Email Alert | RSS

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

• 论著 • 上一篇    下一篇

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△()   

  1. 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△()   

  1. 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)

RICH HTML

   

PDF (PC)

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

图1

Zebris颌运动记录系统的安装"

图2

下颌运动虚拟可视化模型"

表1

下颌肿瘤患者术前临床资料"

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

表2

下颌肿瘤重建术后患者临床资料"

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

图3

最大张口运动时的切点运动轨迹"

图4

活动指数在静息和最大力咬合状态下的变化趋势"

图5

术后患者8健侧、患侧分别咀嚼口香糖时两侧咬肌及颞肌的肌电图"

表3

咀嚼肌肌电活动的数据分析"

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)

表4

肌肉活动不对称指数"

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
[1] 袁道英, 杨佑成, 宋冰 . 下颌骨髁状突骨软骨瘤一例报告[J]. 中华肿瘤防治杂志, 2007,14(22):1759-1760.
[2] Krause I, Eisenstein B, Davidovits M , et al. Maxillomandibular brown tumor: a rare complication of chronic renal failure[J]. Pediatr Nephrol, 2000,14(6):499-501.
doi: 10.1007/s004670050803
[3] Park SR, chung SM, Lim JY , et al. Giant cell tumor of the mandible[J]. Clin Exp Otorhinolaryngol, 2012,5(1):49-52.
doi: 10.3342/ceo.2012.5.1.49
[4] 徐保华, 史宗道 . 下颌髁突原发肿瘤:附12例报告[J]. 实用口腔医学杂志, 2001,17(3):249-250.
[5] Marunick MT, Mathog RH . Mastication in patients treated for head and neck cancer: a pilot study.[J]. J Prosthet Dent, 1990,63(5):566-573.
doi: 10.1016/0022-3913(90)90078-Q
[6] Hidalgo DA . Fibula free flap: a new method of mandible reconstruction[J]. Plast Reconstr Surg, 1989,84(1):71-79.
doi: 10.1097/00006534-198907000-00014
[7] Urken ML, Buchbinder D, Weinberg H , et al. Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients[J]. Laryngoscope, 1991,101(9):935-950.
[8] Lee R, Slevin N, Musgrove B , et al. Prediction of post-treatment trismus in head and neck cancer patients[J]. Br J Oral Maxillofac Surg, 2012,50(4):328-332.
doi: 10.1016/j.bjoms.2011.06.009
[9] Kreeft AM, Krap M, Wismeijer D , et al. Oral function after maxillectomy and reconstruction with an obturator[J]. Int J Oral Max Surg, 2012,41(11):1387-1392.
doi: 10.1016/j.ijom.2012.07.014
[10] Akashi M, Shibuya Y, Takahashi S , et al. Four-dimensional computed tomography evaluation of jaw movement following mandibular reconstruction: a pilot study[J]. J Cranio Maxill Surg, 2016,44(5):637-641.
doi: 10.1016/j.jcms.2016.01.027
