运用输送盘牵张成骨术重建猴下颌髁突的实验研究

目的研究在猴颞下颌关节（TMJ）缺损动物模型上运用输送盘牵张成骨术重建髁突的可行性及其整复效果。方法选取6只成年恒河猴,手术截除其双侧关节髁突与关节盘,在下颌升支部行“L”形骨切开术,形成骨输送盘,并安置自行研制的牵张器。按每次0.4 mm,每次间隔12 h的牵张速率向上牵引输送盘至关节窝。牵张结束后第4、12、24周各处死2只动物。通过影像学分析和组织学检查评价输送盘改建与牵张间隙内新骨生成情况。以术中切除的髁突作为正常对照组。结果术后所有动物都有不同程度的咬合错乱,牵张结束后咬合基本恢复正常。骨输送盘形态基本接近正常髁突,其下方可见大量软骨细胞;牵张间隙内新骨生成良好。结论输送盘牵张成骨术可以重建一个形态和功能都基本接近正常的髁突,这种技术可以作为一种整复TMJ缺损的新方法。     

牵张成骨增高牙槽嵴对颞下颌关节影响的组织学研究

目的：研究牵张成骨增高牙槽嵴对颞下颌关节的影响的组织学变化。方法：体重20公斤以上健康成年杂种犬18只，3只为对照组，其余随机分为3组，每组5只。拔除双侧下颌所有前磨牙及第一磨牙，1个月后除去对照组外，都在一侧下颌骨植入镍钛记忆合金丝加工成的S形牵张装置。分别在牵张后l、3、6个月后处死6只动物。取双侧颞下颌关节，进行大体、光镜和扫描电镜观察。结果：1、3、6个月后大体及光镜下现察双侧关节无明显变化。3个月后扫描电镜下牵张侧髁状突和关节盘胶原纤维排列部分紊乱，偶见胶原纤维破坏。凝胶状物质菲薄但基本完整。6个月后基本恢复正常。结论：牙槽嵴牵张成骨早期，对牵张侧颞下颌关节有一定的影响，但这种影响是轻微的、可逆的。     

腭裂引起反He的前牵引与下颌髁突位置关系的初步研究

目的：评价应用口外弓加面具对唇腭裂继发骨性反He畸形进行早期阻断性治疗后,下颌骨髁突位置的变化。方法：对8例患者治疗前和治疗6个月的薛氏位片进行分析,比较颞下颌关节（TMJ）前,上,后间隙的宽度,结论：治疗前后双侧TMJ的3个间隙均无明显改变（P＞0．05）。结论：应用口外弓外面具作上颌骨前牵引后,未发现髁突位置的明显改变。     

54例正常人双侧颞下颌关节CBCT测量值分析

目的：探讨应用CBCT（cone-beamcomputedtomography）对成年人两侧颞下颌关节进行多项指标数据测量分析。方法：在TMJ成像与测量技术的基础上，筛选出正常成人54例，通过严格的TMJ临床检查确定为健康关节，利用Newtom9000CBCT对其ICP位颞下颌关节进行成像后测量分析。结果：在轴位测得髁状突水平角以及单侧髁状突距矢状中线的距离；平行于髁状突长轴的斜位，测髁状突长轴径，垂直角度，沿髁状突长轴顶内外极间任意角间隙宽度；垂直于髁状突长轴的斜位测量关节髁状突前中后任意角间隙宽度，关节凹深度和前斜面角度关节颈厚度；矢状位测关节髁状突前中后任意角间隙宽度，关节凹深度和前斜面角度关节颈厚度。结论：正常成人双侧髁状突位置及关节窝形态性别差异不明显，双髁状突位置及关节窝形态基本对称。     

