。在一定范圍內(nèi),隨著下頜前徙距離的增加,關(guān)節(jié)窩后外側(cè)區(qū)域與髁突的相應(yīng)接觸面積逐漸增大,其應(yīng)力逐漸增大。從遠(yuǎn)期來看,規(guī)范的正頜手術(shù)一般不會(huì)對(duì)骨性下頜后縮患者的髁突與顳下頜關(guān)節(jié)窩產(chǎn)生不良影響。
[Abstract]:Objective: the main manifestations of skeletal mandibular retraction are type II orthodontic occlusion, which affect the function and facial features of the oral and maxillofacial areas. Adult patients often need orthodontic and orthognathic therapy to obtain the best occlusion and coordinate the soft tissue profile of the maxillofacial region. Ar joint, TMJ) is closely related. The effect of orthognathic surgery on the health of TMJ has been a concern in the academic world, but it has not yet formed a unified conclusion. The finite element method (finite element method, FEM) has been widely used in the study of oral biomechanics because of the incomparable advantages of direct experimental analysis. This experiment uses three. The finite element (finite element, FE) model of TMJ and mandible and its masticatory muscle system before and after orthodontic mandibular orthognathic operation was built with the software of dimensional modeling and finite element analysis. The long term effect of orthognathic surgery on the biomechanics of TMJ was clearly defined by the finite element method. Method: 1 cases of orthodontic orthodontics were selected to complete and have been diagnosed clearly. A healthy adult male with simple osseous mandibular retraction is scanned by 16 layers of X ray computed tomography to obtain the DICOM format data of CT plain and three-dimensional reconstruction of the maxillofacial region, combined with Mimics, Geomagic Studio, Unigraphics NX, and the removal of the mandible and its upper teeth, bilateral joint fossa, and the temporal bone. The model was removed from the median sagittal and one side (left) was studied. The 0.2mm thick periodontal membrane was established on the surface of the clinical root of the half side model. The 0.3,0.5mm thick cartilage was established on the surface of the condyle head and the joint fossa, and the condyle in the model was divided into the anterior condyle according to the gap between the condyle head and the joint fossa. The 4 regions of the oblique, transverse, posterior, condylar neck were divided into 5 regions: the anterior, the central, the medial, and the outside. The model was marked with the masseter, the temporalis, the intramuscular and extragarial muscles and the direction of the muscle strength. The model was recorded as the preoperation model. The position of the mandibular anterior migration is set as a clinical common 4,8,10mm, which keeps the muscle attachment area unchanged. The direction of the original muscle force varies with the position of the attachment area of the muscles and becomes the ultimate direction of the muscle force, and regenerates a new one according to the gap between the condyle head and the joint fossa. The corresponding models are the model 1,2,3. in workbench for the contact type, the type of interface and the coefficient of friction in the model of 1,2,3 in the post operation model, the type of interface and the coefficient of friction to set the tetrahedral mesh, set the fixed constraints, and set the masticatory muscle strength according to the maximum masticatory muscle state after the material properties of the component and the size of the masticatory muscle strength. Results: 1. the results were as follows: 1. the TMJ, the FE model of the mandible and the masticatory muscle system of the mandible and the masticatory muscle system were successfully established before and after the operation and the mandibular migration, and the FE model of the mandible and the masticatory muscle system had better geometric similarity with the real TMJ and the mandible. 2. the vonmises stress distribution and the maximum vonmises stress value of the vonmises stress distribution of TMJ under the maximum masticatory muscle force in the discontinuous region of the mandible were successfully obtained before and after the maxillary mandibular retrusion, and the maximum vonmises stress in the condyle was located in the neck of the condyle. The maximum vonmises stress is maximum when the mandible moves forward 4mm. The maximum vonmises stress in the condyle head is located on the outer side of the front of the anterior oblique and the neck of the neck. When the mandible migrations 8mm, the maximum vonmises stress is maximum. The largest vonmises stress in the joint fossa before and after the 21.898mpa. orthognathic operation is located in the anterior region, when the mandible migrations before 10mm, The maximum Von Mises stress is maximum, and the stress of Von Mises in the posterior and lateral area of the joint fossa is obviously increased with the increase of the mandibular migration distance. In the process of the mandibular migration, the transverse ridge, the posterior oblique surface of the condyle, the maximum Von Mises stress in the central area of the joint fossa are small. The maximum Von of the medial section of the fossa fossa from 4mm to 8mm is migrating before the mandible. Mises stress increased greatly. The maximum Von Mises stress of the condyle neck decreased greatly when the mandibular forward migration ranged from 8mm to 10mm. The overall condyle Von Mises stress value was significantly greater than that of the articular fossa. Conclusion: the comprehensive use of Mimics, Geomagic Studio, Unigraphics NX, can establish a better geometric and mechanical resemblance to the bone. The FE model of the TMJ and the mandibular masticatory muscle system before and after maxillary orthognathic operation. The mandibular retrusion and the condyle neck of the mandibular condyle after orthognathic operation are the most concentrated parts of the TMJ stress. The anterior condylar surface of the condyle is the main functional surface of the condyle. In the long term, normal orthognathic surgery generally does not have a bad effect on the condyle and the temporomandibular fossa in the patients with skeletal mandibular retraction.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R783.5
