超声辅助颧弓骨折牵引复位的临床应用

目的：探讨超声辅助下牵引复位导板外固定治疗单纯闭合性颧弓骨折的可行性、准确性及临床应用价值。方法：对40例颧弓骨折在超声监测下钢丝牵引复位,同时根据骨折的方向调整牵引方向使骨折线对齐,导板固定2周后拆除。结果：全部病例复位成功,39例骨折端完全对位整齐,其中1例骨折端垂直向移位对位稍差,但术后功能及外形正常。结论：超声辅助下颧弓骨折复位具有复位疗效好、非手术复位,无X线辐射,费用低、美观,值得临床推广应用。     

The use of a single volar locking plate for AO C3-type distal radius fractures

Background

A single volar locking plate (VLP) is now frequently used for open reduction and internal fixation (ORIF) of many types of distal radius fractures. Comminuted intra-articular distal radius fractures (AO C3-type) are typically the most challenging to surgically treat. No studies directly address the adequacy of a VLP alone for maintaining reduction of AO C-type fractures. We hypothesized that a single VLP provides an effective method for maintaining reduction for these fractures.

Methods

We retrospectively evaluated radiographs of a series of AO C-type fractures. Seventy-seven patients with 77 AO C3-type fractures were identified from billing records and were eligible for the study. All patients were treated by fellowship-trained hand surgeons. Radiographs at the time of union were compared to those from immediately postoperatively.

Results

Sixty-nine of 77 (89.6 %) fractures treated with VLP fixation alone for AO C3-type distal radius fractures united without loss of reduction. Eight of 77 (10.4 %) patients treated with VLP for AO C3 fractures lost reduction. The most common fracture fragment to lose reduction was the lunate fossa (5 of 8); loss of reduction of the scaphoid fossa die-punch fragment (2 of 8) and the radial styloid (1 of 8) were also seen.

Conclusions

The majority (89.6 %) of AO C3-type fractures treated with a single volar locking plate come to union without loss of reduction.Level of evidence: Level IV.     

Hepatic artery reconstruction preserving the pancreaticoduodenal arcade in pediatric liver transplantation with celiac axis compression syndrome: Report of a case

CACS is rare, although it has been reported to be a potential risk factor for hepatic artery thrombosis following LT. We herein present the case of a 14‐yr‐old male with stenosis of the origin of the celiac trunk. Preoperative CT and color ultrasonography showed narrowing of the proximal celiac artery. The patient underwent DDLT with standard arterial reconstruction without dividing the gastroduodenal artery. His postoperative course was uneventful, with an excellent hepatic artery flow on Doppler ultrasonography. Applying a meticulous preoperative evaluation and the appropriate surgical technique is crucial in patients with CACS.     

仙灵骨葆胶囊治疗老年骨质疏松性腰椎压缩骨折40例

目的:观察仙灵骨葆胶囊治疗老年骨质疏松性腰椎压缩骨折的临床疗效。方法:将80例患者随机均分为2组。对照组行开放手术内固定治疗,术后给予常规性营养神经、止痛、消肿、加强骨组织营养、预防伤口感染等对症支持治疗,观察组在对照组基础上给予仙灵骨葆胶囊,口服,3粒/次,2次/d。连续服用6周。观察2组治疗前后疼痛情况、活动能力评分和骨密度及骨降钙素水平的变化情况。结果:疼痛及活动能力评分治疗前后2组组内比较,差异有统计学意义(P0.05);治疗后组间比较,差异也有统计学意义(P0.05)。骨密度及骨降钙素治疗前后2组组内比较,差异有统计学意义(P0.05);治疗后组间比较,差异也有统计学意义(P0.05)。结论:针对老年骨质疏松所致腰椎压缩性骨折患者,使用仙灵骨葆胶囊治疗,能有效提高骨密度,减轻患者痛苦,提高患者活动能力。     

