Herbst双期拔牙矫治对颞下颌关节位置影响的CBCT研究

目的:探讨Herbst双期拔牙矫治对颞下颌关节位置关系的影响.方法:纳入15例恒牙列早期安氏Ⅱ类错(牙合)下颌后缩患者,一期矫治采用Herbst矫治器,然后拔除每位患者的4个前磨牙;二期矫治采用edgewise固定矫治器.在Herbst矫治器矫治前两周(T1期)、Herbst矫治器初戴入矫治时(T2期)、Herbst矫治器拆除时(T3期)及二期固定矫治器拆除时(T4期)分别拍摄锥形束CT(cone beam computed tomography,CBCT).应用InvivoDental软件对CBCT图像进行三维重建,再对颞下颌关节间隙进行测量,并进行统计分析.结果:T1-T2-T3期,关节前间隙先减小后增大,关节上间隙、关节后间隙先增大后减小;T3-T4期,关节上、后间隙进一步减小,关节前间隙无明显变化;与T1期比,T4各关节间隙的变化均无明显差异.结论:髁突在关节窝中的位置在Herbst矫治开始时向前下移位,一期功能矫治结束时尤其双期矫治结束时几乎回到了治疗前的位置.     

特发性髁突吸收患者髁突形态特征的CBCT研究

目的:探讨特发性髁突吸收(ICR)患者髁突的三维形态特征.方法:选取符合ICR诊断的患者26例为实验组,无关节疾患的骨性Ⅰ类错(牙合)患者26例为对照组,对颞下颌关节(TMJ)行CBCT扫描,利用Mimics 17.0行三维重建,测量髁突大小及形态,并进行统计学分析.结果:实验组髁突体积、表面积变小(P＜0.01),前后径、内外径变短(P＜0.01),高度降低(P＜0.01),对照组及双侧发病组左右侧对比无明显差异(P＞0.05).结论:ICR患者髁突相比正常髁突,表现出三维方向上的形态改变,可用来评估ICR的进展、疗效及预后.     

膝屈伸肌群等速肌力训练改善膝骨性关节炎患者步态的效果分析

目的探讨膝屈伸肌群等速肌力训练改善膝骨性关节炎(KOA)患者步态的效果。方法采用前瞻性研究方法,为保证研究的安全性和科学性,选择2013年2月~2015年10月在我院诊治的KOA患者98例,根据入院顺序分为观察组与对照组各49例,两组都给予玻璃酸钠关节腔内注射和关节松动治疗,对照组给予积极康复训练,观察组给予膝屈伸肌群等速肌力训练,治疗观察时间都为4周。结果观察组与对照组的疗效优良率分别为93.9%和75.5%,观察组明显高于对照组(0.05)。治疗后观察组与对照组的Lysholm膝关节功能评分分别为(86.33±11.31)分和(75.84±10.71)分,都明显高于治疗前的(56.24±12.55)分和(56.24±11.12)分,组内与组间对比差异都有统计学意义(0.05)。观察组治疗后的屈肌PT与AOPT值分别为(21.87±3.67)N·m和(99.23±11.48)°,而对照组分别为(18.34±4.11)N·m和(89.02±10.45)°,都明显高于治疗前(0.05),且组间对比差异有统计学意义(0.05)。两组在治疗期间都无严重并发症,但观察组的恶心、呕吐、腹痛、腹胀等并发症发生率明显少于对照组(0.05)。结论膝屈伸肌群等速肌力训练在KOA患者中的应用能显著缓解疼痛、增强膝关节功能,具有很好的安全性,从而促进步态改善,具有重要的推广价值。     

钽棒植入与骨瓣移植治疗成年人早期股骨头坏死的近期疗效对比

目的:比较髓芯减压联合金属钽棒植入术与带血管蒂髂骨瓣转移术治疗成年早期股骨头坏死(osteonecrosis of the femoral head,ONFH)的近期临床疗效.方法:回顾性收集本院2012年1月至2015年2月间收治的83例(97髋)非创伤性ONFH患者病历资料,A组43例52髋行髓芯减压并钽棒植入术,B组40例47髋,行自身带血管蒂髂骨瓣转移术,术后随访1年,比较两组手术参数指标、术后1年Harris髋关节功能评分及手术疗效.结果:A组手术时间(40.7±10.3) min、术中失血量(88.0±27.1) mL、术后镇痛泵应用时间(1.68±0.32)d、拆线天数(12.8±1.5)d均显著低于B组[(82.5±17.2) min,(239.4±45.2) mL,(2.15±0.48)d,(14.2±1.9)d;P＜0.05].两组术后12个月Harris总评分及各项目评分均较术前显著提高(P＜0.0s),A组术后Harris总评分(88.4±5.9)及关节功能评分(41.5±4.8)均显著高于B组[(83.6±5.3),(37.5±6.1);P＜0.05].两组术后12个月髋关节功能优良率均较术前显著提高(P＜0.05),A组术后12个月优良率(92.3％)显著高于B组(76.6％,P＜0.05).B组有1例出现髓塌陷,A组无髓塌陷病例.结论:髓芯减压联合金属钽棒植入术较带血管蒂髂骨瓣转移术治疗早期ONFH手术操作相对简单,近期疗效更为明显.     

