曲线牵张成骨修复犬下颌骨缺损的实验研究

发布时间：2018-11-01 17:14

【摘要】：下颌骨缺损是口腔颌面外科临床常见病症。众所周知,下颌骨在口腔功能行使中具有重要作用,其缺损直接影响患者的生活质量,除此之外,下颌骨也是维持面部形貌的重要组成部分,下颌骨缺损所导致的形貌毁损也直接关系到患者的生存质量。目前,尽管临床上对于下颌骨缺损可以达到较为理想的重建效果,但无论是采用自体骨移植或代用品进行重建,均不同程度存在手术创伤大、需要牺牲供区正常组织以及可能出现排斥反应或强度不够等不足,特别是累及下颌骨颏部及下颌角区的缺损,其特定的弧形形态要求使得修复材料塑形困难且难以达到理想的形态与功能重建效果,是颌面修复重建外科领域研究的热点课题之一。牵张成骨(Distraction Osteogenesis,DO)技术为骨缺损修复提供了可靠的方法。近年来,随着该技术广泛应用于颅颌面畸形整复与颌面部骨缺损,取得了常规方法难以比拟的治疗效果,从而成为颌骨缺损修复研究的重点之一。然而,临床上采用的牵张成骨均为线性的直线牵张方式,其加力均采用螺纹方式,不能满足伴有颏部及下颌角区下颌骨缺损牵张成骨的需要,如何通过改变螺纹加力方式的限制,达到曲线乃至三维牵张是亟待研究并解决的问题。本研究在优化设计球形挤压传力内置式曲线牵张器及验证其牵张有效性的基础上,结合本课题组前期研究,探讨不同动物模型曲线牵张成骨效果,旨在为曲线牵张的进一步研究提供必要的实验依据。本实验研究包括两个部分:第一部分:曲线牵张动物模型建立与牵张器制备筛选后以犬作为实验动物,根据曲线牵张设计于一侧下颌骨体部制备3cm颌骨矩形缺损并设计牵张转移盘,建立适合曲线牵张成骨的动物模型。在建立动物模型的基础上,通过CT获取实验动物的头颅数据,构建三维模型并制作实体模型,精密测量模型的下颌骨缺损各项数据,设计并制作个体化球形挤压传力式内置曲线牵张器,经体外实验验证其牵张有效性及牵张轨迹,为动物实验提供参考依据。第二部分:曲线牵张成骨修复犬下颌骨缺损的实验研究本实验在本课题组前期研究的基础上,利用建立的动物模型进行下颌骨体部骨缺损曲线牵张,旨在进一步验证球形挤压传力内置式牵张器在不同条件下的曲线牵张成骨效果,通过大体观察、影像学观察及组织学观察,了解不同时间点曲线牵张的骨形成情况,为曲线牵张的进一步研究及临床应用提供必要的实验依据。本实验研究表明:1、通过建立犬下颌骨矩形缺损进行曲线牵张成骨研究,证明该动物模型可用于曲线牵张相关实验研究。2、球形挤压传力的牵张加力方式稳定,可控性好,体外牵张与轨迹实验均证明具有可靠的稳定性与牵张有效性,该设计为曲线牵张相关研究提供了必要的条件。3、体积优化后的牵张器设计符合牵张成骨研究要求,结构合理。4、牵张成骨轨迹与设计轨迹吻合,曲线牵张与直线牵张成骨过程相似,可达到理想的成骨要求。5、个别牵张区域存在软骨成骨现象,是否与牵张轨迹等因素相关尚有待进一步研究证实。
[Abstract]:Mandible defect is a common clinical condition in oral and maxillofacial surgery. It is well known that mandible has an important role in the function of oral function, and its defect directly affects the quality of life of the patient. In addition, mandible is an important part of maintaining facial appearance. The appearance damage caused by mandibular defect is directly related to the patient's quality of life. At present, although the ideal reconstruction effect can be achieved clinically for mandibular defects, the reconstruction can be carried out by adopting a self-bone transplantation or a substitute, so that the surgical wound is large in different degrees, the defect of the normal tissue of the sacrifice area and the possibility of rejection reaction or insufficient strength can be avoided, and in particular, the defect of the mandibular angle region and the lower jaw region is affected, the specific arc shape requirements make the repair material be difficult to shape and achieve the ideal shape and function reconstruction effect, It is one of the hot topics in the field of maxillofacial reconstruction and reconstruction. Distraction Osteogenesis (DO) technique provides a reliable method for repairing bone defect. In recent years, as the technology is widely applied to the reconstruction of cranio-maxillofacial deformity and maxillofacial bone defect, the treatment effect is difficult to compare with the conventional method, thus becoming one of the key points in the research of jaw defect repair. In clinical practice, however, the distraction osteogenesis is linear, the force of which is in threaded way, can not satisfy the need of distraction osteogenesis in the mandibular defect accompanied with mandibular angle and mandibular angle region, how to change the limitation of the screw force application way, It is urgent to study and solve the problem that the curve and even the three-dimensional stretch are achieved. On the basis of optimizing design spherical extrusion force built-in curve distractor and verifying its stretch effectiveness, this study combined with the previous research of this group to discuss the effect of different animal model curve distraction osteogenesis, which is intended to provide necessary experimental basis for further study of curve distraction. The experimental study consisted of two parts: the first part: the curve stretch animal model was established and the dog was used as an experimental animal after the preparation and screening of the distractor, a 3cm mandibular rectangular defect was prepared on one side of the mandible body part according to the curve distraction, and a distraction transfer disc was designed. An animal model suitable for curve distraction osteogenesis was established. on the basis of establishing an animal model, acquiring skull data of an experimental animal by CT, constructing a three-dimensional model and manufacturing a solid model, accurately measuring the mandibular defect data of the model, designing and manufacturing an individualized spherical extrusion force-transmitting built-in curve distractor, By means of in vitro experiments, the stretch effectiveness and stretch track were verified, which provided reference basis for animal experiment. The second part: The experimental study of the mandibular defect of canine with curved distraction osteogenesis was carried out on the basis of the previous study of this group, and the bone defect curve of the mandible was induced by the established animal model. aims at further verifying the curve distraction osteogenesis of a spherical extrusion force built-in distractor under different conditions, It provides the necessary experimental basis for further study of curve distraction and clinical application. The results of this study show that the animal model can be used in the experimental study of curve distraction by creating a curve distraction osteogenesis in canine mandibular rectangular defect. The results show that the distraction force of the spherical extrusion force is stable and the controllability is good. In vitro stretch and trajectory experiments both proved to have reliable stability and stretch effectiveness. The design provides the necessary conditions for the study of curve distraction. 3. The design of stretch distractor after volume optimization is consistent with the requirement of distraction osteogenesis, and the structure is reasonable. The distraction osteogenesis is consistent with the design trajectory, and the curve distraction is similar to that of the linear distraction osteogenesis, which can reach the ideal bone requirement.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R782.2

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