不同内固定方式预防下颌角囊性病变病理性骨折的三维有限元分析

郑萍; 吕俊; 黄君杰; 徐帅; 张纲

doi:10.16016/j.2097-0927.202304082

您当前的位置：

首页 >

文章列表页 >

不同内固定方式预防下颌角囊性病变病理性骨折的三维有限元分析

生物医学工程 | 更新时间：2026-01-09

- 不同内固定方式预防下颌角囊性病变病理性骨折的三维有限元分析
- Finite element analysis on different types of rigid internal fixation for preventing postoperative fractures in cystic lesions of the mandibular angle
- 陆军军医大学学报 2023年45卷第19期页码：2092-封3
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院口腔科
- 作者简介：
  
  [ 张纲，E-mail：xqyykqk@163.com ZHANG Gang, E-mail: xqyykqk@163.com
- 基金信息：
  
  陆军军医大学军事医学高新技术培育项目(CX2019JS108);陆军军医大学第二附属医院临床重大创新特色技术项目(2018JSLC0022)
- DOI：10.16016/j.2097-0927.202304082
  中图分类号： R319;R687.32;R782.4
- 收稿：2023-04-19，
  
  修回：2023-06-04，
  
  纸质出版：2023-10-15
- 稿件说明：
移动端阅览
郑萍, 吕俊, 黄君杰, 等. 不同内固定方式预防下颌角囊性病变病理性骨折的三维有限元分析[J]. 陆军军医大学学报, 2023,45(19):2092-封3.

Ping ZHENG, Jun LYU, Junjie HUANG, et al. Finite element analysis on different types of rigid internal fixation for preventing postoperative fractures in cystic lesions of the mandibular angle[J]. Journal of Army Medical University, 2023, 45(19): 2092-封3.
郑萍, 吕俊, 黄君杰, 等. 不同内固定方式预防下颌角囊性病变病理性骨折的三维有限元分析[J]. 陆军军医大学学报, 2023,45(19):2092-封3. DOI： 10.16016/j.2097-0927.202304082.

Ping ZHENG, Jun LYU, Junjie HUANG, et al. Finite element analysis on different types of rigid internal fixation for preventing postoperative fractures in cystic lesions of the mandibular angle[J]. Journal of Army Medical University, 2023, 45(19): 2092-封3. DOI： 10.16016/j.2097-0927.202304082.

摘要

目的

建立下颌角囊性病变病理性骨折的三维有限元模型，对比分析8种钛板内固定方式治疗后下颌骨的生物力学变化，探讨钛板固定方式预防大型下颌骨囊肿病理性骨折的可靠性。

方法

选取1名30岁正常成年男性下颌骨建立单侧下颌角区域的囊性病变模型，模拟咬合力加载造成病理性骨折，获取最大临界囊性病变尺寸大小，比较相同力学条件下不同钛板固定方式的下颌骨生物力学特点及变化情况。

结果

当下颌角囊性病变尺寸超过24 mm×30 mm×30 mm时存在病理性骨折的风险；上缘采用1 mm厚钛板加双侧3孔钛钉固定，下缘采用2 mm厚钛板加双侧4孔钛钉固定，下颌角囊性病变区域应力最低，未超过下颌骨最大屈服强度，未发生病理性骨折。

结论

下颌角大型囊性病变口外手术刮除后采用钛板固定术区上下缘可以降低病理性骨折发生。

Abstract

Objective

To build a model of postoperative pathological fracture of the mandibular angular cystic lesions through 3D finite element analysis (FEA)

to compare and analyze the biomechanical changes of the mandible after treatment with 8 types of titanium plates

and explore the reliability of titanium plate fixation in preventing pathological fracture of large mandibular cysts.

Methods

A 30-year-old healthy male was volunteered and the scans of cone beam computed tomography of his mandible were collected to establish a unilateral cystic lesion model of the mandibular angle region to mimic the pathological fracture caused by occlusal force loading. On the basis of the maximum critical cystic lesion size

the biomechanical characteristics and changes in the mandible with 8 different types of titanium plate fixation under the same mechanical conditions were compared.

