“迷你”负压引流在前臂游离皮瓣移植供区缺损修复中的应用

目的: 探讨“迷你”负压引流在前臂游离皮瓣移植供区缺损修复中的应用效果。方法: 选择口腔颌面部恶性肿瘤患者44例,均接受前臂游离皮瓣移植同期修复肿瘤切除术后缺损,采用腹部全厚皮片修复前臂供区缺损,分别应用“迷你”负压引流法（22例）和传统加压法（22例）。观察评估术后前臂区域引流量、移植皮片愈合情况和患者主观满意程度,采用SAS 9.4软件包对数据进行统计学分析。结果: “迷你”负压引流组22例患者中,20例皮片完全成活,创面平整,愈合良好,无结痂、渗出及感染;2例皮片边缘部分坏死,简单清理换药后痊愈。传统加压组22例患者中,18例皮片完全成活,4例出现部分坏死。术后随访6~10个月,“迷你”负压引流组皮片颜色接近正常皮色,手部运动、感觉功能正常,患者主观满意度显著高于传统加压组（P<0.05）。结论: “迷你”负压引流应用于前臂皮瓣制备后缺损的植皮修复,安全有效,成本低廉,患者满意舒适度高,值得临床推广应用。     

“青马工程”实施背景下高校学生骨干培育径探析

高校学生骨干是大学生中的典型代表,也是“青年马克思主义者培养工程”的主要培育对象。为了更好地推进“青马工程”,发挥其对高校学生骨干培育的重要作用,本文主要采取文献研究和调查研究的方法,对“青马工程”实施背景下高校学生骨干培养的重要意义、现状进行剖析,进而从模式、方法和保障等方面探讨培养路径,以期提升高校学生骨干培养的科学性、系统性和有效性。     

“盾构术”应用于美学区种植的研究进展

上前牙美学区在拔牙后常发生唇侧牙槽骨吸收、塌陷,极大影响种植后前牙区的美学效果。为了尽可能保存唇侧软、硬组织,近年来有学者提出了“盾构术”的概念,即通过保留唇侧部分牙根,以保存束状骨-牙周膜复合体,从而减少吸收。本文就“盾构术”近年来的研究进展进行回顾,并对影响“盾构术”效果的因素及其较传统即刻种植的优势与局限性进行综述。     

“新净界漱口水”对放射性口腔黏膜炎的防治效果观察

目的： 前瞻性随机双盲研究“新净界漱口水”对放射性口腔黏膜炎的防治效果。方法：60例拟行放疗的口腔癌患者随机分为试验组和对照组;试验组30例,自放疗第1天起,每天使用“新净界漱口水”含漱4次,每次5 mL,含漱 5 min,直至放疗结束。对照组30例使用生理盐水含漱,方法同试验组。按RTOG口腔黏膜炎分级标准评价2组患者的口腔黏膜炎严重程度,记录疼痛程度,并照相存档。3级口腔黏膜炎视为终止指标,发生者给予其他药物治疗。应用Stata 12.0软件包对数据进行统计分析。结果：2组患者的年龄、性别、放疗技术和剂量无显著差异（P>0.05）。试验组首次观察到黏膜炎的发生时间较对照组晚（照射11.0次∶9.1次,P<0.05）,且试验组在早期出现疼痛的比例较对照组低（36.7%∶70.0%,P<0.05）。另外,试验组3级口腔黏膜炎的出现时间较对照组晚（照射18.9次∶15.9次,P<0.05）,发生率较对照组低（63.3%∶90.0%,P<0.05）。结论：“新净界漱口水”能延缓放疗所致口腔黏膜炎的发生时间,减轻患者的疼痛症状,并能减少3级口腔黏膜炎的发生率,值得临床使用。     

