髁状突囊内骨折的治疗方式同颞下颌关节强直相关性的实验研究

发布时间：2018-06-12 18:05

本文选题：颞下颌关节 + 关节强直　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:本研究旨在阐明不同处理方式治疗髁状突囊内骨折与创伤性颞下颌关节强直发生的关系,初步探讨髁状突囊内骨折继发颞下颌关节强直的机理,为髁状突囊内骨折治疗方法的选择及预防创伤性颞下颌关节强直发生提供可靠的数据支持。方法:本研究采用手术方法模拟髁状突囊内骨折建立小型猪动物模型。在实验动物模型建立的基础上进行对照实验,根据不同的治疗方式将实验动物分为生理盐水组、地塞米松组、钛板固定组和自然愈合组。其中自然愈合组为对照组,其它三组为实验组。1.术后6个月,通过大体标本观察、影像学和组织学检查评价各组颞下颌关节强直的形成。2.利用免疫组织化学染色定性检测各组颞下颌关节中血管内皮生长因子(Vascular endothelial growth factor,VEGF)、骨钙素(Osteocalcin,OCN)、骨桥蛋白(Osteopontin,OPN)和骨形态发生蛋白-2(Bone morphogenetic protein 2,BMP2)的表达情况。3.利用RT-PCR和Western Blot技术相对定量检测各组颞下颌关节中VEGF、OCN、OPN和BMP2的mRNA和蛋白表达改变。结果:1.通过大体标本观察、影像学和组织学检查发现,各实验组颞下颌关节强直发生率显著低于对照组,差异有统计学意义(P0.05)。2.免疫组织化学染色定性检测发现,各实验组颞下颌关节中VEGF、OCN、OPN和BMP2的平均光密度明显低于对照组,差异有统计学意义(P0.01)。3.RT-PCR实时定量分析发现,实验组颞下颌关节中VEGF、OCN、OPN和BMP2的mRNA表达水平明显低于对照组,差异有统计学意义(P0.01)。4.Western Blot检测发现,VEGF、OCN、OPN和BMP2在实验组颞下颌关节中的蛋白表达明显低于对照组,差异有统计学意义(P0.01)。结论:1.小型猪髁状突囊内骨折实验动物模型的建立具有可重复性,该动物模型能为探索创伤性颞下颌关节强直的发生机制提供研究平台。2.不同处理方式治疗髁状突囊内骨折与创伤性颞下颌关节强直的发生率密切相关。3.将骨折复位并采用微型钛板固定,且将移位的关节盘复位固定可以有效减少颞下颌关节强直的发生。4.地塞米松局部注射于关节腔内可有效预防颞下颌关节强直的发生。5.清理骨创间血肿、减少骨创面的暴露及抑制新骨过度修复是预防关节强直发生的关键因素。
[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.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.4

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