数字化下颌运动记录及咀嚼肌肌电图在下颌骨肿瘤患者口颌功能评价中的应用

doi:10.19723/j.issn.1671-167X.2019.03.029

北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (3): 571-578. doi: 10.19723/j.issn.1671-167X.2019.03.029

数字化下颌运动记录及咀嚼肌肌电图在下颌骨肿瘤患者口颌功能评价中的应用

王晶,陈俊鹏,王洋,许向亮,郭传瑸^△()

北京大学口腔医学院·口腔医院,口腔颌面外科国家口腔疾病临床医学研究中心口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室,北京 100081

收稿日期:2019-03-18 出版日期:2019-05-10 发布日期:2019-06-26
作者简介:郭传瑸,北京大学口腔医(学)院院长,主任医师、教授、博士生导师。研究方向及专长为口腔颌面肿瘤诊治及口腔癌转移机制研究、数字外科技术在颅底区肿瘤诊治的应用及颅颌面手术机器人的研发。
主要学术贡献:(1)在国内率先开展头颈癌患者的临床营养学研究课题,主持建立适用于消瘦型营养不良患者的快速、客观、准确的营养评价方法,满足了临床需要,有关研究成果获2001年度北京市科学技术进步奖三等奖;(2)开展各种颈淋巴清扫术在口腔癌治疗的应用及副神经的保留与重建,建立口腔鳞癌颈淋巴结转移动物模型,研究转移机制及转移标志物,成果获2016教育部高等学校自然科学奖二等奖;(3) 较大规模开展颅底肿瘤治疗的手术入路及导航手术研究,以降低手术风险,提高颅底肿瘤的手术治疗效果。率先研发颅颌面精确诊疗机器人系统,研制出两个辅助手术机器人样机,属本专业领域首创。
主持完成国家级课题4项,省部级4项,在研国家级项目1项,省部级1项。迄今共发表论文180篇,其中60篇被SCI收录;获各种科技奖励10次。
兼任中华口腔医学会副会长,中国医师协会口腔医师分会会长,中国抗癌协会头颈外科专业委员会副主任委员,中华口腔医学会口腔医学教育专业委员会主任委员,中华口腔医学会第三届口腔医学设备器材分会主任委员,中华口腔医学会第二届口腔医疗服务分会副主任委员,国务院学位委员会第七届学科评议组成员(召集人),全国医学专业学位研究生教育指导委员会口腔医学分会召集人,国际先进数字技术基金会共同主任等,是《中华口腔医学杂志》等10本学术杂志的副主编和编委,享受国务院特殊津贴,为国家卫生健康委员会有突出贡献的中青年专家。
基金资助:
北京大学临床科学家计划专项(BMU2019LCKCJ009)-中央高校基本科研业务费、北京大学口腔医院青年基金(PKUSS20180202)

Application of digital mandibular movement record and masticatory muscle electromyography in the evaluation of stomatognathic function in patients with mandibular tumor

Jing WANG,Jun-peng CHEN,Yang WANG,Xiang-liang XU,Chuan-bin GUO^△()

Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China

Received:2019-03-18 Online:2019-05-10 Published:2019-06-26
Supported by:
Supported by the Fundamental Research Funds for the Central Universities: Peking University Clinical Scientist Program (BMU2019LCKCJ009) and Youth Fund of Peking University School and Hospital of Stomatology (PKUSS20180202)

