上海市2001-2005年狂犬病流行状况及防治对策

2001年以来上海市的狂犬病病例均为外来人口，犬伤门诊就诊人数持续增多，2003年起狂犬伤人事件时有发生，狂犬病流行特征发生了改变，现对2001～2005年上海市狂犬病流行特征以及在犬伤者中采取的措施进行分析。     

医源性胆管损伤诊治分析

目的探讨医源性胆管损伤的原因、治疗及预防。方法回顾分析23例医源性胆管损伤。结果医源性胆管损伤多发生于胆囊切除术，胆道解剖异常、局部病理因素、术中出血及麻醉欠佳、患者体型等为其客观因素；而本组人为因素非常明显，损伤与过分自信、草率，盲目追求小切口、高速度有关。不同类型的胆管损伤应采取不同方法及早处理；术中发现者，可行裂口修补或端端吻合、T管支撑引流术，强调置管时间不少于6个月。对胆漏先行胆道及腹腔引流术，3个月后再作胆道重建术，手术方法以胆管空肠Roux—en—Y吻合最为理想。术后黄疸病例行胆管空肠Roux—cn—Y吻合术，疗效佳。结论提高医生对胆管损伤的警觉性，术中解剖清楚，是预防医源性胆管损伤的关键。     

杭州地区蜘蛛咬伤临床特征分析

目的 分析杭州地区蜘蛛咬伤病例的临床特征。方法 回顾性分析2020年4月～2021年11月因蜘蛛咬伤收治我科住院患者71例，对患者人群特征、临床表现、实验室检查结果、诊疗情况、转归进行分析、总结。结果 被咬伤人群主要为中青年，每年5~9月为发病高峰期，咬伤部位主要在双下肢，71例患者中58例患者仅有局部症状，13例患者除了局部症状还伴有全身毒性反应发症。 结论：杭州地区蜘蛛毒性较小，伤人后主要以局部症状为主，合理的局部和全身治疗均能得到痊愈。     

Anterior segmental osteotomies without orthodontics: practicability of the correction of dentoalveolar deformities

We designed this study to determine the efficiency and stability of anterior segmental osteotomies (ASO) without orthodontics for various dentofacial deformities. Records of patients treated with maxillary or mandibular ASO, or both, without orthodontics in the past 15 years were analysed. The assessment included postoperative analysis of patients’ aesthetics and functional satisfaction using a questionnaire and grading (score 0 - 4) system, and the amount of relapse calculated from 12-month postoperative cephalograms. A total of 26 ASO subjects (age range 13- 31 years) were studied (14 maxillary, two mandibular, and 10 bimaxillary). Long-term stability was acceptable in all cases with no significant relapse (p>0.05). No major complications were encountered. All patients reported good to excellent (score = 3 to 4) satisfaction following surgery. Using meticulous planning and a careful surgical technique, ASO without orthodontics is a simple, quick, safe, and stable option for the correction of dentofacial deformities.     

Precision of maxillo-mandibular registration with intraoral scanners in vitro

PurposeTo compare the precision of maxillo-mandibular registration and resulting full arch occlusion produced by three intraoral scanners in vitro.MethodsSix dental models (groups A–F) were scanned five times with intraoral scanners (CEREC, TRIOS, PLANMECA), producing both full arch and two buccal maxillo-mandibular scans. Total surface area of contact points (defined as regions within 0.1 mm and all mesh penetrations) was measured, and the distances between four pairs of key points were compared, each two in the posterior and anterior.ResultsTotal surface area of contact points varied significantly among scanners across all groups. CEREC produced the smallest contact surface areas (5.7–25.3 mm²), while PLANMECA tended to produce the largest areas in each group (22.2–60.2 mm²). Precision of scanners, as measured by the 95% CI range, varied from 0.1–0.9 mm for posterior key points. For anterior key points the 95% CI range was smaller, particularly when multiple posterior teeth were still present (0.04–0.42 mm). With progressive loss of posterior units (groups D–F), differences in the anterior occlusion among scanners became significant in five out of six groups (D–F left canines and D, F right canines, p < 0.05).ConclusionsMaxillo-mandibular registrations from three intraoral scanners created significantly different surface areas of occlusal contact. Posterior occlusions revealed lower precision for all scanners than anterior. CEREC tended towards incorrect posterior open bites, whilst TRIOS was most consistent in reproducing occluding units.     

