THE STUDY OF A JAW MOVEMENT BEFORE AND AFTER TOTAL TMJ REPLACEMENT

全颞下颌关节置换术前后下颌运动的研究

• 批准号: 08457548
• 负责人: SUGAHARA Toshio
• 金额: $ 5.5万
• 依托单位: OKAYAMA UNIVERSITY (1997)Osaka University (1996)
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1996
• 资助国家: 日本
• 起止时间: 1996 至 1997
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-08457548/
• 关键词: Rheumatoid; Total temporomandibular joint replacement; Obstructive sleep apnea syndome; Artificial temporomandibular joint; Respiratory obstruction; 有限要素法

All joints of human body are affected by aging and some disease. They cause the morphologic and functional atrophy. The technique of artificial joint replacement has restored these collapse joints. In Japan, however, the artificial joint for the temporomandibular joint has not been developed before so that we did not have any effective treatment for the TM joints disease with the severe disorder. In this study, we presented the newest Sugahara artificial TM joints, which provides the effective ability to work in the daily life, based on the morphological analysis of human mandibular head and the dynamical factors in the jaw movement. We demonstrated the clinical application in the oral and maxillofacial field.In order to innovate artificial TM joints, we measured anatomically the TM joints taken from cadavers and human skeleton models by the reconstructive 3D-CT images. Based on the measement of the surface form of the mandibular head and the glenoid fossa, the load occurring in the pr … More ocess of chewing was analyzed by Hertz theory and the 3-dimensional finite element method. These results contributed to the first trial of Sugahara artificial TM joint for the human body.We performed this total TM joint replacement technique for the patients who have difficulty in occlusion and obstructive sleep apnea caused by chronic rheumatoid arthritis. These patients were assessed by the occlusal functional examination for chewing and the ultrasonic imaging examination, radiographic examination and measurement of jaw movement for the evaluation of TM joint movement.As a results, in the jaw movement, hinge axis movement was observed with the center of artificial TM joint. And the lateral and gliding movement were not found.According to the evaluation by the electromyogram, the activity of the both temporal and mastoid muscles got weak compared with normal one before the operation. After the operation, the activity of these muscles became weaker. It was seemed that the several months to exercise an opening mouth after the operation would be required to adapt the occlusal position given in this operation.As the anterior replacement of the jaw, the distance of the upper airway was likely to be well to breath. The patient was relived from the respiratory disturbance and also improved in speaking.As our furthermore prospect, the improvement of the form of the artificial TM joint will be discussed. This is expected to lead the high function and safer level of TM joints.Additionally, in the proces of the artificial TM joint innovatin, our new technology involving the reconstructed 3D-CT image, the contact and non-contact type-accurate 3-dimentional measuring and evaluating system, the superimposing method for evaluation, and the quantative evaluation of curved surface could realize the micro-measurement of the development process and the growth direction of the oral and maxilloafacial structure involving the maxilla, facial skelton, and plate. This study contributed to the other field research relating to oral and maxilofacial field. We were awarded the Owen Cole prize in the 8th annual meeting International Congress on Cleft Palate and Related Craniofacial Anomalies in 1997. Less

人体的所有关节都受到衰老和某些疾病的影响。它们导致形态和功能萎缩。人工关节置换技术使这些塌陷的关节得以恢复。然而，在日本，人工关节的颞下颌关节尚未开发之前，我们没有任何有效的治疗TM关节疾病的严重障碍。本研究通过对人类下颌头的形态学分析，结合下颌运动的动力学因素，提出了一种新型的Sugahara人工TM关节，该关节能够在日常生活中提供有效的工作能力。为了创新TM人工关节，我们对取自尸体和人体骨骼模型的TM关节进行了三维CT重建，并对其进行了解剖测量。在测量下颌头和关节窝表面形态的基础上，计算了下颌头和关节窝的载荷， ...更多信息 采用Hertz理论和三维有限元法对咀嚼过程进行了分析。这些结果为Sugahara人工TM关节的首次人体试验奠定了基础，我们对慢性类风湿关节炎引起的阻塞性睡眠呼吸暂停和咬合困难的患者进行了全TM关节置换术。通过咀嚼功能检查、超声影像学检查、X线检查及颌骨运动测量等方法评价TM关节的运动情况，结果显示：在颌骨运动中，关节轴运动以人工TM关节为中心。肌电图检查显示颞肌、乳突肌活动较术前减弱。手术后，这些肌肉的活动变得更弱了。术后需数月的张口训练，以适应本术式的咬合位，由于颌骨的前代，上呼吸道的距离可能会很好。术后患者的呼吸障碍得到缓解，说话能力也得到改善。作为我们进一步的前景，我们将讨论人工TM关节形状的改进。另外，在人工关节技术创新过程中，我们采用了三维CT重建图像、接触式和非接触式精确三维测量评价系统、叠加评价方法曲面的定量评价可实现对口腔颌面结构发育过程及生长方向的微观测量，和盘子。本研究为口腔颌面部其他领域的研究提供了参考。1997年，我们在第八届腭裂及相关颅面畸形国际年会上被授予欧文科尔奖。少

项目成果

菅原 利夫、三島 克章: "液晶レンジファインダーを用いた顔面形態評価システムの開発と唇裂手術の評価" 第5回コンピュータ外科学会合同論文集. 93-94 (1996)

Toshio Sukawara、Katsuaki Mishima：“使用液晶测距仪的面部形态评估系统的开发和唇裂手术的评估”第 5 届计算机外科学会联合会议记录（1996 年）。

T.Sugahara, K.Mishima: "Transactions : 8th International Congress on Cleft Palate and Related Craniofacial Anomalies" Quautitative Evaluation of Bone Graft in An Experimental Alveolar Cleft Model, 932-936 (1997)

T.Sugahara、K.Mishima：“交易：第八届腭裂及相关颅面异常国际大会”实验性牙槽裂模型中骨移植的定量评估，932-936 (1997)

菅原利夫: "今日の治療指針" 医学書院(印刷中), (1997)

菅原敏夫：“当今的治疗指南” Igakushoin（印刷中），（1997 年）

K.Mishima, T.Sugahara: "A Method of Three-demensional Mesurement and Evaluation of External Nasal Forms." J Osaka Univ.Sch.35. 45-58 (1996)

K.Mishima，T.Sugahara：“三维测量和评估外部鼻形态的方法”。

Minami K,Mori Y,Misima K,Sugahara T,Sakuda M: Morphologic Analysis of Alar Base After Secondary Bone Grafting Into Alveolar Cleft. Transactions 8Th International Congress On Cleft Palate And Related Craniofacial Anomaries., 445-449 (1997)

Minami K，Mori Y，Misima K，Sugahara T，Sakuda M：牙槽裂二次骨移植后鼻翼基底的形态分析。