微种植钉辅助无托槽隐形矫治器控制“过山车”效应的疗效分析

目的： 探讨微种植钉辅助无托槽隐形矫治器长距离内收上前牙、关闭间隙过程中控制“过山车”效应的临床疗效。方法： 选择双颌前突成人患者16例,男5例,女11例,平均年龄（25.1±2）岁。所有患者均拔除4颗第一前磨牙且采用无托槽隐形矫治器矫治,所有病例均采用G6设计,其中实验组（8例）在治疗初始即采用微种植钉进行牙的三维控制,对照组（8例）采用常规G6方案,出现明显的“过山车”效应时植入微种植钉辅助解决。采用 Graphpad Prism 6.0 软件包对治疗前、后数据及组间数据进行配对 t 检验。结果： 所有拔牙间隙均顺利关闭,面型获得明显改善。治疗中,实验组前牙转矩控制良好,未出现“过山车”效应;对照组6例在治疗中前牙明显舌倾（P<0.05）,后牙开,前牙区微种植钉施加压低力后,咬合关系改善。结论： 微种植钉能有效预防、消除无托槽隐形矫治器长距离关闭间隙过程中发生的“过山车”效应。     

基于解剖学的“五点八线”皮瓣设计用于半舌缺损精确修复的效果评价

目的: 使用“五点八线”技术（five-point eight-line segment, FIPELS）设计半舌缺损修复皮瓣,并比较“五点八线”技术与传统皮瓣移植方法的临床疗效。方法: 80例半舌缺损修复重建患者随机分为2组,分别为FIPELS组（42例）和传统皮瓣移植组（38例）,使用Likert量表比较2组患者的术后功能恢复及美观效果。采用SPSS 18.0软件包进行统计学分析。结果: FIPELS组的皮瓣与半舌缺损匹配度更高,术中无需修整皮瓣,手术时间较传统皮瓣移植组更短（P=0.02）。FIPELS组的术后吞咽功能、语言清晰度和美观度优于传统皮瓣移植组（P<0.05）。结论: 相比传统皮瓣移植方法,FIPELS设计的皮瓣用于半舌缺损修复具有更好的功能和美观效果。     

自制“V”形支架在眶内侧壁骨折复位术中的应用

目的 探讨鼻内镜下自制“V”形支架在眶内侧壁骨折复位术中的应用效果。方法 回顾性分析15例眶壁骨折患者,均在鼻内镜辅助下经鼻窦入路整复,并以“V”形支架进行支撑,观察临床疗效。结果 15例手术患者均成功整复到位,术后随访3~12个月,全部患者无并发症发生,临床疗效满意。结论 在眶壁骨折复位治疗中,应用自制“V”形支架,可以取得满意疗效。     

半程导板引导下颌“All-on-Four”种植修复一例

本文报道在半程导板引导下采用“All-on-Four”种植修复下颌牙列缺损一例,该患者下颌多颗牙缺失,伴有重度慢性牙周炎。术前对患者进行全面的口腔检查及影像学检查,确定数字化个性化种植方案,制作半程导板。术中拔除下颌余留牙,在截骨导板引导下行下前牙区截骨,增加前牙区修复空间,改善过深的spee曲线,在种植导板引导下行“All-on-Four”种植修复,即刻戴入下颌临时固定义齿。6个月后复查,见种植体骨结合良好,临时义齿功能良好,行下颌永久义齿修复。4个月后随访,见修复效果稳定。     

基于解剖学的“五点八线区”技术用于标准化次全舌重建效果评价

目的：使用基于解剖学的“五点八线区”皮瓣设计技术进行次全舌重建,并进行临床疗效评价。方法：44例舌鳞癌患者采用股前外侧皮瓣进行次全舌重建。根据皮瓣设计方法随机分为2组,分别为“五点八线区”（five-points eight-line-segments, FIPELS）组（23例）和传统皮瓣移植组（21例）。所有患者均进行神经重建,将皮瓣的皮神经与舌神经或舌咽神经吻合。利用Likert量表评估吞咽功能、语言清晰度和美观度,并评价重建舌的精细觉、本体感觉的敏感性、温度觉。采用SPSS 18.0软件包进行统计学分析。结果：除3例患者出现部分坏死外,其余皮瓣均愈合良好。与传统方法相比,FIPELS技术可以获得更大面积的皮瓣;FIPELS组患者的吞咽功能（P=0.016）和美观度（P=0.001）显著改善,但语言清晰度无显著提高（P=0.064）。2组患者在精细觉、本体感觉的敏感性、温度觉方面恢复效果相近。结论：使用基于解剖学的FIPELS技术进行精确次全舌重建,能获得理想的临床效果,值得推广应用。     

