模拟上颌前牵引对上颌骨位置及骨缝影响的动物实验研究
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摘要
安氏Ⅲ类错(牙合)是口腔正畸临床中常见的一类错(牙合)畸形，严重影响颌、(牙合)、面的生长发育，影响口腔功能及颜面美观，病因机制较为复杂，是正畸临床矫治的重点和难点。其中，以上颌骨发育不足为主要畸形表现的患者，临床常采用矫形力牵引上颌骨向前进行矫治。但是对上颌前牵引是否能促进上颌骨发生适应性生长改建，其作用方式、作用机理是什么，目前尚不清楚，而且较深入的相关基础研究较少。本研究结合临床，建立了模拟上颌前牵引的SD大鼠动物模型，对上颌骨位置及骨缝的改变进行实验研究，以了解上颌骨及其骨缝在矫形力作用下发生的变化，从而探讨上颌前牵引的矫治机理，为其临床应用提供部分理论依据。
本研究采用自行设计的上颌前牵引装置，以生长发育期5周龄SD大鼠为实验对象，施加85g的矫形力，建立了模拟上颌前牵引的动物模型，通过X线头影测量分析，观察施力4周后上颌骨的生长发育情况；应用免疫组织化学技术，检测同一力值作用不同时段下TGF-β_1在上颌骨的额颌缝、腭颌缝的表达，彩色病理图象分析系统测定每张切片中阳性染色细胞的平均灰度值，结果采用SPSS
11.0进行方差分析。
结果如下：在模拟上颌前牵引矫形力作用下，(1)生长发育期大鼠上颌复合体在矢状方向生长加快，长度明显增加，并表现出向前向上的逆时针旋转；(2)上切牙唇倾，下切牙的唇倾度没有明显变化，颅脑的形态与大小不受影响；(3)额颌缝和腭颌缝中TGF-β_1的表达，同一时段实验加力组要强于手术对照组与自然生长组，而手术对照组与自然生长组之间无显著性差异。结果说明：模拟上颌前牵引矫形力能加速生长发育期大鼠上颌的向前生长，能促进上颌骨周围骨缝的积极改建，TGF-β_1在上颌骨缝的改建中发挥了重要作用。同时说明，本研究建立的生长发育期SD大鼠上颌前牵引动物模型能较准确地模拟临床上颌前牵引矫治，国内外尚未见报道。
Angle' s class Illmalocclusion is a kind of common dentofacial deformities in orthodontic practice, which can severely degrade the craniofacial development, oral function and facial aesthetics. Having complicated etiological mechanism, it is difficult to correct and should be pay more attention to. The maxillary protraction with orthopedic force is often used to treat those with the primary deformity of maxilla underdevelopment. But whether the maxillary protraction can promote the adaptive growth remodeling of maxilla, what its working biomechanism is, these questions are not solved yet presently, and the relative basic research is quite few. In our research, combined with the orthodontic clinic, the pubertal SD Rats were selected to establish the animal model for simulating maxillary protraction. And in this basis, the changes of the position and sutures of maxilla are investigated to explain what happened to the maxilla and the maxillary sutures with exerting orthopedic force on maxilla, to explore the wo
rking biomechanism of the maxillary protraction and provide partly theoretic basis for orthodontic practice.
In this research, the pubertal five-week-old SD rats were chose as experimental object to establish the animal model for simulating maxillary protraction, on which was imposed the orthopedic force of 85g with utilizing the self-devised maxillary protraction appliance. Located lateral X-ray cephalograms were taken to measure and analyze the changes of maxillary development after exerting the orthopedic force for 4 weeks. The technique of immunohistochemistry was used to investigate the
expression of TGF- , in frontomaxillary sutures (FMS) and palatomaxillary sutures(PMS) with identical force performing for different extent of time. The average hue was selected as indicator, which was measured by the means of the analysis system of pathological color images. The measuring data were analyzed by the one-way ANOVA in software SPSS 11.0 version.
The results are as follows: (1) With the imposing of orthopedic force of simulating maxillary protraction on maxilla, in the sagittal direction, the maxillary complex of the SD Rats in experimental group grows more quickly than that in two control groups, and the extent of the maxillary complex increases more evidently. The maxillary complex displays anti-clockwise forward and upward rotation. (2) With the imposing of orthopedic force on maxilla, upper incisors exhibit labial-inclined, labioclination of lower incisors changes insignificantly, and the shape and the dimension of skull are not affected significantly. (3) The expression of TGF-3 , in frontomaxillary sutures and palatomaxillary sutures shows different intensity in different extent of time. But The expression of TGF-{3, in experimental group is more intensive than that in two control groups, and that in operated control group and natural growth group has no significant difference. The results suggest that: In pubertal SD Rats, the orthopedic forc
e for maxillary protraction can accelerate forward growth .promote the active remodeling of maxillary sutures; TGF- Piplays an important role in the remodeling of maxillary ' sutures. It also indicates that the animal model for simulating maxillary protraction established in this research can imitate precisely the maxillary protraction applying in the clinics, as haven' t been seen yet from the reports internally and internationally.