摘要/Abstract

摘要： 目的将数字化下颌运动记录与肌电图相结合,观察单侧下颌骨体部及升支肿瘤患者术前、术后下颌运动和咀嚼肌功能临床特点,初步探索运动和咀嚼肌功能的相互关系和产生机制。方法纳入单侧下颌骨体部及升支病变术前患者6例以及下颌骨单侧病变节段性切除及颌骨重建术后患者3例。采用下颌运动记录系统及表面肌电图系统,采集患者下颌边缘运动、咀嚼运动的运动轨迹,同时记录双侧咬肌、颞肌表面肌电图,采集患者静息、最大力咬合时双侧咬肌、颞肌表面肌电图。在数字化虚拟模型上观测运动轨迹,并分析下颌边缘运动的幅度和方向。分析患者健、患侧静息,最大力咬合,双侧咀嚼时的咀嚼肌电活动特点,计算不对称指数、活动指数。结果术前患者最大开口度均值为(35.20±6.87) mm,3例患者轻度张口受限,所有患者张口轨迹均偏向患侧。侧向运动中患侧运动平均幅度(10.34±1.27) mm,健侧(6.94±2.41) mm,差异有统计学意义。术后患者最大开口度均值为(30.65±17.32) mm,下颌边缘运动特点与术前患者一致。术前患者最大力咬合时,患侧咬肌肌电活动[44.20 (5.70, 197.90) μV]和颞肌的肌电活动中位数[42.15 (22.90, 155.00) μV]略低于健侧咬肌[45.60 (7.50, 235.40) μV]和健侧颞肌[63.30 (44.10, 126.70) μV],咀嚼时未见异常。术后则出现了个性化的改变,部分患者患侧肌电活动减弱,部分患者患侧肌电活动亢进。结论良、恶性肿瘤及手术均可造成下颌运动和双侧咬肌和颞肌的肌电活动异常。

关键词: 下颌运动, 肌电图, 头颈部肿瘤, 修复重建, 咀嚼肌

Abstract: Objective: To study the clinical characteristics of mandibular movement and masticatory muscle function in preoperative and postoperative patients with unilateral mandibular tumors in the region of mandibular body and ramus by combining digital mandibular movement records with electromyography, and to preliminarily explore the relationship and mechanism between movement and masticatory muscle function.Methods: Six preoperative patients with tumor in unilateral body and ramus of mandible were included, and three postoperative patients with unilateral segmental resection and reconstruction of mandibular bone were included. The mandibular movement recording system and surface electromyography system were used to collect the movement trajectory of the patients’ mandibular marginal movement and chewing movement, and the surface electromyography of bilateral masseter and temporalis was recorded concurrently. The surface electromyography of bilateral masseter and temporalis was collected when the patients were at relaxation and at maximal voluntary clenching (MVC). The motion trajectory was observed on the digital virtual model, and the motion amplitude and direction of mandibular marginal movements were analyzed. The characteristics of masticatory electromyogram (EMG) activity in affected and unaffected sides at relaxation, MVC and bilateral mastication were analyzed, and the asymmetry indexes and activity indexes were calculated. Results: The preoperative mean maximum opening of the patients was (35.20±6.87) mm. Three patients had mild mouth opening limitation, and all the patients’ mouth opening trajectory was skewed to the affected side. During lateral movements, the mean range of motion of the affected side [(10.34±1.27) mm] and that of the healthy side [(6.94±2.41) mm] were significantly different. The maximum opening of the postoperative patients was (30.65±17.32) mm, and the mandibular marginal movement characteristics were consistent with those of the patients before surgery. During MVC in the preoperative patients, the median EMG activities of the masseter muscle [44.20 (5.70, 197.90) μV] and the temporalis muscle [42.15 (22.90, 155.00) μV] on the affected side were slightly lower than those of the masseter [45.60 (7.50, 235.40) μV] and the temporalis muscle [63.30 (44.10, 126.70) μV] on the healthy side. In the postoperative patients, individualized changes occurred. Some patients suffered from weakened electromyographic activity on the affected side, while some other ones showed hyperelectromyographic activity on the affected side.Conclusion: Both benign and malignant tumors as well as their surgery can cause abnormal mandibular movements and change of electromyographic activity of bilateral masseter and temporalis muscles.

