微创Chevron-Akin截骨术治疗轻中度拇外翻的早期疗效分析

目的:探讨微创Chevron-Akin(minimally invasive Chevron-Akin,MICA)截骨术治疗轻中度拇外翻的早期临床疗效。方法:自2019年6月至2021年4月,采用MICA截骨术治疗26例(29足)轻中度拇外翻患者,其中男1例,女25例;年龄19~78(38.3±19.5)岁。观察并比较手术前后拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),第1跖骨短缩。末次随访时采用美国骨科足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)前足评分系统及视觉模拟评分(visual analogue scale,VAS)评价治疗效果,并记录相关并发症。结果:26例(29足)均获得随访,时间12~33(19.6±5.1)个月。HVA、IMA分别由术前的(32.3±6.6)°、(11.7±3.2)°矫正为术后的(13.0±5.3)°、(6.1±3.2)°,差异有统计学意义(P<0.01);第1跖骨短缩(2.7±1.1) mm。AOFAS评分由术前的(55.7±7.4)分提高到术后的(88.5±7.9)分(P<0.01),其中优15足,良11足,可3足。VAS由术前的(6.5±1.5)分改善为术后的(0.7±0.4)分(P<0.01)。结论:MICA截骨术创伤小,术后恢复快,并发症率低,并且能有效改善拇外翻畸形,是治疗轻中度拇外翻的安全可靠手术方法。     

Restorative effects of urban green environments and the role of urban-nature orientedness and noise sensitivity: A field experiment

In this experiment we investigated how individual differences in orientation towards built vs. nature environment as well as noise sensitivity affect psychological and physiological restoration in a constructed urban park, urban woodland and city centre of Helsinki, Finland. The participants, 30–61-year-old healthy women (N = 83), visited each study site once. The experiment consisted of a 15-min viewing session, followed by a 30-min walking session in each environment. We measured restorative effects: perceived restorative outcomes, vitality, and blood pressure in these three environments. The data were analysed in SAS with a linear mixed model. We found significant differences between environments in psychological restorative effects, but not in blood pressure. The urban-nature orientedness, and to a lesser extent noise sensitivity, modified the effect of environment on restoration. In conclusion, individual characteristics affect psychological restoration provided by various urban environments. Varying needs of individuals should be taken into account in city planning.     

Outcome of direct restorations placed within the general dental services in England and Wales (Part 1): variation by type of restoration and re-intervention

AIM: It is the aim of this paper to consider the dental factors associated with the need for re-intervention on a restoration, such as the tooth position, size of cavity, and restoration material. METHODS: Patients whose data were included in this study were those whose birthdays were included within a set of randomly selected dates, one of which was chosen in each possible year of birth. The restoration records consisted of all those records containing directly placed restorations which related to courses of treatment of patients 18 years or older with last date on the claim form after 31st December 1990, and with date of acceptance after September 1990 and before January 2002. For each tooth treated with a direct restoration the subsequent history of intervention on that tooth was consulted, and the next date of intervention, if any could be found in the extended data set, was obtained. Thus a data set was created of direct restorations with their dates of placement and their dates, if any, of re-intervention. RESULTS: Data for over 80,000 different adult patients were analyzed, of whom 46% were male and 54% female. A total of 503,965 tooth restoration occasions were obtained from the data over a period of eleven years. Single surface amalgam restorations were found to have the longest survival --58% at 10 years, and glass ionomer the shortest 38% at 10 years. Factors which were found to reduce restoration outcome included involvement of the incisal angle in composite restorations--this resulted in a reduction in median survival of around two years--and the placement of pins in a restoration. The presence of a root filling was also found to reduce the survival of restorations in the crown of the root filled tooth. CONCLUSIONS: Small amalgam restorations have longer survival times before re-intervention than large amalgam restorations such as MOD. Composite and glass ionomer restorations perform less well than amalgam restorations. Pin placement and root filling reduce the survival time of restorations.     

Factors influencing long-term restoration survival in three private dental practices in Adelaide

Very little is known of dentist and patient factors which may influence the survival or longevity of dental restorative materials placed in private practices. The present retrospective study investigated during 1992 the effects of six factors on the long-term survivals of five types of restorations placed by 20 male dentists in 100 adult patients, at 3 selected Adelaide dental practices. There were no significant effects on restoration survival from change of dentist, and generally only one or two types of restorations had their survivals influenced significantly either by dental practice location, or by patient age, frequency of patient attendance, experience of dentist, and whether or not the restorations were replacements during the study period. Restoration survival was not influenced significantly by whether, or not, any replacements were made by the dentist who placed the initial restorations. The median survival times for amalgams were 22.52 years, resin composites 16.72 years, castings 13.75 years, and crowns an estimated 26 years. For glass-ionomers, 75 per cent were still present at 11.25 years.     

