可吸收螺钉双皮质骨固定羊髁突矢状骨折的实验研究

中国口腔颌面外科杂志 ›› 2015, Vol. 13 ›› Issue (1): 16-20.

可吸收螺钉双皮质骨固定羊髁突矢状骨折的实验研究

孟凡文¹, 刘美霞², 王家伟¹, 王丽¹, 吴晓亮¹

1.解放军第359医院口腔科; 2.放射科,江苏镇江 212001

收稿日期:2014-06-09 出版日期:2015-02-10 发布日期:2015-03-12
通讯作者: 孟凡文,E-mail: dentist953@163.com
作者简介:孟凡文(1972- ) ,男,博士,副主任医师

Experimental study on surgical treatment of sagittal fractures of mandibular condyle with biocortical resorbable pins in sheep

MENG Fan-wen¹, LIU Mei-xia², WANG Jia-wei¹, WANG Li¹, WU Xiao-liang¹

1.Department of Stomatology; 2.Department of Radiology, the 359th Hospital of PLA. Zhenjiang 212001, Jiangsu Province, China

Received:2014-06-09 Online:2015-02-10 Published:2015-03-12
About author:Supported by Research Fund of Nanjing Military Area (11MA053)
Supported by:
南京军区科研计划项目（11MA053）

摘要/Abstract

摘要： 目的通过髁突矢状骨折（sagittal fractures of mandibular condyle,SFMC）动物模型,检验侧向可吸收螺钉手术治疗SFMC的效果,以及利用该螺钉稳定固位和不稳定固位的区别。方法 16只成年绵羊,制备成右侧SFMC动物模型,随机分为4组,每组4只。对照组采用保守治疗,实验1组采用侧向钛螺钉双皮质骨固定技术予以治疗,实验2组采用侧向可吸收螺钉以拉力螺钉的方式行切开复位内固定手术（open reduction and internal fixation, ORIF）治疗（不稳定固定）,实验3组采用侧向可吸收螺钉以双皮质固定方式行ORIF治疗（稳定固定）,分别在截骨术后、骨折内固定术后即刻、保守治疗或骨折内固定治疗3个月后行颞下颌关节（temporamadibular joint,TMJ）计算机断层扫描（computed tomography,CT）,对TMJ的形态改变进行放射学评分。治疗3个月后处死动物,解剖、观察、测量TMJ形态变化及组织学改变。采用SPSS 18.0软件包中的配对t检验和两样本t检验对结果进行统计学分析。结果对照组、实验2组动物实验侧TMJ CT影像及髁突的前后径和内外径明显异常,关节盘与髁突黏连,质地变脆,部分区域关节盘破损,关节窝有不同程度虫蚀状骨质破坏。实验1组和3组实验侧TMJ基本正常,反映TMJ形态改变的放射学评分2.60±0.94（实验1组）和2.90±1.06（实验3组）显著低于对照组（11.40±1.98）和实验2组（10.20±2.18）。组织学检查提示,对照组、实验2组动物实验侧关节盘出现纤维软骨黏液变性,髁突和关节窝表面软骨也出现黏液样变性,髁突骨质不规则增生,实验1组和3组实验侧关节盘、髁突和关节窝表面软骨未见明显改变。结论髁突矢状骨折后精确复位和稳定固定,是TMJ恢复正常解剖形态的前提,只要操作得当,可吸收螺钉与钛螺钉一样,均可获得稳定的固位和良好的治疗效果,由于不需二次手术取出,可吸收螺钉作为SFMC内固定材料,具有一定的优越性。保守治疗或不稳定的ORIF治疗,会导致TMJ严重病理改变。

关键词: 下颌骨骨折, 髁突矢状骨折, 可吸收螺钉, 切开复位内固定

Abstract: PURPOSE: To investigate the effect of surgical treatment of sagittal fractures of mandibular condyle (SFMC) with biocortical resorbable pins and compare the difference between unstable and rigid fixation with resorbabale pins. METHODS: Sixteen sheep were used to creat SFMC models on right temporamadibular joints (TMJ) through osteotomy, and divided into 4 groups randomly (n=4). The control group was treated with closed treatment. Group 1 was treated by open reduction and internal fixation (ORIF) with lateral titanium screws. Group 2 was treated by unstable ORIF with lateral resorbable pins. Group 3 was treated by open reduction and rigid fixation with lateral resorbable pins. Computed tomograms (CT) of TMJ were obtained for the control group after osteotomy and 3 months later. For group 1, 2 and 3, CT films were obtained after osteotomy immediately and 3 months later after open reduction and internal fixation (ORIF). CT taken 3 months after osteotomy was scored according to the criteria for assessing osteoarthrotic changes and ankylosis of right TMJ. Three months later after treatment, the sheep were killed and TMJs were dissected, observed, measured and histologically examined. The data were analyzed using SPSS 18.0 software package. RESULTS: CT images of right TMJ in control group and group 2 3 months after treatment were obviously abnormal. The radiological scores that indicated the degree of osteoarthrotic changes and ankylosis of right TMJ in group 1 and 3 were significantly lower than those in control group and group 2. Anatomical observation showed severely deformed condyles, worm-eaten erosion of the temporal surface, and the discs partially adherent to the condyle, and fragile articular cartilage of the right TMJ in control group and group 2. Histological examination showed myxoid degeneration of discs and articular cartilage in the right TMJ in control group and group 2. In contrast, the right TMJ in group1 and 3, and the left TMJ in all groups were closed to normal. CONCLUSIONS: The study demonstrates that appropriate reduction and rigid fixation are essential for SFMC to reconstruct anatomical shape. If conducted properly, fixation of SFMC with resorbable pins is rigid as titanium screws and yields good results. There are advantages in using resorbable pins to fix SFMC, because they obviate the need for removal. Closed treatment or unstable ORIF for SFMC can lead to severely pathological changes in TMJ.

Key words: Mandibular fractures, Sagittal fractures of mandibular condyle, Resorbable pins, Open reduction and internal fixation

中图分类号:

R782.4

孟凡文, 刘美霞, 王家伟, 王丽, 吴晓亮. 可吸收螺钉双皮质骨固定羊髁突矢状骨折的实验研究[J]. 中国口腔颌面外科杂志, 2015, 13(1): 16-20.

MENG Fan-wen, LIU Mei-xia, WANG Jia-wei, WANG Li, WU Xiao-liang. Experimental study on surgical treatment of sagittal fractures of mandibular condyle with biocortical resorbable pins in sheep[J]. China J Oral Maxillofac Surg, 2015, 13(1): 16-20.

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