[Abstract]:Objective: the main manifestations of skeletal mandibular retraction are type II orthodontic occlusion, which affect the function and facial features of the oral and maxillofacial areas. Adult patients often need orthodontic and orthognathic therapy to obtain the best occlusion and coordinate the soft tissue profile of the maxillofacial region. Ar joint, TMJ) is closely related. The effect of orthognathic surgery on the health of TMJ has been a concern in the academic world, but it has not yet formed a unified conclusion. The finite element method (finite element method, FEM) has been widely used in the study of oral biomechanics because of the incomparable advantages of direct experimental analysis. This experiment uses three. The finite element (finite element, FE) model of TMJ and mandible and its masticatory muscle system before and after orthodontic mandibular orthognathic operation was built with the software of dimensional modeling and finite element analysis. The long term effect of orthognathic surgery on the biomechanics of TMJ was clearly defined by the finite element method. Method: 1 cases of orthodontic orthodontics were selected to complete and have been diagnosed clearly. A healthy adult male with simple osseous mandibular retraction is scanned by 16 layers of X ray computed tomography to obtain the DICOM format data of CT plain and three-dimensional reconstruction of the maxillofacial region, combined with Mimics, Geomagic Studio, Unigraphics NX, and the removal of the mandible and its upper teeth, bilateral joint fossa, and the temporal bone. The model was removed from the median sagittal and one side (left) was studied. The 0.2mm thick periodontal membrane was established on the surface of the clinical root of the half side model. The 0.3,0.5mm thick cartilage was established on the surface of the condyle head and the joint fossa, and the condyle in the model was divided into the anterior condyle according to the gap between the condyle head and the joint fossa. The 4 regions of the oblique, transverse, posterior, condylar neck were divided into 5 regions: the anterior, the central, the medial, and the outside. The model was marked with the masseter, the temporalis, the intramuscular and extragarial muscles and the direction of the muscle strength. The model was recorded as the preoperation model. The position of the mandibular anterior migration is set as a clinical common 4,8,10mm, which keeps the muscle attachment area unchanged. The direction of the original muscle force varies with the position of the attachment area of the muscles and becomes the ultimate direction of the muscle force, and regenerates a new one according to the gap between the condyle head and the joint fossa. The corresponding models are the model 1,2,3. in workbench for the contact type, the type of interface and the coefficient of friction in the model of 1,2,3 in the post operation model, the type of interface and the coefficient of friction to set the tetrahedral mesh, set the fixed constraints, and set the masticatory muscle strength according to the maximum masticatory muscle state after the material properties of the component and the size of the masticatory muscle strength. Results: 1. the results were as follows: 1. the TMJ, the FE model of the mandible and the masticatory muscle system of the mandible and the masticatory muscle system were successfully established before and after the operation and the mandibular migration, and the FE model of the mandible and the masticatory muscle system had better geometric similarity with the real TMJ and the mandible. 2. the vonmises stress distribution and the maximum vonmises stress value of the vonmises stress distribution of TMJ under the maximum masticatory muscle force in the discontinuous region of the mandible were successfully obtained before and after the maxillary mandibular retrusion, and the maximum vonmises stress in the condyle was located in the neck of the condyle. The maximum vonmises stress is maximum when the mandible moves forward 4mm. The maximum vonmises stress in the condyle head is located on the outer side of the front of the anterior oblique and the neck of the neck. When the mandible migrations 8mm, the maximum vonmises stress is maximum. The largest vonmises stress in the joint fossa before and after the 21.898mpa. orthognathic operation is located in the anterior region, when the mandible migrations before 10mm, The maximum Von Mises stress is maximum, and the stress of Von Mises in the posterior and lateral area of the joint fossa is obviously increased with the increase of the mandibular migration distance. In the process of the mandibular migration, the transverse ridge, the posterior oblique surface of the condyle, the maximum Von Mises stress in the central area of the joint fossa are small. The maximum Von of the medial section of the fossa fossa from 4mm to 8mm is migrating before the mandible. Mises stress increased greatly. The maximum Von Mises stress of the condyle neck decreased greatly when the mandibular forward migration ranged from 8mm to 10mm. The overall condyle Von Mises stress value was significantly greater than that of the articular fossa. Conclusion: the comprehensive use of Mimics, Geomagic Studio, Unigraphics NX, can establish a better geometric and mechanical resemblance to the bone. The FE model of the TMJ and the mandibular masticatory muscle system before and after maxillary orthognathic operation. The mandibular retrusion and the condyle neck of the mandibular condyle after orthognathic operation are the most concentrated parts of the TMJ stress. The anterior condylar surface of the condyle is the main functional surface of the condyle. In the long term, normal orthognathic surgery generally does not have a bad effect on the condyle and the temporomandibular fossa in the patients with skeletal mandibular retraction.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R783.5
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