All-on-4种植即刻修复对口腔健康相关生活质量的影响

目的: 应用口腔健康影响程度量表（OHIP-14）观察all-on-4种植修复对牙列缺失患者口腔健康相关生活质量的影响。方法: 对11例单颌或全口牙列缺失患者采用all-on-4进行种植即刻修复,单颌植入4~6颗种植体,采用树脂临时固定桥修复,临时固定桥戴用3~6个月后进行永久性支架固定桥修复,以OHIP-14中文版对患者种植前（T0）、临时固定修复后1周（T1）、永久修复后3个月（T2）的口腔健康相关生活质量（OHRQoL）进行问卷调查,比较不同阶段生活质量的变化。采用SPSS13.0软件包对量表数据进行统计学分析。结果: 总得分在T2期明显下降,“功能受限”、“生理性疼痛”、“心理不适”、“生理障碍”、“心理障碍”在T2期显著下降;另外“功能受限”、 “心理不适”、“生理障碍”、“心理障碍”在T1期也明显下降,但是“社会障碍”、“残疾”在治疗前、后无显著变化。结论: All-on-4种植治疗过程中,支架支持的固定永久修复对改善患者的OHRQoL优于树脂临时固定桥修复。     

Use of clinical services compared with patients' perceptions of and satisfaction with oral health status

OBJECTIVES: To examine the relationship between rates of clinical service use and self-reported perception of and satisfaction with oral health status. METHODS: Dental services provision rates were calculated using health maintenance organization electronic data for members 55 years of age and older with at least four years of eligibility between 1990 and 2000. A mail survey yielded 986 responses (response rate = 65.7%). Poisson regression was used to examine the relationship between service utilization rates and self-reported perception of and satisfaction with oral health status, controlling for age, education, sex, and marital status. RESULTS: Perceptions of oral health status and levels of satisfaction with oral health status generally were closely associated. Greater dissatisfaction with oral health status and perception of poorer oral health status were associated with higher usage of nonpreventive dental services. Less satisfaction with oral health status was associated with higher restorative services usage and lower preventive services usage and slightly associated with periodontal service usage. Perception of a less favorable oral health status was strongly associated with higher restorative and periodontal services usage, but had only a weak association with preventive services usage. CONCLUSIONS: Dental plan members' service use is associated with their perception of their oral health status and their level of satisfaction with it. Future work should seek to clarify whether opinions on oral health status and satisfaction are a result of clinical experiences over time or whether the behavior and the values associated with seeking and obtaining care instead shape opinions on status and satisfaction.     

MTA根尖屏障术治疗年轻恒牙根尖周炎的临床疗效及满意度评价

目的:比较MTA根尖屏障术和Vitapex根尖诱导成形术对年轻恒牙根尖周炎的临床疗效,并进行患者满意度评价.方法:将75例年轻恒牙根尖周炎患者随机分为对照组(n=37)和实验组(n=38),对照组患者行Vitapex根尖诱导成形术,实验组患者行MTA根尖屏障术,比较2组患者在3、6、9个月及1年复查时的临床疗效,以及接受治疗的平均次数和平均周期,并对2组患者在就医环境、医护服务、后期保健指导、治疗费用、治疗周期及治疗效果等6个方面进行满意度评价.采用SPSS19.0软件包对2组患者的临床疗效、治疗次数和周期以及满意度等指标进行统计学分析.结果:在3个月和6个月复查时,实验组的临床疗效优于对照组,但组间差异不显著(P＞0.05);在9个月和1年复查时,实验组的总有效率显著高于对照组(78.38％:94.74％,P=0.037;75.68％:97.37％,P=0.006).实验组的治疗次数和治疗周期均显著低于对照组(P均＜0.05),分别为(3.24±0.39)次、(0.68±0.23)个月和(7.78±0.65)次、(8.24±2.95)个月.2组患者对就医环境、医护服务、后期保健指导及治疗周期的满意率无显著差异(P＞0.05),但在治疗费用和治疗效果2个调查项目上,实验组患者的满意率显著高于对照组(P均＜0.05).结论:MTA根尖屏障术较使用Vitapex根尖诱导成形术临床疗效更优、治疗次数更少、治疗周期更短、患者满意度更高,适合在临床上推广应用.     