间接性颞下颌关节损伤后IL-8的表达及其意义

目的：通过观察羊颞下颌关节（TMJ）间接创伤后不同时期髁突软骨中IL-8的表达，探讨IL-8在TMJ创伤后导致TMJ骨关节病过程中的作用。方法：用自制撞击装置造成山羊双侧颞颌关节间接性创伤，分别于伤后2h,7d,1月，3月取材，并以正常TMJ作为对照，用免疫组化法进行观察。结果：TMJ创伤后髁突软骨中IL-8的表达明显强于正常对照组，其着色程度越靠近结构破坏区越明显。结论：IL-8在TMJ创伤后导致TMJ骨关节病过程中起重要作用。     

Herbst矫治器治疗与颞下颌关节改建

本文综述了使用Herbst矫治器对颞下颌关节（TMJ）的髁突、关节窝和关节盘的影响，并探讨了使用Herbst矫治器是否会导致颞下颌关节紊乱（TMD）的问题。这有利于正畸医生正确理解功能性矫治器与TMJ的关系，以指导选择矫治时机的适应性。     

单侧有一种症状的TMD患者双侧关节CBCT对比研究

目的：探讨单侧有一种症状的颞下颌关节紊乱病（ TMD）患者双侧颞下颌关节（ TMJ）在CBCT成像上可能存在差异的参考层面。方法：选取仅单侧有症状的TMD患者29例,通过CBCT三维成像和重建,观察两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS13．0软件对各测量指标做两样本配对t检验。结果：两侧TMJ在垂直位60°关节间隙时的测量值差异有统计学意义（P＜0．05）,其余测量值均无统计学意义（P＞0．05）。结论：对于单侧有一种症状的TMD患者,接近矢状位是较易观察到左右两侧有差异的位置,并可观察到患侧前间隙增大,在此层面重建对诊断和对比研究更有参考价值。     

小型猪一侧失牙及义齿修复后颞下颌关节的组织病理学观察

目的：观察一侧失牙及义齿修复对小型猪颞下颌关节（temporomandibular joint，TMJ）组织结构的影响。方法：11只小型猪随机分为空白组（2只）、拔牙组（4只）、修复组（5只），将拔牙组和修复组左侧后牙全部拔除，修复组并于拔牙后3个月进行义齿修复。小型猪一侧失牙6个月时处死，解剖TMJ并制作光镜（HE染色）和透射电镜标本，观察其组织结构改变。结果：拔牙组和修复组小型猪双侧TMJ均发生不同程度的退行性改变。髁突软骨表面带玻璃样变性、断裂、剥脱；肥大带下陷成乳突样，软骨细胞成簇；骨小梁破坏呈蚕蚀状。关节盘胶原纤维变性、紊乱、断裂，盘后组织出现明显软骨化生。髁突软骨瘀斑、凹陷、剥脱的超微病理特征分别是细胞变性、凋亡、坏死。结论：长期一侧失牙可导致双侧TMJ退行性变，及时义齿修复可减轻TMJ的病理损伤。     

双侧下颌牵张成骨对转化生长因子β1在颞下颌关节髁突表达的影响

目的　研究狗的双侧下颌牵张成骨中颞下颌关节髁突的形态改变及转化生长因子β1(TGF-β1)在髁突的 表达。方法　16只狗随机分为4组,每组4只,分别为牵张6 d组、牵张后固定2周组、牵张后固定8周组及正常对 照组。各实验组的牵张频率均为1 mm/d,1次/天。对每组动物的髁突标本进行苏木精-伊红染色及TGF-β1的免 疫组化染色观察。结果　苏木精-伊红染色可见实验组动物的髁突纤维软骨早期有不同程度的损伤,增殖带、肥 大带细胞增生活跃,软骨钙化层及其深层软骨成骨活跃;TGF-β1阳性染色主要定位在肥大带细胞胞浆、周围基质和 成骨反应活跃处的成软骨细胞、成骨细胞及周围基质。牵张后固定2周时这种改建修复现象最明显,8周时逐渐恢 复至正常对照组的表现。结论　双侧下颌牵张成骨对颞下颌关节髁突影响主要表现为髁突纤维软骨组织形态学 的改变和软骨、骨的改建活动,但随着固定时间的延长这种改变逐渐修复。     