Spatial frequency processing conditions on intraoral computed radiography

Radiographic information on the imaging plate was read with a pixel size of 50 μm×50 μm and recorded with 100 μm×100 μm. Various frequency-enhanced images were produced by an unsharp masking process that can maximize the spatial frequency enhancement at 0.25, 0.50, 1.00, 2.00, and 4.00 cycles/mm. Using these images, the effect of frequency enhancement processing for the X-ray diagnosis of normal anatomical structures and simulated bone changes on intraoral computed radiography was investigated. The imaging conditions under which the most valuable radiographic images for diagnosis of normal anatomical structures were obtained was a frequency type that diminished the low level density area, a non-linear gradation and an enhancement rank of 4 at the spatial frequency of 2.00 cycles/mm. These iamges projected a higher image quality than conventional periapical films. In addition, the intraoral computed radiography had equivalent or better ability to detect fine-simulated bone changes compared to conventional periapical films. These findings suggest that the spatial frequency enhancement area needed to obtain images with significant diagnostic value, equivalent to or better than conventional periapical film images, is 2.00 cycles/mm in intraoral computed radiography, with maximal spatial resolution of 5.00 cycles/mm.     

个体化钛支架在构筑颌骨三维形态中的应用

目的　在运用快速成型技术制作的颌骨模型上作成个体化钛支架 ,以构筑颌骨三维形态。方法　 18例颌骨缺损患者进行个体化钛支架联合游离组织瓣修复重建。其中 10例上颌骨缺损以钛网支架重建上颌骨前壁、外侧及底壁 ,如内侧壁缺损则一并恢复 ,其口鼻创面以前臂皮瓣或串联腓骨肌瓣修复 ;8例下颌骨缺损以钛板支架塑形 ,联合游离腓骨 ,精确恢复下颌骨外形及髁突生理位置。结果　所有的病例随访 6～ 12个月 ,除 1例于术后9个月眶外侧壁复发外 ,其余未见肿瘤复发。皮瓣除 2例因术后放疗部分坏死外全部成活。所有患者面部外形均非常满意 ,张口度 2 .5～ 4cm ,正常进食。上颌骨重建病人无口鼻瘘 ,语音较为清晰 ,下颌髁突均在正常解剖生理位置 ,面部软组织亦很对称。结论　个体化钛支架应用于颌骨重建 ,能够较为精确地恢复颌骨外形 ,有利于术中引导移植骨准确对位 ,可避免术后的继发功能障碍 ,有效节省手术时间 ,其在复杂颅颌面疾病诊治中的应用前景非常乐观。     

功能和固定矫治器联合矫治安氏Ⅱ类1分类骨性错畸形

目的 通过对功能和固定矫治器联合矫治恒牙列早期安氏Ⅱ类1分类骨性错(牙合)畸形的研究,探讨发育期骨性错(牙合)畸形一期矫治的优越性。方法 应用双(牙合)垫矫治器或斜面导板结合方丝弓矫治器对12例恒牙列早期安氏Ⅱ类1分类骨性错(牙合)联合矫治,对治疗前后头颅侧位定位片进行分析。结果 SNB角增加1.28°,FMA角无明显改变,OP-SN值变大,Go-Pog、Go-Ar都呈显著性增大,前牙覆盖减少7.26mm,上下唇至审美平面距离显著减小。结论 利用功能矫治器和固定矫治器联合一期矫治恒牙列早期安氏Ⅱ类1分类骨性错(牙合),,同样可收到双期矫治的效果。     

改良游离牙龈移植技术临床效果评价

目的:评价种植体周围改良游离牙龈移植技术的临床效果。方法:选择36例患者42个下颌后牙区种植位点,种植后颊侧龈缘中点处角化龈宽度均小于2 mm。修复前2个月采用改良游离牙龈移植技术,即供区使用个性化腭护板,受区使用个性化移植物压板。术后观察移植物的成活情况。术后即刻,术后2、6、12个月对种植体颊侧角化龈宽度进行测量。术后1、3、6 d用目测类比法（VAS）记录患者术创疼痛。采用SPSS 25.0软件包对数据进行配对t检验和单因素方差分析。结果:42个种植位点移植瓣均成活。术前种植体颊侧角化龈宽度平均（0.39±0.41）mm,术后12个月平均（4.17±0.43）mm,与术前相比,平均增加（3.78±0.21）mm,平均收缩量为（1.12±0.12）mm。结论:改良游离牙龈移植技术可有效增加种植体颊侧角化龈宽度,术后1年移植物收缩量较小,患者术后疼痛不明显。