唇腭裂上颌前段牵张成骨的三维有限元分析

中国口腔颌面外科杂志 ›› 2016, Vol. 14 ›› Issue (4): 315-323.

唇腭裂上颌前段牵张成骨的三维有限元分析

王司含¹, 钱玉芬¹, 华诚², 卢鸣飞³

1.上海交通大学医学院附属第九人民医院·
口腔医学院口腔正畸科,上海市口腔医学重点实验室,上海 200011;
2.复旦大学力学与工程科学系,上海 200433;
3.西模发特信息科技（上海）有限公司,上海 200336

出版日期:2016-08-20 发布日期:2016-12-08
通讯作者: 钱玉芬,E-mail:qianyf1960@163.com
作者简介:王司含（1990-）,女,硕士,E-mail:wshjrm@163.com
基金资助:
国家自然科学基金（81170989）

Anterior maxillary segmental distraction osteogenesis in cleft lip and palate: a three-dimensional finite element analysis

WANG Si-han¹, QIAN Yu-fen¹, HUA Cheng², LU Ming-fei³

1.Department of Orthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine;
Shanghai Key Laboratory of Stomatology. Shanghai 200011;
2. Department of Mechanics & Engineering Science, Fudan University. Shanghai 200433;
3. ManuSim Solutions Co. Ltd.. Shanghai 200336, China

Online:2016-08-20 Published:2016-12-08

摘要/Abstract

摘要： 目的应用有限元方法获得唇腭裂患者牙槽突裂植骨区不同骨吸收情况下颅上颌复合体对上颌前段牵张成骨的生物力学特性,为临床应用上颌前段牵张成骨纠正唇腭裂继发上颌发育不足提供理论依据。方法采用三维有限元法,建立单侧完全性唇腭裂患者颅上颌复合体模型,模拟上颌骨前段截骨、牙槽突裂植骨及骨吸收,选取双侧第一前磨牙牙颈部节点加载位移6 mm、0.5 mm,分别用于位移规律和应力分布分析。结果植骨不吸收时,健、患侧矢状前移和上颌骨前段逆时针旋转运动对称性、牙弓形态横向稳定性、植骨区两端高度一致性、骨缝应力分布均匀性最佳;植骨吸收部位越接近下方、吸收量越多时,健、患侧不对称前移、牙弓变形、植骨区台阶越明显。结论植骨吸收部位越接近下方、吸收量越多时,上颌前段牵张成骨效果越差。

关键词: 唇腭裂, 上颌发育不足, 上颌前段牵张成骨, 牙槽突裂植骨, 有限元法

Abstract: PURPOSE: To investigate the biomechanic properties of anterior maxillary segmental distraction osteogenesis in craniofacial complex with cleft lip and palate undergoing alveolar bone graft resorption. METHODS: Three-dimensional finite element models simulating anterior maxillary segmental osteotomy and graft resorption were constructed. Displacement pattern of surface landmarks and stress distribution over circum-maxillary sutures were analyzed after 6 mm and 0.5 mm of displacement was loaded on bilateral first premolars, respectively. RESULTS: The model with intact graft exhibited the most favorable outcome regarding to symmetry of sagittal displacement, suture stress distribution and counter-clockwise rotation of anterior segment, stability of arch in transversal dimension, elimination of step across graft site and reduction of stress concentration at graft. As the level of resorption lowered and remaining graft volume diminished, asymmetry of displacement, expansion of arch and step across graft site became more obvious. CONCLUSIONS: The more orally graft resorption occurred and the more graft resorbed, the less desirable the result of anterior maxillary segmental distraction osteogenesis would be.

Key words: Cleft lip and palate, Maxillary hypoplasia, Anterior maxillary segmental distraction osteogenesis, Alveolar bone graft, Finite element method

中图分类号:

R782.2

王司含, 钱玉芬, 华诚, 卢鸣飞. 唇腭裂上颌前段牵张成骨的三维有限元分析[J]. 中国口腔颌面外科杂志, 2016, 14(4): 315-323.

WANG Si-han, QIAN Yu-fen, HUA Cheng, LU Ming-fei. Anterior maxillary segmental distraction osteogenesis in cleft lip and palate: a three-dimensional finite element analysis[J]. China J Oral Maxillofac Surg, 2016, 14(4): 315-323.

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