单侧弹响的颞下颌关节紊乱病患者双侧关节锥形束CT对比研究

目的:探讨仅有单侧弹响的颞下颌关节紊乱病(temporomandibular disorders,TMD),患者双侧颞下颌关节(temporomandibular joint,TMJ)在锥形束计算机体层摄影(cone-beam computed tomography,CBCT)成像上存在差异的参考层面,为TMD诊断和对比研究提供参考.方法:选取一侧TMJ仅有弹响的TMD患者10例,通过CBCT三维成像和重建,观察同一患者两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS13.0软件包对每位患者上述各测量指标做两配对样本t检验.结果:上述横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙等观察指标在同一患者中,左右两侧测量值均无统计学差异(P＞0.05).结论:对于单侧TMJ仅有弹响的TMD患者,锥形束CT不具有对比研究意义上的参考价值.     

Changes in the temporomandibular joint after mandibular lengthening with different rates of distraction

This study assessed the changes in the condyle after mandibular lengthening with 2 different rates of distraction (1 mm/day and 2 mm/day). Unilateral mandibular distraction was performed in 8 young adult goats. The animals were sacrificed 8 weeks after the completion of distraction, and the temporomandibular joint (TMJ) specimens were harvested and processed for histologic examination and histomorphometric analysis. Adaptive changes in the condyle were observed in the goats distracted at a rate of 1 mm/day, whereas degenerative alterations were found in those distracted at a rate of 2 mm/day. This study suggests that the TMJ is able to withstand the impact of distraction at a rate of 1 mm/day, but more rapid distraction may induce degeneration in the condylar cartilage.     

Microscopic changes in the condyle and disc in response to distraction osteogenesis of the minipig mandible.

PURPOSE: Unilateral mandibular distraction osteogenesis (DO) has been shown to cause gross changes in the mandibular condyle and articular disc. The purpose of this study was to correlate histologic findings with these gross changes in a minipig distraction model. MATERIALS AND METHODS: Semiburied distractors were placed via submandibular incisions in 15 minipigs. Two unoperated animals served as controls. The protocol consisted of 0-day latency and rates of 1, 2, or 4 mm/day for a 12-mm gap. After the minipigs were killed (at 0, 24, or 90 days), ipsilateral and contralateral condyles and discs were harvested, decalcified, prepared for standard paraffin embedding, and evaluated to determine changes in 1) morphology and thickness of the articular cartilage and subchondral bone and 2) morphology of the disc. RESULTS: In control animals, there were no degenerative changes in the articular cartilage and underlying condylar bone; there were no significant differences in the mean articular cartilage thickness. The temporomandibular joint discs were normal. In experimental animals, distracted condyles showed increasing degenerative changes and mean articular cartilage thickness as the DO rate increased. The discs were thinner. These changes were present, but to a lesser degree, in the contralateral condyles. After 90 days, degenerative changes in the condyles and discs were reduced, after remodeling, except in the 4 mm/day DO group. CONCLUSIONS: Histologic changes in the condyles and temporomandibular joint discs in response to mandibular DO correlated with previously reported gross changes. These changes were greater at higher distraction rates and remodeling back to normal occurred in mandibular condyles distracted at 1 mm/day.     

Changes in the condyle and disc in response to distraction osteogenesis of the minipig mandible.

