| 摘要: | 顳顎關節是人體最重要的關節之一。當顳顎關節發生病變時會讓患者在日常生活起居中產生極大的不方便和痛苦。文獻指出，約有40%的人口皆發生過顳顎關節疼痛或功能障礙，基本上大部分的顳顎關節障礙症都可以藉由物理治療和咬和調整等方式來進行治療。但對於嚴重的顳顎關節病變如：關節僵硬症、腫瘤、嚴重的關節炎等無法由上述治療方式來改善原有的問題，則需要進行人工顳顎關節置換手術。雖然過去已有很多探討全人工顳顎關節的研究，但絕大多是臨床醫學報告，對於顳顎關節植入物本身並沒有做深入的探討與分析，或是僅著重於植入物的材料和磨耗等問題，導致與人工髖、膝關節手術相比下，手術成功率相對低很多。本研究計畫利用電腦斷層掃瞄影像建立局部頭骨和完整下顎骨之有限元素模型，並利用人造假骨進行體外測試來驗證模型的準確性；先探討正常的顳顎關節在進行功能性動作時，下顎骨及顳顎關節如何進行力量的傳遞及分佈；再配合電腦繪圖軟體及有限元素模擬軟體建立臨床手術常用的全人工顳顎關節模型，分析在植入人工關節後，骨頭及顳顎關節植入物的力學傳遞機制；並對植入物進行設計參數調整(如人工顳顎關節的尺寸、大小、形狀、和材料種類等)，探討不同參數對全人工顳顎關節的活動範圍、植入物穩定性及應力應變分析；最後對全人工顳顎關節作參數性的最佳化評估，以期望達到提高手術成功率之目的。
The temporomandibular joint (TMJ) is an important joint of the human skeleton. The temporomandibular diseases can induce oral pain and significant inconvenience. Reviewing the previous literatures, around 40% of the population have some signs or symptoms of temporomandibular disease. These patients can often be managed medically with nonsteroidal anti-inflammatory drugs, physiotherapy, and intra-articular injection of steroids. However, patients with serious osteoarthristis, rheumatoid arthritis, psoriatic arthritis and ankylosis might be good candidates for the receiving a TMJ prosthesis. Although TMJ implants have been used as a surgical treatment for more than 60 years, the use of inappropriate materials and designs has resulted in their success rate being lower than those for total hip and knee prostheses. Most of the many published papers related to the TMJ have been clinical and case reports. In this study, three-dimensional finite element (FE) models of the normal TMJ and the total TMJ prosthesis will be obtained based on computed tomography images and commercial implants, respectively. The FE model will be validated by using in-vitro experiments. Firstly, the mechanism of load transfer in the normal TMJ will be investigated based on the applied loading conditions and constraints of functional TMJ movement, such as chewing and biting. Secondly, biomechanical analyses will be performed on the current available commercial total TMJ prostheses. Finally, the effects of changes to the parameters of the implant (e.g., implant size, shape, and material properties) will be investigated in the finite element models. The data obtained in this study will be useful for optimizing the design of prostheses, in terms of the range movement, initial stability, and induced stresses. |
