Prosthesis Loading After Temporomandibular Joint Replacement Surgery: A Musculoskeletal Modeling Study
Prosthesis Loading After Temporomandibular Joint Replacement Surgery: A Musculoskeletal Modeling Study
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DOI：
10.1115/1.4029503
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发表时间：
2015-04-01
影响因子：
1.7
通讯作者：
Dimitroulis, George
中科院分区：
文献类型：
--
作者：
Ackland, David C.;Moskaljuk, Adrian;Dimitroulis, George
与颞下颌关节（TMJ）假体全关节置换（TJR）手术相关的最广泛报道的并发症之一是髁突组件螺钉松动和不稳定。本研究的目的是建立人类颌骨的肌肉骨骼模型，以评估咀嚼期间假体髁突组件方向和螺钉放置对髁突组件负载的影响。一个三维模型的颌骨包括上颌骨，下颌骨，咀嚼肌，关节软骨，关节盘的开发。对自然TMJ和假体TJR手术后的TMJ进行咀嚼和最大力咬合的模拟，包括髁状突组件向前旋转0 °、5 °、10 °和15 °的咀嚼病例。研究了三种具有临床意义的螺钉配置：完全、后路和最小后路螺钉（MPS）配置。髁突前旋的增加导致假体髁突组件接触应力的增加和髁突组件螺钉应力的显著增加。在髁突固定中使用更多螺钉降低了螺钉应力大小和最大髁突组件应力。上方放置的螺钉承受的应力高于所有其他髁突固定螺钉。本研究的结果具有重要意义的方式，其中假体组件被放置在颞下颌关节假体TJR手术。
One of the most widely reported complications associated with temporomandibular joint (TMJ) prosthetic total joint replacement (TJR) surgery is condylar component screw loosening and instability. The objective of this study was to develop a musculoskeletal model of the human jaw to assess the influence of prosthetic condylar component orientation and screw placement on condylar component loading during mastication. A three-dimensional model of the jaw comprising the maxilla, mandible, masticatory muscles, articular cartilage, and articular disks was developed. Simulations of mastication and a maximum force bite were performed for the natural TMJ and the TMJ after prosthetic TJR surgery, including cases for mastication where the condylar component was rotated anteriorly by 0 deg, 5 deg, 10 deg, and 15 deg. Three clinically significant screw configurations were investigated: a complete, posterior, and minimal-posterior screw (MPS) configuration. Increases in condylar anterior rotation led to an increase in prosthetic condylar component contact stresses and substantial increases in condylar component screw stresses. The use of more screws in condylar fixation reduced screw stress magnitudes and maximum condylar component stresses. Screws placed superiorly experienced higher stresses than those of all other condylar fixation screws. The results of the present study have important implication for the way in which prosthetic components are placed during TMJ prosthetic TJR surgery.