多功能粘结剂和复合树脂修复牙体缺损86例观察

本文将多功能粘结剂和复合树脂应用于86例牙体缺损的修复并进行术后两年的随访复查,成功率达92.3％,依据病损的不同类型统计学上有显著差异。     

多个局部皮瓣在颜面部美学重建中的联合应用

目的 探讨联合应用多个局部皮瓣协同修复颜面部中、小面积的皮肤软组织缺损的优势.方法 根据患者皮肤软组织缺损创面大小及部位的不同,遵循分区修复原则,选择相应的局部皮瓣联合修复覆盖创面,使切口尽可能隐蔽及顺应面部自然轮廓线或皮肤皱纹线.结果 77例患者中74例创面Ⅰ期愈合,3例Ⅱ期愈合;术后全部随访1～8个月,修复皮瓣与周围皮肤在色泽、质地、轮廓等方面均有较好的相似度,切口隐蔽、无明显瘢痕,肿瘤切除后未见复发,面部轮廓及视觉效果良好,美学效果满意.结论 联合应用多个局部皮瓣对颜面部创伤缺损进行修复,可以明显提高修复质量,最大程度地恢复颜面部美学外观.     

胸腰椎骨折复位固定器的研制与临床应用

目的：探索一种简便有效的外固定器具来治疗胸腰椎骨折。方法：从生物力学角度，利用脊柱过伸复位，三点固定的原理，研制出一种复位固定器。该复位固定器的后板弧度可以调节，患者仰卧于弓起的后板上，通过患者自身的重量，达到缓慢过伸复位。复位后收紧固定带，使胸片的上、下端与后板的距离相对固定，防止再移位。结果：固定器法与二桌法相比，该法患者疼痛轻，不易疲劳，与石膏背心固定相比，该复位固定器轻巧，易被患者接受。适用于稳定型和轻度不稳定型胸腰椎骨折、无条件手术的严重不稳定型胸腰椎骨折，各种胸腰椎疾病手术后需要外固定的病人。结论：固定器法操作简单，效果确切，优于二桌法，是非手术治疗的良好补充。     

腘动脉外侧皮支单蒂皮瓣或联合腓动脉穿支双蒂皮瓣游离移植修复手足创面

目的 探讨腘动脉外侧皮支单蒂皮瓣或联合腓动脉穿支双蒂皮瓣游离移植修复手足皮肤软组织缺损的临床效果。方法 回顾性研究。纳入2013年3月—2020年6月东莞市长安新安医院手足显微外科收治的手足皮肤缺损伴肌腱、骨骼外露患者21例,其中男19例、女2例,年龄16~65岁（平均37.8岁）。手部创面8例,足部创面13例;软组织缺损面积3.5 cm×5.5 cm~10.0 cm×14.0 cm。观察患者术后皮瓣成活情况,采用英国医学研究会颁布的感觉功能恢复分级评价标准评估患者皮瓣感觉功能恢复情况,采用笔者参考皮瓣功能7项检查制定的皮瓣外观功能10项检查表进行皮瓣外观功能综合评价。结果 21例患者术后皮瓣全部成活。采用腘动脉外侧皮支单蒂皮瓣游离移植修复13例、腘动脉外侧皮支联合腓动脉穿支双蒂皮瓣游离移植修复8例,皮瓣切取面积4.0 cm×6.5 cm~10.0 cm×16.0 cm,供区创面直接缝合或植皮覆盖。术后随访6~36个月,皮瓣质地良好,厚薄适中,两点间辨别觉13~25 mm;皮瓣外观功能综合评价：优7例、良11例、可3例,优良率为85.7％。小腿供区无功能性影响。结论 腘动脉外侧皮支单蒂皮瓣或联合腓动脉穿支双蒂皮瓣游离移植修复手足创面,皮瓣血供有保障,成活率高,是修复手足软组织创面的有效术式之一。     

三种不同固位形式嵌体冠修复短冠磨牙的应用比较

目的：采用不同固位形式嵌体冠对短冠磨牙进行修复,对比观察疗效,评估其临床修复效果。方法：选取66颗根管治疗后的短冠磨牙进行钴铬合金嵌体冠修复,分为髓室固位嵌体冠组、常规桩核嵌体冠组、插销桩核嵌体冠组。所有患者修复2年后,对修复体粘结效果进行评价。结果：髓室固位嵌体冠粘结强度小于常规桩核嵌体冠和插销桩核嵌体冠,但3组之间无明显差异。结论：3种固位方式嵌体冠的粘结强度均能满足临床修复的要求,临床上应视基牙情况选择适合的修复方式。