标准型人工颞下颌关节假体在开口运动中的特征分析

Analysis of the characteristics of standard alloplastic temporomandibular joint prostheses during mouth opening movement

李响 ¹丁若仪 ²王秀梅 ¹何冬梅 ²王冬梅³

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作者信息

1. 上海大学机电工程与自动化学院,上海 200444
2. 上海交通大学医学院附属第九人民医院口腔外科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海市口腔医学研究所,中国医学科学院口腔颌面再生医学创新单元,上海 200011
3. 上海交通大学机械与动力工程学院,上海 200240
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摘要

目的:分析标准型人工颞下颌关节置换术后(alloplastic temporomandibular joint replacement,ATJR)开口运动的特征.方法:分别收集10例正常颞下颌关节志愿者和10例单侧Biomet标准型人工关节置换术后患者的下颌运动和颌面部CT数据.使用Proplan CMF 3.0进行颌骨三维重建并导出颌骨模型,在Geomagic Wrap 2021软件中与下颌运动数据配准结合,通过Anybody 7.0软件建立运动学模型,从髁突/假体顶点向下每5 mm取一点(P0～P-50),计算各点在开口运动中的轨迹及弧长.将人工关节假体模拟安装在正常人及患者的非置换侧髁突,比较开口运动中假体顶点之间的运动范围差异.采用SPSS 25.0软件包对数据进行统计学分析.结果:正常人髁突顶点的运动轨迹为凹向上的弧线,弧长为(15.18±2.31)mm,P-30处运动轨迹最短.人工颞下颌关节假体(alloplastic temporomandibular joint pros-thesis,ATJP)顶点运动轨迹为凸向上的短弧线,相比正常髁突对应点(P-10)的轨迹弧长显著缩短[(3.55±0.45)mm:(11.61±1.63)mm,P=0.00],P-20处运动轨迹最短;ATJP非置换侧髁突顶点的运动轨迹与正常髁突轨迹形态相似,弧长为(13.35±1.54)mm,无显著差异(P=0.07),P-40处运动轨迹最短.ATJP顶点的运动范围显著小于非置换侧髁突对应点和正常人髁突对应点P-10的运动范围(P=0.00).结论:标准型人工颞下颌关节置换后髁突假体在开口运动中的滑动距离和范围显著小于有翼外肌附着的正常和非置换侧髁突对应点的运动距离和范围.

Abstract

PURPOSE:To analyze the characteristics of alloplastic temporomandibular joint replacement(ATJR)in mouth opening movement.METHODS:Jaw movement and maxillofacial CT data were collected from 10 normal temporo-mandibular joint volunteers and 10 patients who underwent unilateral Biomet standard joint replacement surgery.Three-dimensional reconstruction of the jawbone was performed using Proplan CMF 3.0 software,and the jawbone model was ex-ported.The jaw movement data were combined with the jawbone model using Geomagic Wrap 2021 software,and a kine-matic model was established using Anybody 7.0 software.Points were taken every 5 mm downward from the condyle/pros-thesis apex(P0-P-50)to calculate the trajectory and arc length of each point during mouth opening.The artificial joint pros-thesis was simulated to be installed on the non-replaced condyle of normal individuals and patients,and the differences in the range of motion between the prosthesis vertices during mouth opening were compared.SPSS 25.0 software package was used for data analysis.RESULTS:The movement trajectory of the condylar apex in normal individuals was a concave arc upwards,with an arc length of(15.18±2.31)mm,and the shortest movement trajectory was at P-30.The movement trajectory of the alloplastic temporomandibular joint prosthesis(ATJP)apex was a convex short arc upwards,with a significantly shortened arc length compared to the corresponding point of the normal condyle(P-10)[(3.55±0.45)mm vs(11.61±1.63)mm,P=0.00],and the shortest movement trajectory was at P_20.The movement trajectory of the non-replaced condyle apex of the ATJP was similar in shape to that of the normal condyle,with an arc length of(13.35±1.54)mm and no significant dif-ference(P=0.07),and the shortest movement trajectory was at P-40.The range of motion of the ATJP apex was significantly smaller than that of the corresponding point on the non-replaced condyle and the normal condyle corresponding point P_10(P=0.00).CONCLUSIONS:The sliding distance and range of the condylar prosthesis after standard temporomandibular joint replacement surgery are significantly smaller than the movement distance and range of the corresponding points on the normal and non-replaced condyles.

关键词

颞下颌关节假体/颞下颌关节置换/开口运动

Key words

Temporomandibular joint prostheses/Temporomandibular joint replacement/Mouth opening movement

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基金项目

上海市重中之重研究中心(2022ZZ01017)

中国医学科学院医学与健康科技创新工程资助项目(2019-I2M-5-037)

出版年

2024

中国口腔颌面外科杂志

中华口腔医学会

中国口腔颌面外科杂志

CSTPCD

影响因子：0.751

ISSN：1672-3244

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