67颗早期隐裂牙的临床分析

牙隐裂是中老年患者常发生的一种牙体慢性损伤，磨牙多见。由于病变位置隐匿 ,临床表现不一 ,易误诊或漏诊 ,处理不当往往造成患牙丧失。早期牙隐裂的诊断和有效治疗 ,对保存患牙功能甚为重要。作者从１９９６～１９９９年对５９例患者共６７颗早期隐裂牙采用综合治疗 ,疗效满意 ,现报道如下。材料与方法一、一般资料门诊随机抽取５９例患者共６７颗早期隐裂牙 ,男性５８颗 ,占７４．６% ,女性１７颗 ,占２５．４ %。牙位分布情况 :磨牙多见 ,共６３颗 ,占９３．９% ,尤其以上颌第一磨牙最多 ,共４６颗 ,占５６．１% ,下颌第一双尖牙最少为…     

牙隐裂的生物力学特征分析

目的:研究牙隐裂的磨牙及前磨牙的临床表现,探讨发病原因及不同的治疗方法。方法:对248颗出现牙隐裂的磨牙及前磨牙行临床调查,采取不同的治疗方法后,进行至少3年的随访。结果:牙隐裂发生频率为:下颌第一磨牙>上颌第一磨牙>上颌前磨牙>上颌第二磨牙>下颌第二磨牙>下颌前磨牙。调查发现患牙的同位牙中,对侧同位牙41颗牙,占16.5%,对颌同侧同位牙27颗牙,占10.1%,对颌对侧同位牙9颗牙,占3.6%有隐裂或因隐裂而发生的牙齿折裂。治疗方法中高嵌体对于有牙髓活力的隐裂牙,全冠对于无牙髓活力的隐裂牙治疗效果最佳,治愈率达93.1%。结论:牙隐裂的有较高的发病率,应针对引起牙隐裂的病因和采取有效的防治措施。     

全冠治疗对早期小儿牙隐裂牙体牙髓预后的作用初探

目的探讨全冠治疗对早期小儿牙隐裂牙体牙髓预后的作用。方法纳入2016年6月至2017年6月黑龙江省佳木斯市中心医院68例(82颗患牙)早期牙隐裂患儿,摸球法分为研究组(全冠治疗)与对照组(调颌充填治疗)。随访12个月,观察两组治疗效果及活髓保护成功率。结果治疗6个月研究组整体总有效率分别为(94.12%比70.59%,P=0.011),治疗12个月(97.06%比76.47%,P=0.032),差异均有统计学意义。治疗后6个月研究组活髓保护成功率高于对照组(95.24%比75.00%,P=0.007),治疗后12个月(97.62%比77.50%,P=0.014),差异均有统计学意义。结论早期小儿牙隐裂治疗中应用全冠治疗,能改善牙体牙髓预后,值得推广应用。     

牙隐裂的临床诊断及综合治疗

目的 探讨牙隐裂的临床诊断及综合治疗方法.方法 对无症状隐裂牙和有症状隐裂牙的临床诊断进行阐述,并针对16颗无症状早期隐裂牙中的13颗牙采取直接金属烤瓷冠(PFM)修复,58颗有症状隐裂牙采取完善根管治疗后.再行PFM修复.结果 在1～3年的疗效观察中,PFM修复的13颗无症状隐裂牙全部成功,成功率100%,58颗有症状隐裂牙总患牙保存率96.7%.结论 牙隐裂早期发现及早期PFM修复,可以减少牙髓炎和牙折裂的发生.     