Results

The risk of pathological fracture existed when the cystic lesion size in the mandibular angle exceeds 24 mm×30 mm×30 mm. The stress in the lesion area was the lowest when the upper edge was fixed with 1 mm thick titanium plate and bilateral 3 screws

and the lower edge was fixed with 2 mm thick titanium plate and bilateral 4 screws. At the same time the maximum yield strength of the mandible was not exceeded and no pathological fracture of the mandible occurred.

Conclusion

The incidence of pathological fracture can be reduced by using titanium plate fixation on the upper and lower margins of the mandibular angle after extraoral surgical curettage for large cystic lesions.

关键词

Keywords

references

邱蔚六. 口腔颌面外科学[M]. 6版. 北京: 人民卫生出版社, 2008.

QIU W L. Oral and maxillofacial surgery[M]. 6th Ed. Beijing: People's Health Publishing House, 2008.

XIAO X, DAI J W, LI Z, et al . Pathological fracture of the mandible caused by radicular cyst: a case report and literature review[J ] . Medicine (Baltimore), 2018, 97(50): e13529. DOI: 10.1097/MD.0000000000013529.

KOUHSOLTAN M, MESGARZADEH A H, MORADZADEH KHIAVI M. Mandibular fracture associated with a dentigerous cyst: report of a case and literature review[J]. J Dent Res Dent Clin Dent Prospects, 2015, 9(3): 193-198. DOI: 10.15171/joddd.2015.035.

GRAU-MANCLUS V, GARGALLO-ALBIOL J, ALMENDR-OSMARQUÉS N, et al . Mandibular fractures related to the surgical extraction of impacted lower third molars: a report of 11 cases[J ] . J Oral Maxillofac Surg, 2011, 69(5): 1286-1290. DOI: 10.1016/j.joms.2010.05.059.

GERHARDS F, KUFFNER H D, WAGNER W. Pathological fractures of the mandible. A review of the etiology and treatment[J]. Int J Oral Maxillofac Surg, 1998, 27(3): 186-190. DOI: 10.1016/s0901-5027(98)80007-6.

张志愿. 口腔颌面外科学[M]. 7版. 北京: 人民卫生出版社, 2012: 307-309.

ZHANG Z Y. Oral and maxillofacial surgery[M]. 7th Ed. Beijing: People's Health Publishing House, 2012: 307-309.

GENDVILIENE I, LEGRAND P, NICOLIELO L F P, et al . Conservative management of large mandibular dentigerous cysts with a novel approach for follow up: two case reports[J ] . Stomatologija, 2017, 19(1): 24-32.

虎小毅, 李立峰, 史婧怡, 等. 不同程度骨吸收的下颌骨囊性病变治疗方式的选择及相关生物力学分析[J]. 现代口腔医学杂志, 2019, 33(4): 193-196. DOI: 10.3969/j.issn.1001-3733.2018.05.014.

HU X Y, LI L F, SHI J Y, et al . Strategy for the treatment of cystic lesions of mandible with different degrees of bone resorption: analysis based on biomechanics[J ] . J Mod Stomatol, 2019, 33(4): 193-196. DOI:10.3969/j.issn.1001-3733.2018.05.014.

OH J S, YOU J S, KIM S G. Clinical and histomorphometric evaluation of decompression followed by enucleation in the treatment of odontogenic keratocyst[J]. J Dent Sci, 2018, 13(4): 329-333. DOI: 10.1016/j.jds.2018.06.001.

SZUCS A, BUJTÁR P, SÁNDOR G K, et al . Finite element analysis of the human mandible to assess the effect of removing an impacted third molar[J ] . J Can Dent Assoc, 2010, 76: a72.

丁云波, 姚小武, 陈仕生, 等. 下颌骨大型囊性病变开窗术后骨腔改变及其影响因素[J]. 口腔颌面外科杂志, 2020, 30(2): 85-89. DOI: 10.3969/j.issn.1005-4979.2020.02.005.

DING Y B, YAO X W, CHEN S S, et al . Influencing factors on changes of bone cavity in large cystic lesions of the mandible after marsupialization[J ] . China J Oral Maxillofac Surg, 2020, 30(2): 85-89. DOI:10.3969/j.issn.1005-4979.2020.02.005.

