无牙颌的种植义齿支持式固定修复——附1例病例报道

目的:探讨无牙颌固定式种植义齿修复模式和临床应用体会,为无牙颌患者的临床治疗提供一些有意义的参考。方法:报道1例全口无牙颌患者的种植修复诊疗全过程及3年追踪观察的临床疗效。结果:19枚种植体术中及术后均未发生感染及神经损伤等并发症,修复前均达到骨结合;义齿固位效果良好,达到患者对美观和功能的要求,疗效满意。结论:全口无牙颌的种植义齿支持式固定修复可有效恢复咀嚼功能,改善患者容貌,临床效果可靠,是一种值得推广的无牙颌修复方式。     

上颌后牙区骨量严重不足的种植1例临床报告

种植修复已成为临床上牙列缺损或缺失后常规的义齿修复方法.上颌后部牙齿缺失需要种植的病例约为种植病例的1/3,该部位由于有上颌窦的存在,使得牙齿缺失后牙槽嵴顶距上颌窦底的高度有限,往往不能满足种植的需要,上颌窦外侧壁开窗窦底提升植骨术有效地解决了这一问题.本文就1例上颌窦底位置较低同时伴有牙槽嵴顶严重吸收的病例,行上颌窦...     

维生素D受体基因TagI和BsmI位点单核苷酸多态性与种植体周围炎的易感性研究

目的研究维生素D受体（vitaminDreceptor,VDR）基因TagI和BsmI位点单核苷酸多态性与种植体周围炎易感性的关系。方法采用病例对照试验设计,收集种植体周周炎组及无种植体剧围炎组各50例,应用聚合酶链反应一限制性内切酶片段长度多态性分析方法研究2组VDRTagI和BsmI位点的基因型以及等位基因分布特点,并探讨其与种植体周围炎的相关性。结果VDR基因BsmI位点各基因型（X2=3．184,P=0．074）和等位基冈频率（,=3．269,P=0．071）在2组问分布差异无统计学意义。VDR基冈TagI位点主要基因型为TT纯合子和Tt杂合子,2种基因型（X2=4．337,P=0．037）和T、t等位基因频率（X2=3．907,P=0．048）在2组的分布差异具有统计学意义。TT型在种植体周围炎组中较为多见。结论避免吸烟、牙周炎病史等混杂因索后,种植体周围炎与VDRTaql位点单核苷酸多态性间存在遗传相关性,尚不能认为与BsmI位点的多态性相关。     

Autologous chondrocyte implantation drives early chondrogenesis and organized repair in extensive full‐ and partial‐thickness cartilage defects in an equine model

Autologous chondrocyte implantation (ACI) has been used clinically for over 15 years and yet definitive evidence of chondrocyte persistence and direct impact on cartilage repair in full‐thickness lesions is scant and no data are available on ACI in partial‐thickness defects in any animal model. This study assessed the effect of chondrocytes secured using periosteal overlay in partial‐ and full‐thickness cartilage defects in the equine model. Paired cartilage defects 15 mm in diameter were made in the patellofemoral joint of 16 horse and repaired with ACI or periosteal flap alone. Response was assessed at 8 weeks by clinical, microradiographic, and histologic appearance, and by collagen type II immunohistochemistry, and proteoglycan and DNA quantification. ACI improved histologic scores in partial‐ and full‐thickness cartilage defects, including defect filling, attachment to the underlying subchondral bone, and presence of residual chondrocyte accumulations. For partial‐thickness defects chondrocyte predominance, collagen type II content, and toluidine stained matrix were enhanced, and attachment to the surrounding cartilage improved. DNA and PG content of grafted partial‐thickness defects was improved by chondrocyte implantation. Periosteal patches alone did not induce cartilage repair. This study indicated implantation of chondrocytes to cartilage defects improved healing with a combination of persisting chondrocyte regions, enhanced collagen type II formation, and better overall cartilage healing scores. Use of ACI in the more challenging partial‐thickness defects also improved histologic indices and biochemical content. The equine model of cartilage healing closely resembles cartilage repair in man, and results of this study confirm cell persistence and improved early cartilage healing events after ACI. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29: 1121–1130, 2011     

Cardiac surgery in the Pacific Islands

Background: Rheumatic heart disease constitutes a significant disease burden in under‐resourced communities. Recognition of the devastating impact of rheumatic heart disease has resulted in volunteer cardiac teams from Australasia providing surgical services to regions of need. The primary objective of this study was to compare New Zealand hospitals' volunteer cardiac surgical operative results in Samoa and Fiji with the accepted surgical mortality and morbidity rates for Australasia. Methods: A retrospective review from seven volunteer cardiac surgical trips to Samoa and Fiji from 2003 to 2009 was conducted. Patient data were retrospectively and prospectively collected. Preoperative morbidity and mortality risk were calculated using the European System for Cardiac Operative Risk Evaluation (euroSCORE). Audit data were collated in line with the Australasian Society of Cardiac and Thoracic Surgeons guidelines. Results: One hundred and three operations were performed over 6 years. EuroSCORE predicted an operative mortality of 3.32%. In‐hospital mortality was 0.97% and post‐discharge mortality was 2.91%, resulting in a 30‐day mortality of 3.88%. Conclusion: This study demonstrated that performing cardiac surgery in Fiji and Samoa is viable and safe. However, the mortality was slightly higher than predicted by euroSCORE. Difficulties exist in predicting mortality rates in patients with rheumatic heart disease from Pacific Island nations as known risk scoring models fail to be disease, ethnically or culturally inclusive. Audit processes and risk model development and assessment are an essential part of this complex surgical charity work and will result in improved patient selection and outcomes.     

