- 學位論文
正顎手術不同截骨斷面之生物力學影響
Biomechanical Effect of Parameters in Different Osteomy Sections of Orthognathic Surgery
摘要
Le fort I截骨術與矢狀分離截骨術因為有廣泛的適應症，所以被廣泛的使用在矯正面顎畸形。本研究之目的是利用有限元素分析來探討上下顎截骨術在全顎進行食團咬合時之生物力學效應，其中搭配下顎十種切法與四種骨板，上顎使用Le Fort I截骨術與L型骨板來進行模擬探討。希望藉由系統性之全顎分析來探討上下顎截骨術在不同截骨斷面與骨板固定之情況與探討其固定骨板應力分佈與穩定性來提供臨床正顎手術參考之應用。本研究有限元素模型包含上顎、下顎、顳顎關節盤、牙齒、齒槽神經、微骨板以及微骨釘。在分析本研究的模型主要分成兩階段，第一階段是分析不同截骨斷面的矢狀分離截骨術，而第二階段則是結合Le Fort I截骨術的正顎手術的全顎力學影響。在模型之負載條件在單獨下顎截骨術是給予下顎咬合肌群肌肉拉力與在門牙與第一大臼齒給予300N之垂直咬合力，全顎模型是給予下顎咬合肌群之拉力，並在門牙與第一大臼齒放置食團模擬真實咬合情形。 在分析結果，其單獨下顎之應力趨勢都呈現當垂直咬合力施加於門牙時是高於施加於第一大臼齒，在骨板固定之穩定度，I型骨板表現較佳。在全顎分析中，上顎之最大等效應力與位移量都遠小於下顎，並且在CO截骨斷面組別，有骨接觸面積愈大應力愈小之趨勢，在穩定度結果上，使用門牙咬合時，其穩定度有變差之趨勢，其全顎分析之下顎窩與髁狀突之應變結果，使用本研究之肌肉負載，並無骨吸收與骨破壞之情形。綜合結論從全顎模型之應力角度來看，選擇RO1截骨斷面搭配X型骨板應是破壞風險最小之組合；以穩定度來看，選擇GO2截骨斷面搭配BOX型骨板為最佳組合。
並列摘要
Le Fort I and sagittal split osteotomy have been applied widely in maxilla and mandible respectively, to correct the jaw deformity. The purpose of this study is to investigate biomechanical effect of two jaw osteotomy under food bolus mastication by finite element analysis, ten resection plane and four types of bone plate for mandible and the Le Fort I osteotomy and L-shape bone plate for maxilla. The systemic analysis of the two jaw osteotomy with different resection planes and bone plates could provide reference guide line of clinical application by investigating stress distribution and stability of the bone plates. The model of finite element jaw osteotomy analysis was consisted of maxilla, mandible, disc, teeth, alveolar nerve, miniplate, and miniscrew. Two stages were simulated in this study, first stage was performed in the single mandibular osteotomy to investigate the effect of biomechanics in the ten resection plane combined with four types of bone plate, second stage was examined masticated biomechanical effect of the two jaw by osteotomy. Muscular forces of close mouth and vertical force of 300 N at the incisor and molar as the loading conditions were applied in the single mandible models, muscular forces of close mouth and food bolus at the incisor and molar as the loading conditions were used in the two jaw models. The results showed that equivalent stress in the models of incisor biting force were larger than that of molar biting force, I-shape plate could provide a better biomechanical performance in stability. For two jaw osteotomy analysis, the maximum equivalent stress and displacement in the maxilla was much smaller than mandible, moreover, the models of the CO series of resection planes revealed in tendency of bone contact area increase to reflect stress magnitude decrease. In the stability evaluation, the worse trend in stability was detected in the two jaw osteotomy model under food bolus biting at the incisor region. On the other hand, the index of micro strain in the mandibular condylar head and fossa were not significant difference to reflect bone resorption effect. General conclusions of this FE simulations were that the model of RO1 resection plan combined with X-type plate for two jaw osteotomy was observed in the minimum risk of plate fracture, for viewpoint of stability, the model of GO2 resection plan combined with BOX-type plate for two jaw osteotomy was evidenced the best biomechanical effect
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