Patient satisfaction with emergency oral health care in rural Tanzania

Emergency oral health care, as conceived in Tanzania, is an on-demand service provided at a rural health center or dispensary by a Rural Medical Aide. The service includes: simple tooth extraction under local anesthesia, draining of abscesses, control of acute oral infection with appropriate drug therapy, first aid for maxillo-facial trauma, and recognition of oral conditions requiring patient referral for further care at the district or regional hospital dental clinic. The objective of the present study was to describe patient satisfaction with emergency oral health care services in rural Tanzania and determine the relative importance of factors influencing patient satisfaction. The study was carried out as a cross-sectional interview survey between April 1993 and May 1994 using a patient satisfaction questionnaire in rural villages in the Rungwe district of Tanzania. It included 206 patients aged 18 years or more who had received emergency oral health care between April 1993 and March 1994. Overall, 92.7% of the respondents re-ported that they were satisfied with the service. Patients who were married, had no formal education and lived more than 3 km from the dispensary were more likely to be satisfied with treatment. In a logistic regression model, a good working atmosphere at the dispensary, a good relationship between care provider and patients (art of care) and absence of post-treatment complications significantly influenced patient satisfaction with odds ratios of 10.3, 17.4 and 6.2, respectively.     

66例老年患者种植固定修复的长期临床效果观察

目的 评价老年患者种植义齿固定修复的长期临床效果.方法 1995年6月至2004年5月,为66例60岁以上老年患者植入了149颗种植体并完成上部结构修复,种植体系统分别为ITI系统和BLB系统.经过19个月至9年的追踪,进行X线片、临床观察、患者满意度调查评估.结果 61例患者141颗种植体完成骨整合.5例患者8颗种植体松动脱落,累积存留率94.63%.2例折断;烤瓷冠粘结患者中4例崩瓷,5例冠脱落.结论 种植义齿是有效的修复缺失牙的方法,但由于老年患者的生理心理特点,需要给予重视,口腔卫生差引发的感染是老年患者种植失败的主要原因.     

2018例口腔颌面外科日间手术临床分析

目的:总结中南大学湘雅医院口腔颌面外科开展日间手术的临床经验,探讨日间手术在口腔颌面外科的应用效果与安全性。方法:回顾分析2014年7月—2019年6月在中南大学湘雅医院日间手术中心进行治疗的所有口腔颌面外科患者的临床资料,包括患者年龄、性别、疾病名称、麻醉与手术方式或取消原因、住院时间、延期出院原因、术后并发症发生情况及医疗费用等。选取其中手术量最多的8种疾病,以普通住院病房为对照,比较同类型疾病平均住院时间与医疗费用的差异。采用SPSS 23.0软件包对数据进行统计学分析。结果:在纳入研究期间的5年内,中南大学湘雅医院共完成口腔颌面外科日间手术2018例,疾病类型以口腔颌面部软组织肿物、牙及颌骨病变、唾液腺疾病为主。患者年龄2~77岁,平均34.45岁,男女比例为6:4。手术取消率1.13%,术后并发症发生率0.64%,平均住院时间0.89 d,延迟出院率0.40%。与普通病房相比,同类型疾病住院时间与医疗费用均显著降低(P<0.05)。结论:口腔颌面外科能够实施日间手术的疾病类型多,患者依从性好,住院时间短,医疗资源利用率高。在规范管理的前提下,安全可行,值得进一步推广应用。     

Influence of patient,visit, and oral health factors on dental service provision

OBJECTIVES: Service provision should reflect the oral health of the patient. However, patient and visit factors may influence service patterns and the appropriateness of care delivered. The aim of this study was to examine factors associated with variation in dental services and to assess whether variation by patient and visit characteristics persisted after controlling for oral health status. METHODS: A random sample of Australian dentists was surveyed during 1997-98 (response rate = 60.3%). Private general practitioners (n = 345) provided data on service provision, as well as patient, visit and oral health variables from a log of a typical clinical day (n = 4,115 patients). Multivariate Poisson regression models were run for eight service areas (e.g., diagnostic, preventive, and restorative). RESULTS: Significant effects (P < .05) were observed for oral health factors in all eight models, visit factors in all eight models, patient demographics in four models, dental knowledge/behavior in one model, and area-based socioeconomic status in one model. CONCLUSIONS: After controlling for oral health, visit characteristics persisted as significant predictors of services, with nonemergency visits, insurance, and capital city location associated with more favorable service mix patterns. Higher socioeconomic status areas and payment scale ratings also were associated with a better service pattern in particular service areas. These findings show that a wide range of factors, in addition to oral health, contribute to variation in service provision.     