牙隐裂的生物力学特征分析

目的：研究牙隐裂的磨牙及前磨牙的临床表现，探讨发病原因及不同的治疗方法。方法：对248颗出现牙隐裂的磨牙及前磨牙行临床调查，采取不同的治疗方法后，进行至少3年的随访。结果：牙隐裂发生频率为：下颌第一磨牙&;gt;上颌第一磨牙&;gt;上颌前磨牙&;gt;上颌第二磨牙&;gt;下颌第二磨牙&;gt;下颌前磨牙。调查发现患牙的同位牙中，对侧同位牙41颗牙，占16．5％，对颌同侧同位牙27颗牙。占10．1％，对颌对侧同位牙9颗牙，占3．6％有隐裂或因隐裂而发生的牙齿折裂。治疗方法中高嵌体对于有牙髓活力的隐裂牙，全冠对于无牙髓活力的隐裂牙治疗效果最佳，治愈率达93．1％。结论：牙隐裂的有较高的发病率，应针对引起牙隐裂的病因和采取有效的防治措施。     

牙隐裂与(牙合)关系的临床分析

目的：探讨牙隐裂与胎的关系及早期治疗的有效方法。方法：将60颗隐裂牙随机分为A、B、C三组。A、B组均采用调磨加充填法治疗．B组每三个月对患牙进行检查调牙合，C组采用烤瓷全冠修复治疗，治疗后每半年复查1次，连续观察2年，对临床疗效进行比较。结果：A、B、C三组隐裂牙2年治疗成功率分别为50％、65％和80％，三者之间的差异有统计学意义（P〈0．05）。结论：牙隐裂与[牙合]关系密切，良好的咬合关系能延缓隐裂的发展；烤瓷全冠早期修复治疗隐裂牙，可以减少牙髓炎和牙折裂的发生，是一种较好的牙隐裂早期治疗方法。     

隐裂牙保存活髓治疗的临床观察

<正>牙隐裂临床多选择根管治疗后全冠修复,但一概地去除牙髓显得可惜。笔者对隐裂牙牙髓保存治疗时机进行临床观察,报告如下。1材料与方法1.1材料(1)收治121例(156颗)恒牙隐裂牙患者,年龄19～53岁。通过临床表现和检查确诊为隐裂牙下颌磨牙96     

100例隐裂牙综合治疗临床分析

目的：探讨牙隐裂的临床综合治疗及疗效。牙隐裂是临床上常见的一种非龋性庆病，常被漏诊、误诊，临床应结合主诉、视诊、叩诊、冷热诊以及碘酊涂色综合诊断。隐裂牙一般好发于上颌第一磨牙，好发部位为近远中向窝沟正中裂。方法：根据牙隐裂的不同程度和不同临床表现，对100例隐裂牙进行调颌、充填、根管治疗后全冠修复，三个月、六个月、一年复查。以临床症状消除无接管、无松动、牙体完整，能行使正常咀嚼功能，X片示牙周及根周无明显病变为成功标准。结果：100颗隐裂牙治疗成功率达88％，其中调颌治疗成功率50％，充填治疗成功率62．5％，报管治疗后全冠修复成功率95％。结论：牙隐裂有多种诱发因素，与牙齿结构的薄弱环节、咀嚼力过大以及创伤颌作用密切相关。早期牙隐裂的细小裂纹与正常发育沟难以区别，漏诊、误诊率高，保留患牙防止折裂的关键是早期发现、综合治疗。     

窝沟封闭术预防性治疗磨牙(牙合)面窝沟浅龋的近期疗效观察

目的探讨可见光固化窝沟封闭剂治疗磨牙窝沟浅龋的临床应用价值。方法实验组60例6~15岁患者牙合面窝沟浅龋,在去龋后用光固化窝沟封闭剂对龋损部位及窝沟进行封闭术,并采用对侧同名牙或邻牙也有窝沟浅龋者作对照。结果随访1年发现,实验组无1例发展为中龋,而对照组有28颗(32.94%)发展为中龋。结论光固化窝沟封闭术作为磨牙牙合面窝沟浅龋的预防性治疗方法,有较好的近期临床疗效。     

牙隐裂86例临床诊治分析

目的探讨牙隐裂治疗方法和预防措施。方法回顾性分析86例牙隐裂患者(86颗隐裂牙)病因、牙位、牙髓治疗及牙冠修复情况。结果牙尖斜度大、创伤性颌力为发生牙隐裂主要病因;上颌磨牙尤其是第一磨牙隐裂发生率高,其次是下颌磨牙和上颌双尖牙;无牙髓炎症状的隐裂牙治疗有效率83.3%,而有牙髓炎症状的隐裂牙治疗有效率90.6%。结论早期诊断及合理治疗可有效防止牙隐裂的扩大,维护牙齿正常功能;预防性调磨陡峭牙尖可预防牙隐裂发生。     

