下颌骨髁状突骨折牵引治疗的数学模型分析及10例临床疗效观察

发布时间：2019-05-30 08:59

【摘要】：目的：通过建立下颌骨髁状突骨折颌间牵引治疗的数学模型，使用MATLAB软件进行模型受力分析，对髁状突骨折颌间牵引治疗过程提供力学理论基础,并对10例该类病例进行疗效观察。方法：1、选取遵义医学院附属口腔医院颌面外科收治的一名经过CBCT检查，确诊为髁状突骨折的患者并符合保守治疗标准，有后牙早接触、前牙开颌、偏颌等临床症状，需要行颌间牵引治疗。根据解析法中的空间力和力矩平衡，建立其牵引治疗时下颌骨受力方程，使用Simplant Pro软件对患者下颌骨CBCT资料进行数据测量，三维建模，使用MATLAB软件编辑程序语言转化成数学模型，进行力学分析。2、选取我院收治的十例进行下颌骨髁状突骨折牵引治疗的临床病例，使用实验所得结果指导治疗，并观察临床疗效。结果：通过CBCT与MATLAB软件的结合，分析得出颌间牵引治疗时：①牙合垫的位置越靠近后牙，髁状突处的作用力越大。②如保持牵引力大小不变时，牙合垫的高度对髁状突处的作用力无明显影响。③如牵引力大小随牙合垫高度改变，则牙合垫高度与髁状突处作用力成正比例关系。④牵引力位于切牙位置时，髁状突处受力最大，其变化规律与人体牙弓曲线的变化相符。⑤如果改变牵引力的方向，髁状突处会产生相反方向的分力，受下颌骨形状影响，二者并不成线性比例关系。⑥当有多个牵引力时，各力越向下颌骨中间集中，髁状突处所受合力越大。应用以上分析结果，指导治疗10例髁状突骨折并行颌间牵引的患者，均获得较满意治疗效果。结论：对于符合髁状突骨折保守治疗标准的患者，颌间牵引是一种有效的治疗手段，避免了不必要的手术创伤和手术并发症风险。建议在治疗过程中将牙合垫尽量靠后放置，，并且牵引力量尽量位于前牙处，适当向前、内侧倾斜。
[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.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782.4

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