本研究采用自行设计的上颌前牵引装置，以生长发育期5周龄SD大鼠为实验对象，施加85g的矫形力，建立了模拟上颌前牵引的动物模型，通过X线头影测量分析，观察施力4周后上颌骨的生长发育情况；应用免疫组织化学技术，检测同一力值作用不同时段下TGF-β_1在上颌骨的额颌缝、腭颌缝的表达，彩色病理图象分析系统测定每张切片中阳性染色细胞的平均灰度值，结果采用SPSS
11.0进行方差分析。
结果如下：在模拟上颌前牵引矫形力作用下，(1)生长发育期大鼠上颌复合体在矢状方向生长加快，长度明显增加，并表现出向前向上的逆时针旋转；(2)上切牙唇倾，下切牙的唇倾度没有明显变化，颅脑的形态与大小不受影响；(3)额颌缝和腭颌缝中TGF-β_1的表达，同一时段实验加力组要强于手术对照组与自然生长组，而手术对照组与自然生长组之间无显著性差异。结果说明：模拟上颌前牵引矫形力能加速生长发育期大鼠上颌的向前生长，能促进上颌骨周围骨缝的积极改建，TGF-β_1在上颌骨缝的改建中发挥了重要作用。同时说明，本研究建立的生长发育期SD大鼠上颌前牵引动物模型能较准确地模拟临床上颌前牵引矫治，国内外尚未见报道。
Angle' s class Illmalocclusion is a kind of common dentofacial deformities in orthodontic practice, which can severely degrade the craniofacial development, oral function and facial aesthetics. Having complicated etiological mechanism, it is difficult to correct and should be pay more attention to. The maxillary protraction with orthopedic force is often used to treat those with the primary deformity of maxilla underdevelopment. But whether the maxillary protraction can promote the adaptive growth remodeling of maxilla, what its working biomechanism is, these questions are not solved yet presently, and the relative basic research is quite few. In our research, combined with the orthodontic clinic, the pubertal SD Rats were selected to establish the animal model for simulating maxillary protraction. And in this basis, the changes of the position and sutures of maxilla are investigated to explain what happened to the maxilla and the maxillary sutures with exerting orthopedic force on maxilla, to explore the wo
rking biomechanism of the maxillary protraction and provide partly theoretic basis for orthodontic practice.
In this research, the pubertal five-week-old SD rats were chose as experimental object to establish the animal model for simulating maxillary protraction, on which was imposed the orthopedic force of 85g with utilizing the self-devised maxillary protraction appliance. Located lateral X-ray cephalograms were taken to measure and analyze the changes of maxillary development after exerting the orthopedic force for 4 weeks. The technique of immunohistochemistry was used to investigate the
expression of TGF- , in frontomaxillary sutures (FMS) and palatomaxillary sutures(PMS) with identical force performing for different extent of time. The average hue was selected as indicator, which was measured by the means of the analysis system of pathological color images. The measuring data were analyzed by the one-way ANOVA in software SPSS 11.0 version.
The results are as follows: (1) With the imposing of orthopedic force of simulating maxillary protraction on maxilla, in the sagittal direction, the maxillary complex of the SD Rats in experimental group grows more quickly than that in two control groups, and the extent of the maxillary complex increases more evidently. The maxillary complex displays anti-clockwise forward and upward rotation. (2) With the imposing of orthopedic force on maxilla, upper incisors exhibit labial-inclined, labioclination of lower incisors changes insignificantly, and the shape and the dimension of skull are not affected significantly. (3) The expression of TGF-3 , in frontomaxillary sutures and palatomaxillary sutures shows different intensity in different extent of time. But The expression of TGF-{3, in experimental group is more intensive than that in two control groups, and that in operated control group and natural growth group has no significant difference. The results suggest that: In pubertal SD Rats, the orthopedic forc
e for maxillary protraction can accelerate forward growth .promote the active remodeling of maxillary sutures; TGF- Piplays an important role in the remodeling of maxillary ' sutures. It also indicates that the animal model for simulating maxillary protraction established in this research can imitate precisely the maxillary protraction applying in the clinics, as haven' t been seen yet from the reports internally and internationally.