一次性根管充填治疗隐裂牙伴牙髓炎的临床疗效分析

[目的]探讨一次性根管充填法治疗隐裂牙伴牙髓炎的临床疗效.[方法]回顾性分析并比较采用一次性根管充填治疗的47颗隐裂牙(治疗组)与采用传统根管充填治疗的50颗隐裂牙(对照组)的临床疗效.[结果]一次性根管充填治疗组治疗期间疼痛反应率17%与传统根管充填治疗组16%比较差异无显著性(P>0.01);一次性根管充填治疗组临...     

高频彩色多普勒超声在婴幼儿先天性肌性斜颈中的诊断价值

目的探讨高频彩色多普勒超声在婴幼儿先天性肌性斜颈（CMT）中的诊断价值。方法回顾性分析26例CMT患儿声像图特征。结果26例CMT患儿中病变发生在右侧胸锁乳突肌的14例,占53.8%,左侧12例,占46.2%。根据病变胸锁乳突肌超声声像图表现分为三型。①肿块型：5例（19.2%）,均呈不均匀低回声,肌纹理均不清晰,与正常肌肉组织之间有界限;②局部增厚型：13例（50%）,呈稍低回声12例,不均匀低回声1例,肌纹理均清晰,与正常肌肉组织相延续;③弥漫型：8例（30.8%）,回声无明显特殊改变,肌纹理均清晰,但其厚度与健侧相比有显著差异性。结论高频彩色多普勒超声在婴幼儿C MT早期诊断中有重要价值。     

磨牙隐裂综合征的临床治疗

目的探讨牙隐裂综合治疗的方法和临床疗效。方法选取53例磨牙隐裂综合征的患者,年龄28～58岁,随机分为两组,A组行常规根管治疗前仅降低咬合;B组在根管治疗的前,用临时树脂全冠进行保护。采用金属烤瓷全冠修复的原则进行治疗。结果冠修复前,A组4例发生牙折,B组无牙折发生。18个月随访显示:疗效显著,88.1%的患者咀嚼功能良好、无叩痛、无松动。X线片牙周组织及根尖周组织正常。两组有效率比较,差异无统计学意义。结论磨牙隐裂综合征采用根管治疗加全冠修复的方法可达到良好效果。其中在根管治疗前用临时树脂全冠保护,可大大降低治疗时及治疗后观察期的牙折率。     

Advanced core decompression,a new treatment option of avascular necrosis of the femoral head – a first follow‐up

Aseptic necrosis of the femoral head (AVN) leads to destruction of the affected hip joint, predominantly in younger patients. Advanced core decompression (ACD) is a new technique that may allow better removal of the necrotic tissue by using a new percutaneous expandable reamer. A further modification is the refilling of the drill hole and the defect with an injectable, hard‐setting, composite calcium sulphate (CaSO₄)–calcium phosphate (CaPO₄) bone graft substitute. Compression tests were performed on seven pairs of femoral cadaver bones. One femur of each pair was treated with ACD, while the opposite side remained untreated. Clinically, the postoperative outcome of 27 hips in 23 patients was performed by physical examination 6 weeks after ACD and at average follow‐up of 9.69 months, and compared with the preoperative results. MRI was used to assess the removal of the necrotic tissue, any possible progression of AVN and evaluation of collapse. In the biomechanical analysis, the applied maximum compression force that caused the fracture did not significantly differ from the untreated opposite side. The overall results of postoperative physical examinations were significantly better than preoperatively. Five hips (18.5%) were converted to a total hip replacement. The follow‐up MRIs of the other patients showed no progression of the necrotic area. The first follow‐up results of ACD have been encouraging for the early stages of aseptic necrosis of the femoral head. In our opinion, an assured advantage is the high stability of the femoral neck after ACD, which allows quick rehabilitation. Copyright © 2012 John Wiley & Sons, Ltd.     