牙齿脱落对女性髋部骨折风险的影响

目的 分析牙齿脱落与髋部骨折的关系,评估牙齿脱落是否可以用作预测髋部骨折风险的指标.方法 选择保定市骨科医院2008-2012年148例的髋部骨折患者为骨折组和136例在其他科室住院的非骨折患者为对照组,调查项目包括牙齿脱落年龄,脱落数目,骨折发生时情况,骨质家族史及糖皮质激素药物应用史等.牙齿的变化对骨折风险的影响采用多因素Logistic回归模型分析.结果 骨折组与对照组牙齿脱落率比较差异有统计学意义（P＜0.05）;骨折组与对照组平均牙齿脱落年龄及髋部骨折前牙齿脱落的数量比较,差异有统计学意义（P＜0.05）.通过Logistic回归分析显示,牙齿脱落的患者罹患骨折风险高于无脱落者[OR=3.798,95%CI（1.893,7.715）].年龄＜59岁而发生牙齿脱落的个体较年龄＞59岁的个体骨折风险进一步增加[OR=5.768,95%CI（2.603,12.519）];牙齿脱落及脱落数目对髋部骨折的风险无影响.结论 牙齿脱落与髋部骨折风险高度相关,其临床应用前景尚需大样本前瞻性研究来证实.     

不同比重布比卡因在老年髋关节手术麻醉中的应用价值

目的探究不同比重布比卡因在老年髋关节手术麻醉中的应用价值。方法选取本院2011年10月—2012年10月的116例老年髋关节手术患者,根据患者实施麻醉过程中所采用的不同比重布比卡因情况进行随机分组,分成观察组和对照组,每组58例,对两组患者采用不同比重布比卡因麻醉的效果进行比较。结果观察组患者药物使用量和麻醉维持时间均小于对照组,差异有统计学意义（P〈0.05）。观察组的感觉阻滞起效时间和运动阻滞起效时间均小于对照组,差异有统计学意义（P〈0.05）。结论采用等比重布比卡因进行麻醉的临床效果相比较采用轻比重布比卡因进行麻醉的临床效果更加显著,是临床麻醉的可靠选择。     

Association of bone marrow edema with temporomandibular joint (TMJ) osteoarthritis and internal derangements

Purpose: This study reviewed the dental literature in order to determine the association of bone marrow edema with osteoarthritis and temporomandibular joint (TMJ) internal derangement disorders.

Methods: A literature search was performed using electronic databases PubMed/Medline (National Library of Medicine, Bethesda, Maryland) and Cochrane for articles published during the last 15 years (January 2000–December 2014). A predetermined inclusion and exclusion criteria were used for filtering the scientific papers. Research articles fulfilling the basic inclusion criteria were included in the review.

Results: The reviewed studies showed that bone marrow edema is found in painful joints with osteoarthritis in a majority of cases. A few cases with no pain or significant degenerative changes are reported to have a bone marrow edema pattern as well.

Conclusions: Bone marrow edema, increased fluid level, and pain are associated with osteoarthritis in the majority of patients reporting TMJ arthritis. Degenerative and disc displacement conditions are multifactorial and require further investigations. Magnetic resonance imaging can be employed to detect bone marrow edema even in the absence of pain and clinical symptoms in the patients of internal derangements.     

Does TGF-β play a role in degenerative temporomandibular joint diseases? A systematic review

Objectives: The objective of this review was to assess the literature for evidence investigating the role of TGF-β in temporomandibular joint disease with osteoarthritis.

Method: An electronic and manual search was carried out on the databases, MEDLINE/PubMed, Cochrane Library, Web Of Science, and EMBASE, from 1975 to December 2015 by two independent evaluators to identify clinical and laboratory trials in English.

Results: The search produced 693 records. Following a process of selection based on certain criteria, eight articles were included.

Discussion: This systematic review suggests that TGF-β administration alone does not result in joint regeneration; other factors may be involved, such as TGF-β receptor expression ,and TGF-β receptor mutations that do not allow a correct transduction, resulting in TGF-β deficiency. The anabolism induced by this growth factor is also able to neutralize the catabolic processes that are elevated in osteoarthritis. Therefore, further studies are essential to determine how the concentration of TGF-β in the temporomandibular joints acts as a potential marker for the development of degenerative conditions.