【摘要】：目的：通過建立下頜骨髁狀突骨折頜間牽引治療的數(shù)學(xué)模型，使用MATLAB軟件進(jìn)行模型受力分析，對髁狀突骨折頜間牽引治療過程提供力學(xué)理論基礎(chǔ),并對10例該類病例進(jìn)行療效觀察。 方法：1、選取遵義醫(yī)學(xué)院附屬口腔醫(yī)院頜面外科收治的一名經(jīng)過CBCT檢查，確診為髁狀突骨折的患者并符合保守治療標(biāo)準(zhǔn)，有后牙早接觸、前牙開頜、偏頜等臨床癥狀，需要行頜間牽引治療。根據(jù)解析法中的空間力和力矩平衡，建立其牽引治療時下頜骨受力方程，使用Simplant Pro軟件對患者下頜骨CBCT資料進(jìn)行數(shù)據(jù)測量，三維建模，使用MATLAB軟件編輯程序語言轉(zhuǎn)化成數(shù)學(xué)模型，進(jìn)行力學(xué)分析。2、選取我院收治的十例進(jìn)行下頜骨髁狀突骨折牽引治療的臨床病例，使用實驗所得結(jié)果指導(dǎo)治療，并觀察臨床療效。 結(jié)果：通過CBCT與MATLAB軟件的結(jié)合，分析得出頜間牽引治療時：①牙合墊的位置越靠近后牙，髁狀突處的作用力越大。②如保持牽引力大小不變時，牙合墊的高度對髁狀突處的作用力無明顯影響。③如牽引力大小隨牙合墊高度改變，則牙合墊高度與髁狀突處作用力成正比例關(guān)系。④牽引力位于切牙位置時，髁狀突處受力最大，其變化規(guī)律與人體牙弓曲線的變化相符。⑤如果改變牽引力的方向，髁狀突處會產(chǎn)生相反方向的分力，受下頜骨形狀影響，二者并不成線性比例關(guān)系。⑥當(dāng)有多個牽引力時，各力越向下頜骨中間集中，髁狀突處所受合力越大。應(yīng)用以上分析結(jié)果，指導(dǎo)治療10例髁狀突骨折并行頜間牽引的患者，均獲得較滿意治療效果。 結(jié)論：對于符合髁狀突骨折保守治療標(biāo)準(zhǔn)的患者，頜間牽引是一種有效的治療手段，避免了不必要的手術(shù)創(chuàng)傷和手術(shù)并發(fā)癥風(fēng)險。建議在治療過程中將牙合墊盡量靠后放置，，并且牽引力量盡量位于前牙處，適當(dāng)向前、內(nèi)側(cè)傾斜。
[Abstract]:Objective: to establish a mathematical model of mandibular condylar fracture and intermaxillary traction, and to analyze the force of the model with MATLAB software, so as to provide a mechanical theoretical basis for the process of condylar intermaxillary traction. The curative effect of 10 cases was observed. Methods: 1. A patient diagnosed as condylar fracture by CBCT was selected from the Department of Maxillofacial surgery, affiliated Stomatological Hospital of Zunyi Medical College, and met the conservative treatment criteria, such as early contact of posterior teeth, opening of anterior teeth, partial jaw and so on. Intermaxillary traction is needed. According to the balance of spatial force and moment in the analytical method, the mandibular stress equation during traction treatment was established. The CBCT data of the patient's jaw were measured by Simplant Pro software, and the three-dimensional modeling was carried out. MATLAB software was used to edit the program language into mathematical model, and mechanical analysis was carried out. 2. Ten clinical cases of mandibular condylar fracture and traction were selected and guided by the results of the experiment. The clinical effect was observed. Results: through the combination of CBCT and MATLAB software, it was found that the closer the position of occlusal pad was to the posterior tooth, the greater the force at condylar process was. 2 if the traction force remained unchanged, The height of occlusal pad has no significant effect on the force at condyle. 3 if the traction force changes with the height of occlusal pad, the height of occlusal pad is proportional to the force at condylar process. 4 when the traction force is located in the incisor position, The force at the condyle is the largest, and the change law is consistent with the change of the dental arch curve of the human body. 5 if the direction of traction is changed, the condyle will produce the force in the opposite direction, which will be affected by the shape of the jaw. There is no linear proportional relationship between the two. 6 when there are more than one traction force, the more concentrated each force is in the middle of the jaw, the greater the resultant force at the condyle. According to the results of the above analysis, 10 patients with condylar fracture complicated with intermaxillary traction were treated with satisfactory results. Conclusion: intermaxillary traction is an effective treatment for patients who meet the conservative treatment standard of condylar fracture, which avoids the risk of unnecessary surgical trauma and complications. It is suggested that in the course of treatment, the occlusal pad should be placed back as far as possible, and the traction force should be located in the anterior tooth as far as possible, with proper forward and medial tilt.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R782.4

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