Priming the tooth surface with chlorhexidine and antibacterial activity of resin cement

AIM: To evaluate the effect of priming the tooth surface with 2% chlorhexidine gluconate on antibacterial activity of resin cement.METHODS: Ten patients in whom a single missing tooth was present on both the right and left side in the upper or lower arch were selected. Two fixed partial dentures (FPDs) in each patient on the right and left side were planned. Each FPD was assigned either to the control or test group. In the control group, FPD was luted with resin cement and in the test group, the tooth surface was primed with 2% chlorhexidine gluconate before luting with resin cement. Bacteriological samples were collected at base line level, as the patient came to the outpatient department before the start of any treatment, 5 wk prior to cementation of FPD and at 13 wk (8 wk after final cementation). Microbiological processing of all samples was done and the results were statistically analyzed.RESULTS: In the test group, a predominance of aerobic/facultative gram positive cocci rod was seen which indicates a healthy periodontal site, whereas in the control group, a predominance of anaerobic gram negative rods was present which indicates an unhealthy periodontal condition. This is evident by the fact that the anaerobic bacteria percentage in the control sample is 57% and 15% in the test sample after 13 wk, whereas the aerobic/facultative bacteria percentage is 43% in the control sample and 85% in the test sample after 13 wk. The percentage of gram negative bacteria in the control sample is 61% and in the test sample is 20% after 13 wk, whereas the percentage of gram positive bacteria in the control sample is 39% and in the test sample is 80% after 13 wk. The shift from anaerobic gram negative bacteria to aerobic gram positive bacteria is clearly seen from the control to test sample after 13 wk.CONCLUSION: The present study demonstrated that priming the tooth surface with 2% chlorhexidine gluconate may enhance antibacterial activity of the resin cement.     

Microcarcinoma of the cervix uteri (author's transl)]

Microcarcinoma in the true sense of the word must be distinguished from so-called early stromal invasion. A clear diagnosis must be based on the histological investigation of an adequate biopsy specimen which encompasses the entire changes and enalbes tumour measurement in all three dimensions. With increasing experience it was recognized that the mortality due to microcarcinoma was very low even when limited surgery was performed. When only clearly defined cases were considered, the mortality was nill in early invasion and merely 1.2% in microcarcinomas with a fictitious volume of up to 500 cmm. Both morphological signs of regression of invasive buds and recent knowledge of tumour immunology point to the effectiveness of immunological defence reactions, which are directly related to the tumour mass. A correctly diagnosed microcarcinoma represents a still-localized disease process unless other speical criteria such as lymphatic invasion point to the possibility of discontinuous spread. The method of treatment must be chosen between the extremes: When the danger of metastasis may be neglected local excision of the total diseased area will suffice; in the opposite case, radical operation with lymphadenectomy is indicated. Limited treatment of a microcarcinoma is only justified following clear definition of the lesion based on adequately removed and histologically accurately analyzed biopsy material.     

早期帕金森病患者99Tcm—TRODAT-1多巴胺转运蛋白显像研究

目的 研究早期帕金森病（parkinson disease，PD）患者99Tcm—TRODAT—1多巴胺转运蛋白SPECT显像的特点和诊断价值。方法 15例早期PD患者和10例对照者，分别进行99Tcm—TRODAT—1多巴胺转运蛋白（dopamine transporter，DAT）显像，观察其放射性分布特点，并利用半定量分析法，分别计算纹状体（striatum，ST）、尾状核（caudate nucleus，CN）及壳核（putamen，PT）与小脑（cerebellum，CB）的放射性计数比值。比较对照组和早期PD患者两侧纹状体及主要区域DAT功能差异。结果 对照组ST／CB、PT／CB、CN／PD组对侧ST／CB、PT／CB、CN／CB分别为1.23±0．13、1.80±0．15、1．13±0.13；PD组同侧ST／CB、PT／CB、CN／CB分别为1．79±0．13、1．86±0．15、1．78±0.14。PD组对侧与对照组比较，其中ST／CB、PT／CB差异均有统计学意义（t=10．83、15．21，P均〈0.05）；而CN／CB差异无统计学意义（t=1.96，P〉0．05）。PD组对侧与PD组同侧比较，其中ST／CB、PT／CB差异均有统计学意义（t=10.55、11．69，P均〈0.05）；而CN／CB差异无统计学意义（t=1．08，P〉0．05）。结论 早期PD患者存在着惠肢对侧ST、PT区的DAT放射性摄取值的下降，因此99Tcm—TRODAT—1多巴胺转运蛋白SPECT显像可作为PD早期诊断的客观诊断指标之一。     

