国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (1): 12-19.doi: 10.7518/gjkq.2019.01.003

• 论著 • 上一篇    下一篇

创伤性颞下颌关节强直转归机制的动物研究

郭骏1,费伟1,李庆华2()   

  1. 1. 四川省医学科学院·四川省人民医院口腔科 成都 610072;
    2. 攀枝花学院附属医院口腔科 攀枝花 617000
  • 收稿日期:2018-04-09 修回日期:2018-10-12 出版日期:2019-01-01 发布日期:2019-01-11
  • 通讯作者: 李庆华 E-mail:153496777@qq.com
  • 作者简介:郭骏,副主任医师,博士,Email:84005854@qq.com
  • 基金资助:
    四川省卫生和计划生育委员会普及应用项目(18PJ096)

Animal research for the prognostic mechanism of traumatic temporomandibular joint ankyloses

Jun Guo1,Wei Fei1,Qinghua Li2()   

  1. 1. Dept. of Stomatology, Sichuan Provincial Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, China;
    2. Dept. of Stomatology, The Affiliated Hospital of Panzhihua University, Panzhihua 617000, China
  • Received:2018-04-09 Revised:2018-10-12 Online:2019-01-01 Published:2019-01-11
  • Contact: Qinghua Li E-mail:153496777@qq.com
  • Supported by:
    This study was supported by Program for Sichuan Health and Family Planning Commission(18PJ096)

摘要:

目的 在建立小型猪髁突囊内骨折动物模型的基础上,通过评价不同处理方式对髁突囊内骨折预后的影响,探索创伤性颞下颌关节强直发生的机制。方法 小型猪15只,随机分为3组,每组5只(10侧颞下颌关节),采用手术方法造成双侧髁突囊内骨折,切除前外侧部分关节盘;根据髁突骨折临床治疗常用方式,分别用钛板内固定、关节囊内注射生理盐水、观察其自然愈合3种处理方式治疗各组囊内骨折。术后6个月,通过大体标本观察、影像学和组织学检查评价各组颞下颌关节强直的形成;利用免疫组织化学染色、逆转录-聚合酶链反应(RT-PCR)和Western Blot技术检测各组颞下颌关节中血管内皮生长因子(VEGF)、骨钙素(OCN)、骨桥蛋白(OPN)和骨形态发生蛋白-2(BMP2)的mRNA和蛋白表达水平。结果 实验组颞下颌关节强直发生率显著低于自然愈合组(P<0.05),实验组颞下颌关节中VEGF、OCN、OPN和BMP2的mRNA和蛋白表达水平明显低于自然愈合组,差异有统计学意义(P<0.01)。结论 不同处理方式治疗髁突囊内骨折与创伤性颞下颌关节强直的发生率密切相关;清理骨创间血肿、减少骨创面的暴露及骨折碎片的复位是预防关节强直发生的关键因素。

关键词: 颞下颌关节创伤, 颞下颌关节强直, 髁突囊内骨折

Abstract:

Objective To evaluate the effect of different treatment methods on the prognosis of intracapsular condylar fracture based on the animal model of intracapsular condylar fracture in miniature pig, and research the mechanism of temporomandibular joint ankylosis. Methods Fifteen miniature pigs were randomly divided into 3 groups, 5 animals (10 joints) in each group. The bilateral intracapsular condylar fractures caused by adopting the method of operation with removing the lateral part of articular disc. The animals were treated with three kinds of treatment of intracapsular fractures. 6 months postoperative, the formation of temporomandibular joint ankylosis was evaluated by gross specimen observation, imaging and histological examination. The expression of vascular endothelial growth factor (VEGF), osteocalcin (OCN), osteopontin (OPN) and bone morphogenetic protein 2 (BMP2) in temporomandibular joint specimen were detected by immunohistochemical staining. The mRNA and protein expressions of VEGF, OCN, OPN and BMP2 in temporomandi-bular joint specimen were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western Blot respec-tively. Results The incidence of temporomandibular joint ankylosis in the experimental group was significantly lower than that in the control group (P<0.05). The mRNA and protein expression level of VEGF, OCN, OPN and BMP2 in the experi-mental group was significantly lower than that in the control group by RT-PCR and Western Blot (P<0.01). Conclusion Different treatment of intracapsular condylar fractures is closely related to the incidence of traumatic temporomandi-bular joint ankylosis. Removal of hematoma and reduction of bone wound exposure would be the key factors for prevention of temporomandibular joint ankylosis.

Key words: temporomandibular joint trauma, temporomandibular joint ankylosis, intracapsular condylar fracture

中图分类号: 

  • R782.6 +1

图1

建模与分组 A:自然愈合组,箭头示髁突头矢状劈开线;B:生理盐水组,箭头示髁突关节囊内置管;C:钛板固定组,箭头示固定骨折块的微型钛板。"

表1

术前与术后6个月体重的变化"

时间 自然愈合组 生理盐水组 钛板固定组
术前 21.00±0.01 14.20±0.04 14.20±0.05
术后 36.00±0.09 24.25±0.11 24.30±0.05

表2

术前与术后6个月各组最大开口度的变化"

时间 自然愈合组 生理盐水组 钛板固定组
术前 6.90±0.16 6.80±0.16 6.84±0.30
术后 4.36±0.11 4.88±0.26* 5.42±0.36*

图2

术后6个月的CT影像 A:自然愈合组,箭头示关节骨性强直形成,全关节骨球融合;B:生理盐水组,箭头示部分关节骨性强直形成;C:钛板固定组,箭头示髁突头改建良好,无关节强直发生。"

图3

术后6个月自然愈合组关节活体标本 箭头示关节面与髁突头纤维及骨性粘连。"

表3

实验组与自然愈合组关节强直发生率的比较"

分组 样本量/侧 关节强直 强直率/% P
自然愈合组 10 9 1 90
生理盐水组 10 4 6 40 0.029
钛板固定组 10 2 8 20 0.003

图4

术后6个月组织学观察 A:自然愈合组 HE × 400;B:自然愈合组 Masson × 400;C:生理盐水组 HE × 400;D:生理盐水组 Masson × 400;E:钛板固定组 HE × 400;F:钛板固定组 Masson × 400。A~F箭头分别示:软骨类软骨细胞、软骨类软骨细胞、成纤维细胞、纤维基质、软骨基质、软骨细胞。"

图5

VEGF、OCN、OPN和BMP2的平均光密度箱图 A:生理盐水组;B:钛板固定组;C:自然愈合组。"

图6

VEGF、OCN、OPN和BMP2在各组关节组织中的表达 免疫组织化学 × 400"

图7

VEGF、OCN、OPN和BMP2的mRNA表达值箱图 A:生理盐水组;B:钛板固定组;C:自然愈合组。"

图8

Western Blot检测VEGF、OCN、OPN和BMP2蛋白相对表达量"

图9

Western Blot检测VEGF、OCN、OPN和BMP2在各组的表达"

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