上海市社区口腔公共卫生人力资源及工作满意度调查

目的:调查上海市社区口腔公共卫生人力资源现状及其工作满意度,为完善社区口腔公共卫生服务能力建设提供依据.方法:采用普查方法,对上海市246家社区卫生服务中心参与口腔公共卫生服务的人员进行问卷调查,内容包括人员基本情况和工作满意度.采用SPSS 20.0软件包对工作满意度及人员基本情况进行统计学分析.结果:上海市有759...     

Determinants of general dentists' decisions to accept capitation payment: a conceptual model and empirical estimates

Abstract – Background: Shifts in payment options for dental care over several decades have resulted in more dental expenditures being paid through health maintenance organizations (HMOs), preferred provider organizations (PPOs), and capitation arrangements. Patients’ and employers’ choices to participate in these arrangements is determined in part by dentists’ willingness to participate in plans, and plan choices may be influenced by patient satisfaction, self‐reported oral health, and/or quality or cost of care. Objectives: This study examined determinants of dentists’ decisions to accept capitation payment for services. Research Design: Cross‐sectional mail survey in December 2006. Subjects: 1605 general dentists in Oregon. Measures: Questions addressed dentists’ perceptions of the importance of control over various practice parameters, willingness to accept capitation payment, employment or ownership status within the practice, and practice characteristics. Results: Capitation was accepted by 22.6% of the respondent dentists (n = 729). Reported average fees (2007 dollars) ranged from $60 (initial oral examination) to approximately $800 (porcelain crowns). The likelihood of accepting capitation payment was related to the number of dentists in the practice, but surprisingly owner‐dentists were no less likely than employee‐dentists (associates) to accept capitation. As expected, dentists’ usual and customary fees were negatively associated with accepting capitation. In contrast, measures of dentists’ importance of control were not related to decisions about capitation. Longer average appointment delays were related to acceptance of capitation, but the effects were small. Conclusions: Dentists’ behavior regarding payment acceptance is generally consistent with microeconomic theory of provider behavior. Study findings should inform practitioners, plan managers, and researchers in examining dentist payment decisions.     

老年患者口腔健康生命质量的相关因素分析

目的：初步研究老年口腔疾病患者的口腔健康生命质量及其影响因素。方法：选择在中山大学光华口腔医学院门诊就诊的250名55岁以上（含55岁）的老年人，应用老年口腔健康评价指数（geriatric oral healthassessment index，GOHAI）量表中文版、一般项目表及自我口腔健康评价表对其口腔健康生命质量进行调查，通过多元回归分析得出影响口腔健康生命质量的相关因素。结果：GOHAI中文版平均得分为12．26±7．67。多元回归方程为：GOHAI中文版得分=-6．477＋0．309×自我评价的口腔健康＋0．164×缺失牙数＋0．237×对口腔状况的满意度＋0．127×对生活的满意度，方程的决定系数为0．423。结论：自我评价的口腔健康、缺失牙数、对口腔状况的满意度及对生活的满意度是影响老年患者口腔健康生命质量的主要因素。     

甘肃省口腔健康流行病学抽样调查报告

目的:了解并分析甘肃省城乡人群口腔健康状况,为口腔预防保健工作提供信息支持.方法: 按照第三次全国口腔健康流行病学调查标准和方法,采用多阶段分层等容量随机抽样方法对3 158 名5、12、35～44、 65～74 岁4 个年龄组的甘肃省城乡常住人口进行口腔健康调查.结果: 被调查的4 个年龄组患龋率分别为55.80%、19.09%、61.95%、78.63%,龋齿充填率3.11%、10.76%、10.34%、4.60%;12、35～44、65～74 岁组牙龈出血检出率82.81%、93.55%、85.34%,牙结石检出率69.66%、99.37%、92.54%;35～44岁、65～74 岁组牙周袋检出率60.94%、62.20%,口腔黏膜病检出率6.32%、7.71%,义齿修复情况以可摘局部义齿和非正规固定桥多见.结论: 甘肃省城乡人群龋病患病情况低于2005 年全国平均水平,多数年龄组比1995 年甘肃省结果明显降低,但牙周病患病情况严重且高于全国平均水平.