Key words: Mandibular movement, Electromyography, Head and neck tumor, Rehabilitation and reconstruction, Masticatory muscle

中图分类号:

R782.13

王晶,陈俊鹏,王洋,许向亮,郭传瑸. 数字化下颌运动记录及咀嚼肌肌电图在下颌骨肿瘤患者口颌功能评价中的应用[J]. 北京大学学报（医学版）, 2019, 51(3): 571-578.

Jing WANG,Jun-peng CHEN,Yang WANG,Xiang-liang XU,Chuan-bin GUO. Application of digital mandibular movement record and masticatory muscle electromyography in the evaluation of stomatognathic function in patients with mandibular tumor[J]. Journal of Peking University(Health Sciences), 2019, 51(3): 571-578.

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No.	Gender	Age/years	Diagnosis	Benign/ malignant	Tumor range	Muscle involved
1	F	64	Gingival SCC	M	Right second premolar to middle ramus	Part of temporalis and medial pterygoid
2	F	18	Right mandibular fibrosis	B	Right second premolar to middle ramus	None
3	F	57	AME	B	Right first molar to upper ramus	Part of temporalis
4	F	73	Gingival SCC	M	Left first premolar to middle ramus	Part of masseter and temporalis
5	M	55	AME	B	Right first molar to sigmoid notch	Part of masseter and temporalis
6	F	22	AME	B	Right first molar to condylar neck	Part of masseter and medial pterygoid

No.	Gender	Age/ years	Diagnosis	Postoperation time	Osteotomy range	Muscle involved	Reconstruction method
7	M	24	AME	17 months	Right lateral incisor to right condylar neck	Part of the masseter, temporalis and medial pterygoid, lateral pterygoid	Fibula free flap
8	M	33	AME	9 months	Right central incisor to right mandibular angle	Part of the masseter, medial pterygoid	Iliac crest free flap
9	M	38	AME	10 months	Left canine to left condylar neck	Part of the masseter, temporalis and medial pterygoid	Fibula free flap

Muscle and kinetics	Preoperative/μV, median (min, max)	Postoperative/μV, median (min, max)
Relax
UM	3.90 (2.30, 7.60)	8.00 (5.60, 11.00)
AM	4.50 (2.00, 5.70)	5.20 (4.90, 6.00)
UT	8.15 (4.10, 21.80)	5.60 (3.20, 7.80)
AT	9.85 (5.80, 59.20)	5.90 (5.90, 7.00)
MVC
UM	45.60 (7.50, 235.40)	77.80 (53.50, 95.00)
AM	44.20 (5.70, 197.90)	65.20 (13.70, 103.90)
UT	63.30 (44.10, 126.70)	34.90 (28.80, 165.60)
AT	42.15 (22.90, 155.00)	19.90 (13.90, 371.80)

Patients	Total asymmetry index	Masseter asymmetry index	Temporalis asymmetry index	Activity index
Relax
1	-0.08	-0.04	-0.10	-0.38
2	-0.61	0.14	-0.75	-0.67
3	-0.18	0.07	-0.20	-0.85
4	-0.15	-0.14	-0.16	-0.18
5	0.13	-0.16	0.24	-0.47
6	-0.14	0.07	-0.31	-0.07
7	0.07	0.14	-0.03	0.10
8	0.14	0.38	-0.30	0.27
9	0.05	0.04	0.05	-0.16
MVC
1	0.15	0.01	0.32	0.11
2	-0.26	0.02	-0.41	-0.31
3	0.32	0.43	0.24	-0.19
4	0.12	0.28	-0.10	0.13
5	-0.12	-0.23	0.17	0.45
6	0.48	0.14	0.51	-0.82
7	0.24	0.19	0.43	0.53
8	0.52	0.70	0.18	0.31
9	-0.37	-0.32	-0.38	-0.55

数字化下颌运动记录及咀嚼肌肌电图在下颌骨肿瘤患者口颌功能评价中的应用

Application of digital mandibular movement record and masticatory muscle electromyography in the evaluation of stomatognathic function in patients with mandibular tumor

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