脑卒中偏瘫患者继发骨质疏松症的特点

背景脑卒中及脑损伤所致偏瘫后易造成继发性骨质疏松,其骨密度值和骨矿含量是预测骨质疏松骨折的危险性的有效参数.目的通过对偏瘫患者骨密度值及骨矿含量的测定与分析,探讨偏瘫患者骨质疏松发生的特点.设计病例分析.对象选择1999-03/2002-05在北京博爱医院神经康复科住院的偏瘫患者156例.男87例,女69例;年龄17～65岁,平均年龄(47.0±5.3)岁;病程19 d～1年,平均病程(5.0±3.5)个月;疾病类型脑梗死89例,脑出血67例;瘫痪侧别左侧79例,右侧77例.方法所有患者使用LUNAR双能X射线骨密度仪从头部至足部进行全身扫描,测量骨密度和骨矿含量.主要观察指标①不同病程偏瘫患者中骨质疏松发生率.②不同部位瘫痪患者的骨矿含量.结果156例患者全部进入结果分析.①病程在3～6个月骨质疏松发生率最高(44%,16/36),病程在9～12个月骨质疏松发生率最低(21%,7/33),总体骨质疏松发生率为31%(48/156).②病程在3个月内47例患者中有9例为弛缓性瘫,均患有骨质疏松,其中2例发生骨折.病程3～6个月36例患者中有3例为弛缓性瘫,也患有骨质疏松.③上肢患侧的骨矿含量明显低于健侧[(154.76±43.91)g,(172.59±43.78)g,(t=3.591,P＜0.001)].下肢患侧的骨矿含量与健侧基本接近[(463.41±309.28)g,(464.11±86.45)g,(t=0.027,P＞0.05)].结论偏瘫患者的骨量变化随偏瘫时间的不同有不同的变化.上肢患侧的骨矿含量低,下肢患侧骨矿含量接近正常,这是由于下肢较早的进行功能锻炼,说明骨量的大小与运动有密切关系.     

经颅多普勒超声对椎-基底动脉流速减慢的分析与探讨

目的通过经颅多普勒超声(TCD)检测椎-基底动脉,对平均血流速度(Vm)减慢病例进行分析,探讨引起椎-基底动脉Vm减慢的真正原因。方法对156例椎-基底动脉Vm减慢(至少一侧椎动脉Vm低于25cm/s或基底动脉Vm低于30cm/s)患者与椎-基底动脉血管CT(CTA)或血管造影(DSA)对照分析。结果156例患者中,椎-基底动脉正常者,18.6%;双椎动脉发育不对称者,17.3%;一侧椎动脉狭窄者,16.0%;双侧椎动脉狭窄者,19.2%;一侧椎动脉闭塞者,14.8%;一侧狭窄一侧闭塞者,9.0%;基底动脉狭窄者,5.1%。结论TCD在检测椎-基底动脉狭窄过程中发挥了不可替代的作用。     

It's a knockout: survey of the management of avulsed teeth

Avulsion of a tooth is a not uncommon childhood injury, with up to 16% of dental injuries involving the loss of a tooth. Although this is an apparently 'minor' injury, for a child there may be long-term psychological and treatment problems. Correct advice in the early stages of this injury, and the recognition that prompt treatment may allow a tooth to be successfully reimplanted are vital in the management of these injuries. Often, nursing staff in the accident and emergency or paediatric department may be asked for advice either professionally or informally, and can influence the long-term dental health for these patients. This paper looks at the knowledge of parents and healthcare professionals in the management of these injuries.