PURPOSE: Distraction osteogenesis (DO) is a commonly used technique for mandibular lengthening, but changes in the temporomandibular joint have not been well documented. The purpose of this study was to evaluate the effect of DO, at varying rates, on the mandibular condyle and articular disc. MATERIALS AND METHODS: Semiburied distractors were placed via submandibular incisions in 15 minipigs. Two unoperated animals served as controls. The protocol consisted of 0 day latency and rates of 1, 2, or 4 mm/d for a 12-mm gap. After the animals were killed (0, 24, or 90 days), ipsilateral and contralateral condyles and discs were harvested and evaluated to determine changes in 1) condylar form and size, 2) condylar surface, and 3) the articular disc. RESULTS: Articular surfaces of the condyles in control animals were smooth, with no irregularities or erosions. In animals undergoing distraction, ipsilateral condyles showed increasing changes in morphology and AP dimension, and surface contour irregularities as the DO rate increased. These changes were present, but to a lesser degree, in the contralateral condyles. Articular discs of both ipsilateral and contralateral sides showed variable thinning at the medial aspect at end DO. After 90 days, changes in the condyles and discs were reduced by remodeling except in the 4 mm/d DO groups. CONCLUSIONS: Results of this preliminary study indicate that gross changes occur in condyles and discs after unilateral mandibular DO. These changes are more severe at faster distraction rates (4 mm/d) and tend to resolve during neutral fixation when a rate of 1 mm/d is used.     

牵张成骨延长山羊下颌骨后下齿槽神经的组织学变化

目的 :研究下颌骨牵张成骨术后不同时间内下齿槽神经的组织学改变。方法 :对 8只成年山羊行双侧下颌体骨皮质切开术 ,经口外安置自行研制的下颌牵张器 ,以每天 1mm的速率向前牵引延长其中 6只山羊的下颌骨10mm。于牵张结束后第 2、4、8周各处死 2只动物 ,取双侧下齿槽神经作组织学检查 ,另 2只未牵张的山羊作对照。结果 :下齿槽神经受牵张力作用发生了一定程度的沃勒变性 ,主要表现为髓鞘肿胀、碎裂及轴索数目减少。但随着固定时间的延长 ,受损神经纤维逐渐得以再生。结论 :下颌骨牵张成骨术后下齿槽神经发生了轻度的退行性变 ,但这种退行性变在适宜的速率牵张下是可逆的     

Changes in the inferior alveolar nerve after mandibular lengthening with different rates of distraction.

PURPOSE: This study investigated the changes in the inferior alveolar nerve after mandibular lengthening with different rates of distraction. MATERIALS AND METHODS: Bilateral mandibular corticotomies were performed in 8 goats. The mandibles in 6 goats were lengthened 10 mm using a custom-made distractor with 2 different rates of distraction (1 mm/d [n = 3] and 2 mm/d [n = 3]); the other 2 nondistracted mandibles served as a control. The goats with distracted mandibles were killed at 2 weeks after completion of distraction. The inferior alveolar nerve specimens from all animals were harvested and processed for histologic and ultrastructural evaluation. RESULTS: The mandibles were lengthened successfully in the distracted animals. Morphologic changes in the inferior alveolar nerves were observed when compared with the nondistracted controls. Moreover, signs of nerve degeneration, such as demyelination, axonal swelling, axoplasmic darking, and decrease in the number of axons, were more extensive and prominent in those nerves distracted at a rate of 2 mm/d. CONCLUSIONS: Degenerative changes in the inferior alveolar nerve occur after mandibular lengthening by distraction osteogenesis. The distraction rate of 1 mm/d appears to be tolerable and safe for the inferior alveolar nerve, but rapid distraction may cause serious degeneration.     

不同速率牵张山羊下颌后下齿槽血管变化与血管生成的实验研究

目的:研究不同速率牵张延长山羊下颌骨后下齿槽动静脉的变化和新骨组织内血管生成情况。方法:8只成年山羊随机分为3组,A组(3只)以110 mm/d牵张,B组(3只)以210 mm/d牵张,C组(2只)为对照。A、B两组均牵张延长下颌10 mm,于牵张结束固定后第2周时处死动物,取牵张区下齿槽动静脉及新骨组织行组织学和定量组织学研究,观察下齿槽血管的管壁厚度和管径大小变化,以及新骨中微血管数量变化。结果:两种速率牵张后均未见下齿槽血管壁有病理性改变,但210 mm/d组的血管管径变小,管壁变薄,与对照组相比有显著差异(P<0105)。110 mm/d牵张后微血管密度较210 mm/d牵张后微血管密度高,且新生骨小梁更为成熟,其差异具有统计学意义(P< 0105)。结论:下颌骨牵张后下齿槽血管无明显变化,但快速牵张可能对牵张间隙内血管生成有不良影响。     

