Does fixation method affects temporomandibular joints after mandibular advancement?
Does fixation method affects temporomandibular joints after mandibular advancement?
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DOI：
10.1016/j.jcms.2018.03.024
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发表时间：
2018-06-01
影响因子：
3.1
通讯作者：
Apaydin, Aysegul
中科院分区：
文献类型：
--
作者：
Ureturk, Erdogan Utku;Apaydin, Aysegul
目的：矢状支劈开截骨术（SSRO）是一种标准手术，其中使用微型钢板和螺钉来实现稳定。虽然钛板和螺钉固定系统是稳定的，但也使用可吸收固定系统。对于SSRO手术的理想固定技术及其对髁突的影响，目前尚无共识。方法：建立半侧下颌骨三维有限元模型，在计算机上模拟前伸5 mm时的应力分布。采用了四种不同的固定技术：倒L形双皮质螺钉、L形双皮质螺钉、微型钢板+单皮质螺钉、微型钢板+单皮质螺钉+双皮质螺钉。为可吸收材料和钛材料制备两次计算机模型。施加600N的载荷和肌肉力。结果：双皮质螺钉增加了颞下颌关节的总应力，且应力分布在后牙区大于前牙区。结论：根据我们的分析，双皮质螺钉的使用增加了髁突上的应力。对于有颞下颌关节紊乱病倾向的患者，使用微型钢板固定技术可以减少髁突周围的力。这些发现对口腔外科医生在决定颞下颌关节紊乱病患者最合适的固定技术时是有用的。(C)2018年欧洲颅颌面外科协会。由爱思唯尔有限公司出版。保留所有权利。
Purpose: Sagittal split ramus osteotomy (SSRO) is a standard procedure in which miniplates and screws are used to achieve stabilization. Although the titanium plate and screw fixation system is stable, resorbable fixation systems are also used. There is currently no consensus on the ideal fixation technique for SSRO procedures and its effect on the condyle. We aimed to evaluate the stress distribution on temporomandibular joints (TMJ).Methods: A 3D finite element model of a hemimandible was designed and 5 mm advancement was simulated on a computer model. Four different fixation techniques were applied: inverted-L shaped bicortical screws, L-shaped bicortical screws, miniplate with monocortical screws, and miniplate with monocortical screws and bicortical screw. Computer models were prepared twice for resorbable and titanium material. Load of 600N and muscle forces were applied. In the finite element analysis, computer models simulated and analyzed stress distribution of bone, fixation materials and condyle.Results: Bicortical screws increase the total stress on TMJ, and the stress is located more on the posterior part than the anterior. Miniplates decrease the stress, and the forces are located more on the anterior aspect of the TMJ.Conclusion: According to our analysis, the use of bicortical screws increases the stress amount on the condyle. For the patients with a tendency toward temporomandibular disorders, using miniplate fixation techniques may decrease the forces around the condyle. These findings should be useful for oral surgeons when deciding on the most appropriate fixation technique in patients with a tendency toward temporomandibular joint disorders. (C) 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.