脱位型髁突游离端对无下颌升支高度降低型SFMC预后影响的实验研究

发布时间：2018-03-27 18:24

  本文选题：动物模型　切入点：髁突游离端　出处：《宁夏医科大学》2016年硕士论文

【摘要】：目的模拟“M”型无下颌升支高度下降SFMC临床特点,构建羊的SFMC模型,以明确脱位型髁突游离端复位内固定对TMJ形态、功能及组织病理学指标的影响。方法1、构建右侧髁突SFMC动物模型:全麻下,常规消毒铺巾;由耳屏前切口入路,切开皮肤、皮下组织后翻瓣;暴露TMJ关节囊和颧弓后份;沿髁突长轴纵形切开关节囊,再沿颧弓根部下缘横形切开关节囊,形成一角形切口,暴露右侧髁突;由髁突关节面中点至髁颈髁突翼肌窝下方斜向中线方向纵形切开髁突;将髁突骨折片向前向方推移至关节结节前下方,保持髁突残端位置不变,形成下颌升支高度无下降的SFMC模型。2、下颌升支无下降型SFMC模型制备完成后,保留髁突游离端于关节结节的前下方,分层缝合切口,常规饲养,即为保守治疗组;下颌升支无下降型SFMC建模完成后,立即将脱位的髁突骨折片解剖复位,并以髁突把持钳保持髁突骨折片与髁突残端紧密接触。再以侧向拉力螺钉从髁突残端处钉入,横穿骨折断端,使髁突骨折片与髁突残端达到解剖位及坚固内固定,即为手术治疗组。3、按照术后4w、8w、12w的时间点,以TMJ结构及功能、影像资料及组织病理学方法等评价髁突游离端复位内固定对SFMC坚固内固定术后,骨折愈合、髁突改建、TMJ形态功能影响。结果本研究成功构建了绵羊脱位型下颌升支无下降型SFMC动物模型。通过保守治疗及手术治疗分组,在不同时间点,与术前相比,保守治疗组最大开口度、前伸和左侧向运动度显著减少,手术治疗组下颌的运动度无显著性变化,但咬合关系无明显差异。平均放射学评分,手术治疗组显著低于保守治疗组。从病理观察可见,在治疗4w时,髁突表面有不规则新骨形成,保守治疗组动物手术侧髁突新骨形成较手术治疗组明显。12w时,保守治疗组动物手术侧髁突形态改变较以前更明显,甚至骨赘形成,髁突出现畸形。相比之下,手术治疗组动物手术侧髁突形态趋于正常。所有动物非手术侧髁突形态没有改变。结论1.本研究成功构建了绵羊无下颌升支高度降低型SFMC的模型。2.手术治疗组实验动物被动张口度、下颌前伸及侧向运动度较保守治疗组改善良好,有利于恢复下颌运动功能。3.对2组实验动物进行CBCT检查及TMJ形态改变的放射学评分后的结果显示,所有手术侧髁突前后径、内外径均有增大。因保守治疗组髁突内外径、前后径明显增大,随着时间的推移,这种变化更加明显,实验组髁突内外径及前后径的改变并不明显。实验组即手术治疗组的放射学评分低于对照组。因此,保守治疗较手术治疗的髁突增生改建明显,不利于TMJ形态及功能的恢复。4.保守治疗组在术后12w时髁突形态出现畸形,而手术治疗组术后12w时髁突形态基本恢复正常。因此,手术治疗髁突形态较保守治疗恢复更佳,有利于TMJ形态及功能的恢复。5.从组织细胞学角度验证,保守治疗组较手术治疗组有较多新骨形成,髁突形态结构畸形严重,不利于TMJ形态及功能的恢复。
[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.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R782.4
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本文编号：1672700