颞下颌关节盘穿孔早期上腔滑液的流体动力学研究

A compuational fluid dyanmic analysis of synovial fluid in upper compartment of temporor-mandibular joint with small disc perforation

目的通过建立颞下颌关节流体动力学模型,分析下颌运动中关节盘穿孔区域关节上腔滑液的流动模式和压力分布规律。方法选择5例单侧颞下颌关节盘穿孔早期患者,利用关节上腔造影与计算机断层扫描相结合的方法获得颞下颌关节在不同下颌骨下降距离时的三维影像学图像,利用Mimics软件及Gambit软件提取患侧关节上腔立体轮廓并进行三维网格划分,应用Fluent软件进行滑液流体动力学分析。利用关节内压测量仪记录开颌运动中滑液压力进行模型验证。结果颞下颌关节上腔滑液的流体动力学模型结果显示:在开颌运动中右侧关节腔内滑液沿逆时针循环。在闭口和小张口位,关节内力小于阈值,上腔滑液形成规律的循环流动;当下颌骨下降距离到达3 cm以上,上腔滑液压力增至(11.78±5.14)mmHg达阈值水平,细小穿孔部位张开形成异常流场和上下腔滑液交通,不利于关节盘的自我修复。结论颞下颌关节盘穿孔的关节滑液循环仿真模型有助于对颞下颌关节紊乱综合征发病机制的研究,可为指导疾病的诊疗和预防提供依据。

Objective To analyze the flow pattern and pressure distribution of synovial fluid in upper compartment of temporormandibular joint （TMJ） with early stage disc perforation during jaw movement susing the fluid dynamics model.Methods Five patients with unilateral small disc perforation were included.Three-dimensional images of TMJ at different jaw-opening positions were obtained by arthrography and computed tomography.Andthe constructedmodel of TMJ was defined by the mimics software and meshed by the Gambit software.Thensynovial fluid dynamics were analyzed by the Fluent software.Finally,the model was validated with the intra-articular pressure measurement data during jaw-opening movements.Results The fluid dynamics model of right TMJ showed that the synovial fluid in the upper compartment formed an anticlockwise circulation.The intra-articular fluid pressure was lower than the threshold level and the synovial fluid generated a regular flow pattern at jaw-closing or jaw opening up to 2 cm.When the jaw-opening reached 3 cm,the pressure increased to the threshold with an abnormal flow field and a communication of fluid in the upper and lower compartments associated with the small disc perforation,which is unfavorable for self-repair of the joint disc.Conclusion The simulated synovial fluid dyanmic model of TMJ with disc perforationis effectively used for analysis of the pathogenesis of TMJ disorders,providing the basis for diagnosis and prevention.