激光泪道成形联合硅胶管植入术治疗上泪道阻塞的临床观察

目的:观察激光泪道成形联合硅胶管植入术治疗上泪道阻塞的临床效果。方法:上泪道阻塞患者128例148眼,全部有流泪病史,均经泪道冲洗检查确诊,行激光泪道成形联合硅胶管植入术,保留硅胶管1a,拔管后随访24mo,定期冲洗泪道,观察泪道通畅情况。结果:拔管后治愈120眼(81.08%),无流泪,泪道保持通畅;好转18眼(12.16%),流泪减轻,泪道通而不畅;无效10眼(6.76%),仍流泪,泪道冲洗不通。总有效率达93.24%。结论:激光泪道成形联合硅胶管植入术是治疗上泪道阻塞的有效方法。     

难治性青光眼复合式小梁切除联合羊膜植入术疗效观察

目的:观察难治性青光眼复合式小梁切除联合羊膜植入术临床疗效。方法:选择我院80例86眼难治性青光眼患者,随机分为复合式小梁切除术联合羊膜植入术组(实验组)43眼和复合式小梁切除术组(对照组)43眼。观察术后眼压、滤过泡形成情况及并发症。结果:随诊12mo,平均眼压:实验组15.5±1.1mmHg,对照组19.7±2.5mmHg,两组术后平均眼压差异有统计学意义(P<0.05);功能性滤过泡:实验组(86%)较对照组(67%)多,差异有统计学意义(P<0.05);术后并发症(浅前房、脉络膜脱离和滤过泡渗漏)发生率实验组明显低于对照组。结论:复合式小梁切除联合羊膜植入术治疗青光眼具有手术成功率高,术后并发症发生率低的特点。     

表面麻醉小切口白内障摘除联合IOL植入术治疗白内障

目的: 观察在表面麻醉下手工小切口白内障手术的效果。方法: 选择2010-01/2013-03在我院眼科进行白内障复明手术者358例372眼,观察术中疼痛感、术后视力及并发症。结果: 手术过程中患者无痛感,术中麻醉效果明显,能很好地配合手术者342眼(91.9%);术中偶感轻微疼痛,可忍受并能配合手术顺利完成者17眼(4.6%);另有8眼(2.2%)患者因疼痛无法耐受手术;5眼(1.3%)患者因无法固视而改行球后或球周麻醉。术后第3d最佳矫正视力4.0～4.5者57眼(15.9%),4.5～4.8者213眼(59.3%),4.8以上者89眼(24.8%)。结论: 表面麻醉下非超声乳化小切口白内障手术避免了相应的并发症,手术时间明显缩短,手术质量较好,适宜于基层的防盲治盲工作。     

白内障超声乳化联合人工晶状体植入术对眼表的影响

目的:观察白内障超声乳化联合人工晶状体植入手术后眼表情况的变化。方法:收集2011-08/2012-10间我院眼科收治的老年性白内障患者78例78眼,经颞侧透明角膜切口行白内障超声乳化联合人工晶状体植入术。分别于术前、术后1d;1wk;1,3,6mo观察眼表情况,记录眼表刺激症状、角膜荧光素染色、泪膜破裂时间、泪液分泌实验(SchirmerⅠtest,SⅠt),并对数据进行统计分析。结果:术后1wk内,患者有明显的干眼症状,术后1d;1wk;1mo,角膜荧光素着色较术前明显增多,而泪液分泌量明显减少,差异具有统计学意义(P<0.05),术后3,6mo与术前无明显差异(P>0.05)。术后1mo内泪膜破裂时间较术前明显缩短(P<0.05),3mo时降至术前水平(P>0.05)并保持至术后6mo。结论:白内障超声乳化联合人工晶状体植入手术对眼表具有一定程度的影响,临床应积极采取措施进行预防和治疗。     

Ahmed valve implantation for neovascular glaucoma after 23-gauge vitrectomy in eyes with proliferative diabetic retinopathy

AIM:To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR).METHODS: Twelve medically uncontrolled NVG with earlier 23-gauge vitrectomy for PDR underwent AGV implantation. The control of intraocular pressure (IOP), preoperative and postoperative best-corrected visual acuity, the development of intraoperative and postoperative complications were evaluated during the follow-up.RESULTS: The mean follow-up was 15.4±4.3 months (9-23 months). Mean preoperative IOP was 49.4±5.1mmHg and mean postoperative IOP at the last visit was 17.5±1.6mmHg. The control of IOP was achieved at the final follow-up visits in all patients, however, 8 of 12 patients still needed anti-glaucoma medication (mean number of medications, 0.8±0.7). The visual acuity improved in nine eyes, and the visual acuity unchanged in three eyes at the final follow-up visits. The complications that occurred were minor hyphema in three eyes, choroid detachment in two eyes, and the minor hyphema and choroid detachments were reabsorbed without any surgical intervention.CONCLUSION: AGV implantation is a safe and effective procedure that enables successful IOP control and vision preservation in the NVG patients with the history of earlier 23-gauge vitrectomy for PDR.