Histological evaluation of condylar hyperplasia model of rabbit following distraction osteogenesis of the condylar neck

Summary Condylar hyperplasia is the excessive unilateral growth of mandibular leading to facial asymmetry, occlusal disturbance, joint pain and dysfunction. The aim of this study is to evaluate the histological presence of temporomandibular joint in model of condylar hyperplasia by lengthening unilateral condylar neck of distraction osteogenesis. An extra oral distractor was employed to achieve unilateral condylar neck distraction (1·0 mm daily for 7 days). The experimental condylar necks were elongated by 7 mm compared to the contralateral. Eleven adult white rabbits were used. Eight rabbits were, respectively, sacrificed after the post‐distraction period (4 or 8 weeks). All animals were evaluated clinically and histomorphometrically. The condyles radiologically showed remodelling, flattening and sclerosis. In 4‐week group, thinning of the cartilage was evident, and the trabeculae were long, not multiply connected. A thin, dense fibrous layer covered all over the surface of cartilage. In 8‐week group, the cartilaginous layer was similar to thickness of the normal cartilage, but still thinner than control. However, the fibrous layers covering condyle manifested slight degenerative changes, and even depressions and erosions were seen in the cartilage and subchondral bone. The trabeculae showed denser and multiply connected. In 8‐week group, the cartilaginous thickness of surgical condyles was significantly thinner than the contralateral. This study indicates that unilateral distraction of condylar neck loads the condyles asymmetrically. Asymmetrical loads affect more on the surgical condyles than the contralateral, and after 8 weeks of the post‐distraction, condyle could recover from asymmetrical loads in some degree.     

不同速率牵张下颌后下齿槽神经的组织学和超微结构改变

目的 研究不同速率牵张延长下颌骨后下齿槽神经的组织学和超微结构改变,为临床上确立合理而安全的牵张速率提供实验依据。方法 ８只山羊随机分为Ａ、Ｂ、Ｃ三组,Ａ、Ｂ组各３只,Ａ组１ｍｍ／ｄ,Ｂ组以２ｍｍ／ｄ牵张,Ｃ组２只动物为对照。牵张延长下颌骨１０ｍｍ,固定２ｗ处死。取下齿槽神经行组织学,透射电镜观察。结果 牵张动物的下齿槽神经均发生了Ｗａｌｌｅｒ变性,以２ ｍｍ／ｄ牵张组神经退行性病变严重而广泛。超微结构病变主要发生于粗大的有髓神经纤维,而细小的有髓神经及无髓神经纤维未见异常。结论 ２ｍｍ／ｄ牵张会对下齿槽神经造成严重损伤,而１ｍｍ／ｄ牵张速率为较适宜而安全的下颌牵张速率。     

Histological changes in the temporomandibular joint in rabbits depending on the extent of mandibular lengthening by osteodistraction

We studied the histological changes in the temporomandibular joint (TMJ) after unilateral mandibular distraction osteogenesis in rabbits. Eight rabbits were used, two of which served as controls and the other six had distraction of the left mandibular body after a latency period of 7 days at a rate of 0.5mm a day for a total of 2mm (n = 2), 3.5mm (n = 2), and 5mm (n = 2) of distraction. After a 14-day consolidation period, TMJs from both sides were harvested and prepared for histological examination under an optical microscope using haematoxylin and eosin stain. We found no degenerative or inflammatory changes in either TMJ in any of the groups. Endochondral ossification in the condyle was greater on the opposite side in the experimental group than in the condyles of the control group. Endochondral ossification was active in the 3.5-mm group.