[11] Haraguchi M, Mukohyama H, Reisberg DJ , et al. Electromyographic activity of masticatory muscles and mandibular movemet during function in marginal mandibulectomy patients[J]. J Med Dent Sci, 2003,50(4):257-264.
[12] Yen CI, Chou PY, Chen CH , et al. Kinematic, kinetic and surface electromyography analysis following zygomatic fracture reconstruction[J]. J Med Biol Eng, 2017,37(4):468-473.
doi: 10.1007/s40846-017-0271-z
[13] Ishida S, Shibuya Y, Kobayashi M , et al. Assessing stomatognathic performance after mandibulectomy according to the method of mandibular reconstruction[J]. Int J Oral Max Surg, 2015,44(8):948-955.
doi: 10.1016/j.ijom.2015.03.011
[14] 樊英显, 孙宏晨, 徐勇忠 . 颞下颔关节紊乱综合征患者咀嚼肌肌电分析[J]. 口腔医学研究, 1994(3):149-150.
[15] Campillo B, Martín C, Palma JC , et al. Electromyographic activity of the jaw muscles and mandibular kinematics in young adults with theoretically ideal dental occlusion: reference values[J]. Med Oral Patol Oral Cir Bucal, 2017,22(3):e383-e391.
[16] 黄超, 许向亮, 孙玉春 , 等. 下颌髁突功能面三维运动轨迹的初步推算和模拟[J]. 中华口腔医学杂志, 2018,53(10):669-673.
[1] 徐心雨,吴灵,宋凤岐,李自力,张益,刘筱菁. 基于下颌运动轨迹的正颌外科术中下颌骨髁突定位方法及初步精度验证[J]. 北京大学学报（医学版）, 2024, 56(1): 57-65.
[2] 刘梅歌,方朴,王严,丛璐,范洋溢,袁远,徐燕,张俊,洪道俊. 远端型遗传性运动神经病8例的临床、病理及遗传学特点[J]. 北京大学学报（医学版）, 2021, 53(5): 957-963.
[3] 房硕博,杨广聚,康艳凤,孙玉春,谢秋菲. 数字化辅助确定再定位牙合垫颌位方法的探索和精度评价[J]. 北京大学学报（医学版）, 2021, 53(1): 76-82.
[4] 刘小璇,张朔,刘娜,孙阿萍,张英爽,樊东升. 震颤分析用于早期帕金森病的诊断价值[J]. 北京大学学报（医学版）, 2019, 51(6): 1096-1102.
[5] 闫树东,杨广聚,莫思怡,刘云,谢秋菲. 大鼠后肢长期抗阻训练对慢性咬肌机械痛觉敏感性的影响[J]. 北京大学学报（医学版）, 2019, 51(1): 21-27.
[6] 李健男，冯芝恩，王琳，王衣祥，郭传瑸. 乏氧诱导因子-1α在口腔鳞状细胞癌颈淋巴转移中的作用[J]. 北京大学学报(医学版), 2018, 50(1): 26-32.
[7] 于尧, 章文博, 王洋, 刘筱菁, 郭传瑸, 俞光岩, 彭歆. iPlan CMF软件辅助下增强CT三维重建在头颈部肿瘤治疗中的应用[J]. 北京大学学报(医学版), 2017, 49(5): 878-882.
[8] 王威，郑磊，刘树铭，黄明伟，石妍，吕晓鸣，张杰，张建国. 单纯放射性粒子治疗后的头颈部腺源性癌远处转移[J]. 北京大学学报(医学版), 2017, 49(3): 547-550.
[9] 刘存瑞， 徐啸翔， 曹烨， 谢秋菲. 咬合干扰时间因素对大鼠咀嚼肌机械痛觉敏感的影响[J]. 北京大学学报(医学版), 2016, 48(1): 51-56.
[10] 张杰, 郑磊, 刘树铭, 黄明伟, 高岩, 张祖燕, 张建国. 空心针穿刺活检在口腔颌面部肿瘤的应用[J]. 北京大学学报（医学版）, 2012, 44(5): 801-803.
[11] 江萍, 马月, 王俊杰, 冉维强, 姜玉良, 曲昂. 超声引导放射性125I粒子植入治疗头颈部复发肿瘤[J]. 北京大学学报（医学版）, 2012, 44(2): 291-294.
[12] 马长城, 王振宇, 于涛. C1-2哑铃型肿瘤的手术治疗[J]. 北京大学学报（医学版）, 2011, 43(2): 301-303.
[13] 张杰, 郑磊, 黄明伟, 刘树铭, 贾凌飞, 石妍, 俞光岩, 张建国. 放射性粒子组织间植入治疗口腔颌面-头颈部腺源性恶性肿瘤近期疗效分析[J]. 北京大学学报（医学版）, 2011, 43(2): 272-275.
[14] 曹烨, 李锴, 傅开元, 谢秋菲. 咬合干扰致大鼠咬肌组织蛋白基因产物及P物质表达变化[J]. 北京大学学报（医学版）, 2010, 42(1): 50-55.
[15] 周崇阳, 杨朝晖, 冯海兰. 咬合重建对咀嚼肌肌电图协同模式的近、远期影响[J]. 北京大学学报（医学版）, 2008, 40(3): 323-326.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部