ABOULHOSN M, NOUJEIM Z, NADER N, et al . Decompression and enucleation of a mandibular radicular cyst, followed by bone regeneration and implant-supported dental restoration[J ] . Case Rep Dent, 2019, 2019: 9584235. DOI: 10.1155/2019/9584235.

RIACHI F, KHAIRALLAH C M, GHOSN N, et al . Cyst volume changes measured with a 3D reconstruction after decompression of a mandibular dentigerous cyst with an impacted third molar[J ] . Clin Pract, 2019, 9(1): 1132. DOI: 10.4081/cp.2019.1132.

王爽, 孙江, 于雁云. 基于CBCT图像的颌骨及牙列有限元建模方法研究[J]. 实用口腔医学杂志, 2019, 35(1): 55-59. DOI: 10.3969/j.issn.1001-3733.2019.01.012.

WANG S, SUN J, YU Y Y. Study on finite element modeling approach of mandible with full dentition based on CBCT images[J]. J Pract Stomatol, 2019, 35(1): 55-59. DOI: 10.3969/j.issn.1001-3733.2019.01.012.

庞亚倩, 张凯, 刘亮, 等. 下颌骨囊性病变的三维有限元模型生物力学分析[J]. 南方医科大学学报, 2020, 40(6): 911-915. DOI: 10.12122/j.issn.1673-4254.2020.06.21.

PANG Y Q, ZHANG K, LIU L, et al . Biomechanical study of cystic lesions of the mandible based on a three-dimensional finite element model[J ] . J South Med Univ,2020, 40(6): 911-915. DOI:10.12122/j.issn.1673-4254.2020.06.21.

李茜茜, 康婷, 陈燕语, 等. 上颌中切牙斜形折裂修复设计的有限元分析[J]. 口腔医学研究, 2020, 36(3): 259-263. DOI:10.13701/j.cnki.kqyxyj.2020.03.017.

LI X X, KANG T, CHEN YY, et al . Finite element analysis of different repairing designs for maxillary central incisor with oblique defect[J ] . J Oral Sci Res, 2020, 36(3): 259-263. DOI:10.13701/j.cnki.kqyxyj.2020.03.017.

COYAC B R, SALVI G, LEAHY B, et al . A novel system exploits bone debris for implant osseointegration[J ] . J Periodontol, 2021, 92(5): 716-726. DOI:10.1002/JPER.20-0099.

SOLBERG K, HEINEMANN F, PELLIKAAN P, et al . Finite element analysis of different loading conditions for implant-supported overdentures supported by conventional or mini implants[J ] . Comput Methods Biomech Biomed Engin, 2017, 20(7): 770-782. DOI: 10.1080/10255842.2017.1302432.

李元, 宋亮, 张建国, 等. 三维有限元分析种植体支持平面型及弹性衬垫型磁性覆盖义齿在正常骨及骨质疏松状态下的应力[J]. 中国组织工程研究, 2022, 26(16): 2540-2544. DOI:10.13701/j.cnki.kqyxyj.2017.03.018.

LI Y, SONG L, ZHANG J G, et al . Three-dimensional finite element analysis of stress distributions in osteoporosis and normal mandibular dental implant-supported overdentures with flat-type and cushion-type magnetic attachments[J ] . Chin J Tissue Eng Res, 2022, 26(16): 2540-2544. DOI: 10.13701/j.cnki.kqyxyj.2017.03.018.

王谜, 刘定坤, 邹俊东, 等. 有限元法模拟下颌磨牙咀嚼载荷的研究进展[J]. 口腔医学,2020, 40(7): 673-676. DOI: 10.13591/j.cnki.kqyx.2020.07.020.

WANG M, LIU D K, ZOU J D, et al . Advances in the masticatory load of mandibular molars simulation by finite element method[J ] . Stomatology, 2020, 40(7): 673-676. DOI:10.13591/j.cnki.kqyx.2020.07.020.

邹英楠, 王屹博, 丁超, 等. 动态载荷下牙半切与种植体联合修复的三维有限元分析[J]. 中国组织工程研究, 2019, 23(2)178-183. DOI: 10.3969/j.issn.2095-4344.1504.

