中国实用口腔科杂志

中国实用口腔科杂志

• 论著 • 上一篇    下一篇

颞下颌关节强直动物模型中最大张口度与强直严重程度关系研究

邓天阁1，王磊2，刘平1，薛洋1，刘昌奎3，王静娟1，孙祥钊1，周宏志1，丁宇翔1，胡开进1   

  1. 1. 军事口腔医学国家重点实验室，国家口腔疾病临床医学研究中心，陕西省口腔疾病临床医学研究中心，第四军医大学口腔医学院口腔外科，陕西 西安 710032；2. 西安市精神卫生中心妇女精神科，陕西 西安 710061；3. 西安医学院口腔医学院口腔外科，陕西 西安 710021
  • 出版日期:2020-12-15 发布日期:2021-02-09
  • 基金资助:
    国家自然科学基金面上项目（81970954；81271103）

  • Online:2020-12-15 Published:2021-02-09

摘要： 目的　研究主、被动最大张口度（AMMO、PMMO）与颞下颌关节强直严重程度的关系。方法　选取28只健康雄性绵羊随机分为实验组和对照组，每组各14只。实验组绵羊双侧颞下颌关节模拟髁突矢状骨折，其中左侧翼外肌被切断以阻断其功能；对照组绵羊未进行手术。于术前及术后12、24周对所有绵羊体重、AMMO、PMMO、颞下颌关节形态学特点进行测量评估。结果　实验组只有右侧保留翼外肌功能的颞下颌关节发生了骨强直。术后12、24周，实验组绵羊AMMO、PMMO、极限距离均显著低于对照组，差异均有统计学意义（均P < 0.05）。实验组绵羊AMMO和PMMO与骨融合区宽度、长度、面积及钙化程度均呈负相关（均P < 0.05），其中骨融合区面积为主要影响因素（术后12、24周相关系数r分别为-0.94、-0.95）。结论　颞下颌关节强直动物模型中阻断翼外肌功能可阻止骨强直的发生；对于早期髁突矢状骨折，可通过牙合垫或牙合板进行张口训练，进而阻断翼外肌功能。当颞下颌关节发生骨强直时，骨融合区面积越大，张口受限越明显。

关键词: 颞下颌关节强直, 骨融合面积, 最大张口度, 翼外肌, 动物模型

Abstract: Objective　To study the relationships between maximal active and passive mouth opening（AMMO and PMMO）and the severity of traumatic temporomandibular joint（TMJ）bone ankylosis. Methods　Twenty-eight healthy male sheep were randomly divided into experimental group and control group with 4 in each group. Experimental sheep underwent bilateral TMJ osteotomy，during which left lateral pterygoid muscle（LPM）function was blocked. Control sheep did not undergo surgery. The body weight of all sheep，AMMO，PMMO，and TMJ morphological characteristics were measured and evaluated before surgery，12 weeks and 24 weeks after surgery. Results　Only right TMJ with maintained LPM function developed bone ankylosis. At 12 weeks and 24 weeks after surgery，AMMO，PMMO and end-feel distance of experimental group were significantly lower than those of control group（P < 0.05）. Furthermore，the AMMO and PMMO in the experimental group was negatively correlated with the width，length，area of bony fusion and the degree of calcification（all P < 0.05），and the bone fusion area was the main influencing factor（at 12 weeks，r = -0.94；at 24 weeks，r = -0.95）. Conclusion　Traumatic TMJ bone ankylosis can be prevented by blocking LPM function；after early sagittal condyle fracture，mouth opening training can be conducted using occlusal pads/open-mouth plates to block the function of LPM. When TMJ bone ankylosis develops，the larger the bone fusion area，the more limited the mouth opening.

Key words: temporomandibular joint ankylosis, bony fusion area, maximum mouth opening, lateral pterygoid muscle, animal model