引文
1．傅民魁等．中国25392名儿童与青少年错(牙合)畸形患病率的调查．中华口腔医学杂志，2002；37(5)：371～373
2．周征，罗颂椒，徐国标．前伸下颌后大鼠髁突软骨生长改建的定量组织学研究．口腔正畸学，1998；5：77
3．罗颂椒，周征．功能矫形前伸大鼠下颌后髁突IGF-Ⅰ表达变化的研究．华西口腔医学杂志．1998；16：161～163
4．徐芸等．双阻板磁力矫治器矫治早期AngleⅢ类错骀．中华口腔医学杂志，1999；34(3)：148～150
5．吴拓江．颌间Ⅲ类矫形力对上颌骨位置及周围骨缝影响的动物实验研究．硕士学位论文，2003
6. Moss ML, Salentyin L. The primary role of functional matrices in facial growth. Am J Orthod, 1969; 55:566
7. Van Lionborgh J. The role of genetic and local environmental factors in the control of postal craniofacial morphogenesis. Acta Morphol, Neerl Scand, 1972; 10: 37
8．罗颂椒主编．当代实用口腔正畸技术与理论(第一版)．北京医科大学中国协和医科大学联合出版社．1996；17～20,31～32
9. Baylink-DJ, et al. Growth factors to stimulate bone formation. J-Bone-Miner-Res. 1993; Dec, 8 Suppl 2:S565～72
10. Baccetti, -T, et al. Skeletal effects of early treatment of class Ⅲ malocchision with maxillary expansion and face-mask therapy. Am-J-Orthod-Dentofac-Orthop, 1998; 113 (3): 333～343
11. Miyasaka-Hirage-J, et al. Finite element analysis for stresses in the craniofacial sutures produces by maxillary protraction forces applied at the upper canine. Br-J-Orthod. 1994; 21 (4): 343～348
12．房兵，邱蔚六，袁文化等．矫治前颌骨对人工腭裂大鼠上颌骨生长发育影响的X线头影测量研究．华西口腔医学杂志．2000：18 (3)：185～188
13. Mustafa Ulgen, Sedat Baran, Hakan Kaya, et al. The influence of the masticatory hypofunction on the craniofacial growth and development in rats. Am J Orthod Dentofac Orthop, 1997; 111(2):189～198
14．罗颂椒，饶跃，王大章等．功能矫形前伸下颌对幼年大鼠颅面颌生长发育影响的研究．华西口腔医学杂志，1992：10：205～209
15．熊宇，容国俊，孙远等．Photoshop在X线头影测量中的应用．口腔正畸学．2002：9(3)：130～131
16. Carlson DS, et al. experimental studies of growth and adaptation of TMJ. Current advances in oral surgery. Vol Ⅲ, St. Louis: Mosby, 1980
17. AsanoT. The effects of mandibular retractive force on the growing rat mandible. Am J Orthod, 1986; 90: 464
18. Spector, -J-A, et al. A molecular analysis of the isolated rat posterior frontal and sagittal sutures: differences in gene expression. Plast-Reconstrsurg. 2000; 106 (4): 852～861
19. Braun, -S, et al. The biomechanics of rapid maxillary sutural expansion. Am-J-Orthod-Dentofac-Orthop. 2000; 1118 (3): 257～261
20. Baccetti, T, et al. Skeletal effects of early treatment of class Ⅲ malocchision with maxillary expansion and face-mask therapy. Am J Orthod Dentofac Orthop, 1998; 113 (3): 333～43
21．彭友俭，高嘉泽 主编．口腔正畸早期治疗学(第一版)．湖北科学技术出版社．2001：31，71～72
22. Weijs WA.Mandibular movements of albino rat during feeding.J Morphol,1975;145:107
23．赵美英，罗颂椒，陈扬熙．牙颌面畸形功能矫治(第一版)．北京：人民卫生出版社，2000
24．胡蕴玉．骨诱导及骨愈合分子生物学研究进展．中华骨科杂志．1997，7(1)：17
25. Lind-M, et al. Chemotaxis of human osteoblasts. Effects of osteotropic growth factors. APMIS, 1995, 103 (2): 140～146
26. Sakai-K, Mohtai-M, Iwamoto-Y. Fluid shear stress increases transforming growth factor beta 1 expression in human osteoblast-like cells: modulation by cation channel blockades. Calcify-Tissue-Int. 1998,63(6):515～520
27. Neidlinger-Wilke C. J Biomech, 1995;28(12):1411～1418
28. Tuner CH, Forwood MR. What role does the osteocyte network play in bone adaption? Bone, 1995:283
29. Sawada,-M, Shimizu,-N. Stimulation of bone formation in the expanding mid-palatal suture by transforming growth factor beta 1 in the rats. Eur-J-Orthod. 1996, Apr, 18(2):169～179
30．李小兵，罗颂椒，张世羽．功能矫形前伸大鼠下颌后髁突软骨β转化生长因子-1(TGF-β_1)表达变化的研究．华西口腔医学杂志，1998；16(4)：352～354
