A Novel Fiber Embedded Hydrogel Temporomandibular Joint Disc Replacement

项目摘要 颞下颌关节(TMJ)疾病约占总人口的5%至12%。对于高级 关节盘的紊乱，通常对保守治疗无效，椎间盘切除是 最常见的手术干预。然而，TMJ盘在分配机械的过程中起着关键作用 对关节的关节表面施加应力并防止磨损。因此，取出光盘可能会进一步破坏 关节动态平衡，驱动退行性变和骨关节炎的发展，这可能导致高度侵袭性 以及具有挑战性的外科干预措施，如重建和全关节置换。之前的尝试 用异体塑料植入物替换椎间盘导致了与磨损有关的有害病理变化 碎片、植入物碎裂和不良炎症反应。因此，考虑佩戴是至关重要的， 在长期循环背景下椎间盘替代材料的机械强度和生物相容性 装上TMJ。总体而言，迫切需要能够恢复关节盘内稳态的椎间盘置换。 关节盘切除时，关节才会发展为严重退变。因此， 这项建议的目标是创造一种人工TMJ盘，以取代原生的机械功能 并防止关节随后的退变。为了实现这一目标，拟议的研究将 表征TMJ的机械加载环境，以确定TMJ的力学标准 将关节内应力降至最低所需的TMJ阀瓣更换(具体目标1)。此外，非 可吸收纤维嵌入水凝胶材料将被制造，优化以显示仿生性能， 并开发成患者专用的合成TMJ椎间盘植入物。严格的机械评估将 确定材料的耐久性和适宜性作为TMJ盘的替代品(具体目标2)。最后，一只大型动物 这项研究将被用来评估所开发的TMJ椎间盘置换的安全性和有效性(特定目的 3)。拟议工作的成功完成将代表着TMJ椎间盘治疗的范式转变 可以减轻关节进一步退化并防止更具侵入性和复杂性的手术的疾病。

Project Summary Temporomandibular joint (TMJ) disorders inflict approximately 5% to 12% of the population. For advanced disorders of the articular TMJ disc, which typically do not respond to conservative treatments, disc resection is the most common surgical intervention. However, the TMJ disc plays a critical role in distributing mechanical stresses and preventing wear to the articular surfaces of the joint. Thus, removing the disc can further disrupt joint homeostasis, driving degeneration and the development of osteoarthritis, which can lead to highly invasive and challenging surgical interventions such as reconstructions and total joint replacement. Prior attempts at replacing the disc with alloplastic implants have led to deleterious pathological changes related to wear debris, implant fragmentation, and adverse inflammatory responses. Therefore, it is crucial to consider wear, mechanical strength, and biocompatibility of disc replacement materials in the context of long-term cyclic loading in the TMJ. Overall, there is a critical need for disc replacements that can restore the homeostasis of the joint when disc resection is required prior to the development of severe joint degeneration. Accordingly, the objective of this proposal is to create an artificial TMJ disc that replaces the mechanical function of the native disc and prevents subsequent degeneration of the joint. Towards this goal, the proposed research will characterize the mechanical loading environment of the TMJ in order to determine the mechanical criteria of a TMJ disc replacement needed to minimize internal stresses in the joint (Specific Aim 1). Further, non- resorbable fiber-embedded hydrogel materials will be fabricated, optimized to exhibit biomimetic properties, and developed into a patient-specific synthetic TMJ disc implant. Rigorous mechanical evaluations will determine material durability and suitability as a TMJ disc replacement (Specific Aim 2). Finally, a large animal study will be utilized to evaluate the safety and efficacy of the developed TMJ disc replacement (Specific Aim 3). Successful completion of the proposed work would represent a paradigm shift in the treatment of TMJ disc disorders that can mitigate further joint degeneration and prevent more invasive and complicated surgeries.