不同功能位颞下颌关节断层影像解剖学研究

发布时间：2018-04-15 17:12

本文选题：颞下颌关节 + 断面解剖　；参考：《第三军医大学》2005年硕士论文

【摘要】：目的:①探讨闭口位颞下颌关节盘及毗邻结构的形态特点及其临床意义。②对照观察闭口位、大开口位、下颌前伸位、下颌侧移位等不同功能位颞下颌关节在横、冠、矢三个方位的薄层断面解剖形态及MRI 表现,为颞下颌关节病变的影像诊断提供形态学依据。③建立闭口位、大开口位、下颌前伸位、下颌侧移位颞下颌关节的三维数字化模型,为颞下颌关节外科手术计划、演示以及关节镜手术的模拟操作等提供帮助。方法:①测量31 侧成人闭口位TMJ 关节盘,观察关节盘及毗邻结构的形态特点及关系。②选取11 例新鲜尸头,建立闭口位、大开口位、下颌前伸位、下颌侧移位不同功能位TMJ 的实验模型。取闭口位4 例,大开口位、颌前伸位、下颌侧移位各1 例,共7 例(14 侧)颞下颌关节功能位标本,利用生物塑化技术制成1mm 厚的轴位、斜矢状位、斜冠状位塑化薄层连续断面;脱钙处理4 例灌注铸型剂的不同功能位的颞下颌关节标本,利用低温冰冻断层切片技术,切成0.9mm 厚的轴位、斜矢状位、斜冠状位连续薄层断面,观察不同功能位颞下颌关节断层解剖形态。③选取4 例标本、2 例青年志愿者,利用高场强MRI 成像仪对闭口位、大开口位、下颌前伸位、下颌侧移位的双侧颞下颌关节行斜矢状位、斜冠状位、轴位三个方位扫描,观察不同功能位颞下颌关节MRI 表现。④在SGI 工作站上重建不同功能位颞下颌关节的关节盘、髁突、下颌窝等结构三维数字模型,并适时测量。结果:①关节盘中间部分薄、周围部分厚;中带最薄,后带最厚,其平均厚度为1.52 ±0.58mm;翼外肌上、下头纤维在颞下颌关节囊前部集中,近关节囊区上头肌纤维与翼外肌下头肌纤维交叉,入盘的上、下头肌纤维量非常有限;②不同功能位断面标本与MRI 对照观察发现,大开口位、下颌前伸位、下颌侧移位非工作侧关节盘与骨性关节面适应性差,关节盘受压,翼外肌表现同步收缩;而闭口位、侧移位工作侧,关节盘无受压,翼外肌上、下头表现舒张。大开口位髁突向前下滑动并转动,下颌前伸位、下颌侧移位非工作侧髁突发生滑动并在关节窝内作复杂的转动,下颌侧移位工作侧髁突仅发生转动。③颞下颌关节的三维重建数字化模型直观地反映了关节盘、髁突、下颌窝三者之间的解剖关系及关节盘的形态变化,在下颌前伸、侧移位非工作侧、大开口位时关节盘中带受压。三维适时测量颞下颌关节,大开口位时关节盘形态变化最大,侧移
[Abstract]:Objective to investigate the morphological features and clinical significance of the disc and adjacent structures of temporomandibular joint in closed position.The thin sectional anatomy and MRI features of the three sagittal directions provide morphological basis for the imaging diagnosis of temporomandibular joint diseases. 3. 3. The 3D digital model of temporomandibular joint (TMJ) was established in closed position, large opening position, mandibular extension position, mandibular lateral displacement and temporomandibular joint (TMJ) displacement.Provides assistance for temporomandibular joint surgery planning, presentation, and arthroscopic simulation.Methods 31 sides of adult TMJ articular disc in closed position were measured by 1: 1. The morphological characteristics and relationship of articular disc and adjacent structures were observed. 11 fresh cadaveric heads were selected to establish closed position, large opening position and mandibular anterior extension position.Experimental model of mandibular lateral displacement with different functional TMJ.The functional specimens of temporomandibular joint (TMJ) were taken from 4 cases of closed position, 4 cases of large opening position, 1 case of maxillary anterior extension, 1 case of mandibular lateral displacement, 7 cases of 14 sides of temporomandibular joint). The 1mm thick axial position, oblique sagittal position and oblique coronal position were plasticized and continuous sections were made by using biological plasticizing technique.Temporomandibular joint (TMJ) specimens at different functional positions were treated with decalcification. 0.9mm thick axial, oblique sagittal and oblique coronal sections were cut by cryogenic section technique.The anatomical morphology of temporomandibular joint (TMJ) in different functional positions was observed. 4 specimens were collected from 2 young volunteers. The closed position, the large opening position and the mandibular anterior extension position were observed by high field MRI imaging.The bilateral temporomandibular joints were scanned with oblique sagittal position, oblique coronal position and axial position. The MRI features of temporomandibular joint in different functional positions were observed. 4. The disc and condyle processes of temporomandibular joint were reconstructed on SGI workstation.Mandibular fossa isomorphic three-dimensional digital model, and timely measurement.Results the middle part of the disc was thin, the surrounding part was thick, the middle band was the thinnest and the posterior band was the thickest, the average thickness was 1.52 卤0.58mm.The fibers of the inferior head were concentrated in the anterior part of the temporomandibular joint capsule on the lateral pterygoid muscle.The superior head muscle fiber in the proximal articular capsule crossed with the inferior head muscle fiber of the external pterygoid muscle. The volume of the lower head muscle fiber in the upper disc was very limited. The results showed that the large opening position and the mandibular anterior extension position were observed in the specimens of different functional positions compared with MRI.The lateral displacement of the mandibular side was not adapted to the bony articular surface, the joint disc was compressed and the lateral pterygoid muscle contracted synchronously, while in the closed position, the lateral displacement worked side, the disc was not compressed, the upper part of the lateral pterygoid muscle and the lower head of the lateral pterygoid muscle showed relaxation.The condyle slid forward and rotated in the large opening position, and the mandible extended forward, and the mandibular lateral displacement of the mandibular lateral condyle slid and made complex rotation in the articular fossa.The digital model of 3D reconstruction of temporomandibular joint (TMJ) of mandibular lateral displacement only showed the anatomical relationship among the disc, condyle and mandibular fossa, and the morphological changes of the articular disc.Lateral displacement of non-working side, large opening position of the articular disc compression.Three-dimensional measurement of temporomandibular joint, large opening position, the largest changes in the shape of the disc, lateral displacement
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2005
【分类号】：R322

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