ZOU Y N, WANG Y B, DING C, et al . Three-dimensional finite element analysis of dental implant combined with residual tooth after hemisection under dynamic loads[J ] . Chin J Tissue Eng Res, 2019, 23(2): 178-183. DOI: 10.3969/j.issn.2095-4344.1504.

THRESHER R W, SAITO G E. The stress analysis of human teeth[J]. J Biomech, 1973, 6(5): 443-449. DOI: 10.1016/0021-9290(73)90003-1.

WESTBURY L D, SHERE C, EDWARDS M H, et al . Cluster analysis of finite element analysis and bone microarchitectural parameters identifies phenotypes with high fracture risk[J ] . Calcif Tissue Int, 2019, 105(3): 252-262. DOI: 10.1007/s00223-019-00564-7.

HOEFERT S, TAIER R. Mechanical stress in plates for bridging reconstruction mandibular defects and purposes of double plate reinforcement[J]. J Cranio Maxillofac Surg, 2018, 46(5): 785-794. DOI: 10.1016/j.jcms.2018.01.016.

TIAN A, ZHONG Z, LI Y M, et al . Biomechanical role of trabecular microstructure on peri-implant strain based on micro-CT finite element modeling of aging mice[J ] . Int J Oral Maxillofac Implants, 2021, 36(4): 715-722. DOI: 10.11607/jomi.8611.

卢苇. 基于医学影像的下颌骨模型构建及应用研究[D]. 贵阳: 贵州大学, 2022.

LU W. Research on the construction and application of mandibular model based on medical images[D]. Guiyang: Guizhou University, 2022.

ZHANG H, CUI J W, LU X L, et al . Finite element analysis on tooth and periodontal stress under simulated occlusal loads[J ] . J Oral Rehabil, 2017, 44(7): 526-536. DOI: 10.1111/joor.12512.

HUEMPFNER-HIERL H, SCHALLER A, HEMPRICH A, et al . Biomechanical investigation of naso-orbitoethmoid trauma by finite element analysis[J ] . Br J Oral Maxillofac Surg, 2014, 52(9): 850-853. DOI:10.1016/j.bjoms.2014.07.255.

SUEI Y, TAGUCHI A, TANIMOTO K. Simple bone cyst of the jaws: evaluation of treatment outcome by review of 132 cases[J]. J Oral Maxillofac Surg, 2007, 65(5): 918-923. DOI: 10.1016/j.joms.2006.06.297.

MUHAMMAD J K, AKHTAR S, ABU AL NASSAR H, et al . Regeneration of a compromized masticatory unit in a large mandibular defect caused by a huge solitary bone cyst: a case report and review of the regenerative literature[J ] . J Maxillofac Oral Surg, 2016, 15(Suppl 2): 295-305. DOI: 10.1007/s12663-015-0828-8.

AYALI A, ERKMEN E. Three-dimensional finite element analysis of different plating techniques for unfavorable mandibular angle fractures[J]. J Craniofac Surg, 2018, 29(3): 603-607. DOI: 10.1097/SCS.0000000000004327.

MURAKAMI K, YAMAMOTO K, TSUYUKI M, et al . Theoretical efficacy of preventive mea sures for pathologic fracture after surgical removal of mandibular lesions based on a three-dimensional finite element analysis[J ] . J Oral Maxillofac Surg, 2014, 72(4): 833. e1-833.18. DOI: 10.1016/j.joms.2013.12.019.

CHAMPY M, WILK A. Stable, dynamic, elastic miniplate osteosynthesis in cranio-maxillofacial surgery: evolution of concepts, biomechanical study and applications[J]. China J Oral Maxillofac Surg, 2014, 12(2): 152-166. DOI:10.1016/s1010-5182(96)80140-5.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

下颌第一磨牙在不同咬合接触受力下的有限元分析

肘关节有限元模型模拟碰撞损伤的生物力学特性分析

经椎间孔腰椎椎间融合术植骨融合前后应力分布差异的有限元分析

种植支持全牙弓和分段式受力的对比分析

轴向应力作用下的舟骨有限元分析