三种数字化分析算法测量咬合接触分布及面积的对比研究

目的:研究三种数字化分析算法测量石膏牙颌模型三维咬合接触分布及面积的检测效果,并与传统咬合分析方法进行比较,探究各数字化分析算法的特点和应用。方法:选取一副正常受试者的上、下颌石膏牙颌模型,使用3shape E4牙颌模型三维扫描仪进行数字化扫描得到数字模型,在三维测量分析软件Geomagic Studio 2013及Geomagic Qualify 2013中采用“三维偏差色阶图法”、“点云统计分析法”和“虚拟咬合纸法”三种数字化分析算法获得相应的三维咬合接触分布及面积,同时使用牙合记录硅橡胶法及咬合纸扫描法两种传统咬合分析方法获得咬合接触分布和面积。各方法的咬合检测阈值为100 μm,量化评价各数字化分析算法与传统咬合分析方法的检测结果。结果:上述五种方法所得的全牙列咬合接触分布的定性评价结果基本一致,三维偏差色阶图法、点云统计分析法、虚拟咬合纸法、牙合记录硅橡胶法和咬合纸扫描法所得到的总咬合接触面积分别为133.10 mm ²、142.08 mm ²、128.95 mm ²、163.31 mm ²、100.55 mm ²。三种数字化分析算法间的检测结果差异性不大,数字化方法与传统方法检测的总咬合接触面积有一定差异。结论:三种数字化分析算法均可提供较为可靠、准确的牙颌模型咬合接触分布及面积量化分析结果,可为口腔临床修复体数字化设计制作及咬合分析提供参考。     

交叉专科护理在颧骨复合体骨折患者中的应用分析

目的:分析交叉专科护理在颧骨复合体骨折患者治疗中的作用价值,为后续临床护理提供方法参考.方法:25例颧骨复合体骨折患者于2017年1月-2019年1月期间在我科室接受治疗,患者围术期均采取眼科及口科的交叉专科护理,分析护理效果.结果:25例患者术后颜面情况恢复良好,术后并发症较少;随访6个月后患者眼球内陷等状况改善,咬合状况良好.结论:颧骨复合体骨折临床治疗中采取交叉专科治疗可明显提高治疗效果,降低术后并发症发生率,具有临床推广价值.     

Comparison of immediate complete denture, tooth and implant-supported overdenture on vertical dimension and muscle activity

PURPOSE

To compare the changes in the occlusal vertical dimension, activity of masseter muscles and biting force after insertion of immediate denture constructed with conventional, tooth-supported and Implant-supported immediate mandibular complete denture.

MATERIALS AND METHODS

Patients were selected and treatment was carried out with all the three different concepts i.e, immediate denture constructed with conventional (Group A), tooth-supported (Group B) and Implant-supported (Group C) immediate mandibular complete dentures. Parameters of evaluation and comparison were occlusal vertical dimension measured by radiograph (at three different time intervals), Masseter muscle electromyographic (EMG) measurement by EMG analysis (at three different positions of jaws) and bite force measured by force transducer (at two different time intervals). The obtained data were statistically analyzed by using ANOVA-F test at 5% level of significance. If the F test was significant, Least Significant Difference test was performed to test further significant differences between variables.

RESULTS

Comparison between mean differences in occlusal vertical dimension for tested groups showed that it was only statistically significant at 1 year after immediate dentures insertion. Comparison between mean differences in wavelet packet coefficients of the electromyographic signals of masseter muscles for tested groups was not significant at rest position, but significant at initial contact position and maximum voluntary clench position. Comparison between mean differences in maximum biting force for tested groups was not statistically significant at 5% level of significance.

CONCLUSION

Immediate complete overdentures whether tooth or implant supported prosthesis is recommended than totally mucosal supported prosthesis.     

Comparative Analysis of Osteosynthesis of Mandibular Anterior Fractures Following Open Reduction Using ‘Stainless Steel Lag Screws and Mini Plates’

Introduction

The purpose of this study was to compare the outcome of open treatment of mandibular fracture (symphysis or parasymphysis) using lag screw or mini plate clinically as well as radiologically in young (age range 12–45 years) and healthy individuals of poor socioeconomic status.

Method

This prospective study was conducted on 30 patients diagnosed as cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups––Group A: Two 2.5 mm stainless steel lag screws were placed in 15 patients. Group B: Two 2.5 mm stainless steel mini plates were placed in 15 patients for the fixation of fractures. Subsequent follow up was done on 2nd, 4th, 6th and 8th week postoperatively. During every follow up patient was assessed clinically for infection, malocclusion, loosening of plate/screw, sensory disturbance, plate fracture, malunion/non-union, devitalisation of associated dentoalveolar segment and masticatory efficiency. Radiographs were taken if necessary and patients were further assessed for any complaint. Pain was objectively measured using a visual analogue scale, bite force was measured using a bite force transducer at biweekly interval. The data collected was subjected to unpaired t test and paired t test for statistical analysis.

Results

During follow up period a significant improvement in bite force was present in both the groups, with more improvement seen in the lag screw group (p < 0.01). There was a significant pain reduction present in the lag screw group (p < 0.01) and also masticatory efficiency showed a steadier improvement in lag screw group while mini plate group patients showed a tendency to masticate only food items of medium hard consistency.

Conclusion

The sample size is small to conclude lag screws are better than mini plates but the result of our study provides a basis for further studies done to conclude that the application of LAG SCREW is an effective, inexpensive, quick treatment modality to accelerate healing of fresh, displaced mandibular anterior fracture.