2．周征，罗颂椒，徐国标．前伸下颌后大鼠髁突软骨生长改建的定量组织学研究．口腔正畸学，1998；5：77
3．罗颂椒，周征．功能矫形前伸大鼠下颌后髁突IGF-Ⅰ表达变化的研究．华西口腔医学杂志．1998；16：161～163
4．徐芸等．双阻板磁力矫治器矫治早期AngleⅢ类错骀．中华口腔医学杂志，1999；34(3)：148～150
5．吴拓江．颌间Ⅲ类矫形力对上颌骨位置及周围骨缝影响的动物实验研究．硕士学位论文，2003
6. Moss ML, Salentyin L. The primary role of functional matrices in facial growth. Am J Orthod, 1969; 55:566
7. Van Lionborgh J. The role of genetic and local environmental factors in the control of postal craniofacial morphogenesis. Acta Morphol, Neerl Scand, 1972; 10: 37
8．罗颂椒主编．当代实用口腔正畸技术与理论(第一版)．北京医科大学中国协和医科大学联合出版社．1996；17～20,31～32
9. Baylink-DJ, et al. Growth factors to stimulate bone formation. J-Bone-Miner-Res. 1993; Dec, 8 Suppl 2:S565～72
10. Baccetti, -T, et al. Skeletal effects of early treatment of class Ⅲ malocchision with maxillary expansion and face-mask therapy. Am-J-Orthod-Dentofac-Orthop, 1998; 113 (3): 333～343
11. Miyasaka-Hirage-J, et al. Finite element analysis for stresses in the craniofacial sutures produces by maxillary protraction forces applied at the upper canine. Br-J-Orthod. 1994; 21 (4): 343～348
12．房兵，邱蔚六，袁文化等．矫治前颌骨对人工腭裂大鼠上颌骨生长发育影响的X线头影测量研究．华西口腔医学杂志．2000：18 (3)：185～188
13. Mustafa Ulgen, Sedat Baran, Hakan Kaya, et al. The influence of the masticatory hypofunction on the craniofacial growth and development in rats. Am J Orthod Dentofac Orthop, 1997; 111(2):189～198
14．罗颂椒，饶跃，王大章等．功能矫形前伸下颌对幼年大鼠颅面颌生长发育影响的研究．华西口腔医学杂志，1992：10：205～209
15．熊宇，容国俊，孙远等．Photoshop在X线头影测量中的应用．口腔正畸学．2002：9(3)：130～131
16. Carlson DS, et al. experimental studies of growth and adaptation of TMJ. Current advances in oral surgery. Vol Ⅲ, St. Louis: Mosby, 1980
17. AsanoT. The effects of mandibular retractive force on the growing rat mandible. Am J Orthod, 1986; 90: 464
18. Spector, -J-A, et al. A molecular analysis of the isolated rat posterior frontal and sagittal sutures: differences in gene expression. Plast-Reconstrsurg. 2000; 106 (4): 852～861
19. Braun, -S, et al. The biomechanics of rapid maxillary sutural expansion. Am-J-Orthod-Dentofac-Orthop. 2000; 1118 (3): 257～261
20. Baccetti, T, et al. Skeletal effects of early treatment of class Ⅲ malocchision with maxillary expansion and face-mask therapy. Am J Orthod Dentofac Orthop, 1998; 113 (3): 333～43
21．彭友俭，高嘉泽 主编．口腔正畸早期治疗学(第一版)．湖北科学技术出版社．2001：31，71～72
22. Weijs WA.Mandibular movements of albino rat during feeding.J Morphol,1975;145:107
23．赵美英，罗颂椒，陈扬熙．牙颌面畸形功能矫治(第一版)．北京：人民卫生出版社，2000
24．胡蕴玉．骨诱导及骨愈合分子生物学研究进展．中华骨科杂志．1997，7(1)：17
25. Lind-M, et al. Chemotaxis of human osteoblasts. Effects of osteotropic growth factors. APMIS, 1995, 103 (2): 140～146
26. Sakai-K, Mohtai-M, Iwamoto-Y. Fluid shear stress increases transforming growth factor beta 1 expression in human osteoblast-like cells: modulation by cation channel blockades. Calcify-Tissue-Int. 1998,63(6):515～520
27. Neidlinger-Wilke C. J Biomech, 1995;28(12):1411～1418
28. Tuner CH, Forwood MR. What role does the osteocyte network play in bone adaption? Bone, 1995:283
29. Sawada,-M, Shimizu,-N. Stimulation of bone formation in the expanding mid-palatal suture by transforming growth factor beta 1 in the rats. Eur-J-Orthod. 1996, Apr, 18(2):169～179
30．李小兵，罗颂椒，张世羽．功能矫形前伸大鼠下颌后髁突软骨β转化生长因子-1(TGF-β_1)表达变化的研究．华西口腔医学杂志，1998；16(4)：352～354