“简化”旋髂浅动脉穿支皮瓣在舌癌术后缺损修复中的应用

目的:探讨仅解剖旋髂浅动脉(SCIA)浅支作为血管蒂的"简化"旋髂浅动脉穿支(SCIAP)皮瓣在舌癌术后缺损修复中应用的可行性及治疗效果。方法:6例舌癌患者术中制备SCIAP皮瓣时舍弃SCIA深支,仅解剖浅支作为皮瓣的血管蒂,并以之修复病灶切除术后的舌缺损。术后随访3～6月评价修复效果。结果:6例患者均存在SCIA浅支。切取SCIAP皮瓣的平均面积为41(24～54) cm²,血管蒂平均长度为6.5(6.0～7.5) cm。SCIA浅支平均管径为0.9(0.5～1.2) mm,旋髂浅静脉平均管径为1.6(1.0～2.0) mm。5例SCIAP皮瓣修复成功,术后复查皮瓣形态佳,口腔功能恢复良好。1例因术中血管危象导致SCIAP皮瓣修复失败,术中更改为左前臂皮瓣修复舌缺损,并将SCIAP皮瓣修成全厚皮片修复前臂供区缺损。所有患者髂部术创拉拢缝合,均达成一期愈合,且术创瘢痕隐蔽。结论:“简化”的SCIAP皮瓣制备过程简单,足以胜任一般的舌癌术后缺损修复,且髂部供区瘢痕隐蔽,并发症少,具有一定的推广价值。     

腹壁浅动脉穿支皮瓣修复口腔颌面部软组织缺损3例报道

目的: 评价腹壁浅动脉（superficial inferior epigastric artery,SIEA）穿支皮瓣在口腔颌面部肿瘤术后软组织缺损修复重建中的应用价值。方法 选择临床诊断为舌癌、颊癌、口底癌的患者各1例,术前应用彩色多普勒超声和（或）计算机体层扫描血管造影对双侧下腹部血管条件进行评估,明确腹壁浅动、静脉的起始管径和走行,并完成体表定位。根据病灶部位和缺损大小、形态,设计血管蒂的长度和皮瓣的大小、位置。术中解剖血管蒂,制备皮瓣,转移至受区,完成缺损修复。评价患者的受区重建效果及供区并发症发生情况。术后随访12~14个月。结果 3例患者的腹壁浅动、静脉血管条件良好。根据术区缺损大小,制取的SIEA穿支皮瓣分别为9 cm×6 cm、8 cm×5 cm、10 cm×6 cm,血管蒂长度8~10 cm,血管蒂动脉管径0.7~1.0 mm,静脉管径1.8~2.0 mm,血管分别与受区的甲状腺上动脉、面总静脉吻合。术后皮瓣成活,受区软组织缺损修复效果良好,下腹部供区无并发症。结论 SIEA穿支皮瓣的血管蒂位置比较表浅,可通过影像学检查进行体表定位,降低了皮瓣制备的难度;同时,皮瓣制备过程中不损伤腹直肌鞘及腹部肌肉,术后供区并发症少,且瘢痕隐蔽。SIEA穿支皮瓣可望成为口腔颌面部软组织缺损修复重建较好的临床选择。     

股前外侧穿支嵌合皮瓣修复头颈肿瘤根治术后缺损

目的:探讨股前外侧穿支嵌合皮瓣的制备要点及修复头颈肿瘤根治术后缺损的优缺点。方法:2007年12月—2011年3月制备股前外侧穿支皮瓣,同时解剖保护血管蒂上的肌分支,设计一蒂多岛的穿支嵌合皮瓣修复66例头颈肿瘤根治术后缺损。舌、口底癌32例,舌根、咽侧癌30例,颊癌2例,颌骨中央性鳞癌1例,腮腺癌1例。切取股前外侧皮瓣面积7cm×4cm～16cm×7cm,肌瓣约3cm×4cm,观察并发症及受、供区功能恢复情况,总结穿支嵌合皮瓣制取技术及优点。结果:65例穿支嵌合皮瓣成活,成活率98.5%。1例术后5d出现危象,最终放弃,创口均Ⅰ期愈合。2例发现无合适穿支血管,改用股前内侧穿支皮瓣修复成功。术后随访0.5～3a,皮瓣6个月后萎缩停止,局部外形丰满,语言及吞咽功能恢复满意。供区均拉拢缝合,瘢痕隐蔽,下肢无功能障碍。结论:逆行和顺行解剖技术相结合是制备穿支嵌合皮瓣的理想手段,能够帮助外科医师克服穿支血管的解剖变异。股前外侧穿支嵌合皮瓣能提供不同类型的组织进行三维修复,减少术后并发症(感染、瘘、血肿等)的发生率,是头颈肿瘤术后复合组织缺损修复的理想选择之一。     

颞浅血管额支蒂皮瓣在老年人唇颊部恶性肿瘤术中的应用

目的:探讨颞浅血管额支蒂皮瓣修复老年人唇颊部恶性肿瘤手术中组织缺损的特点及技巧.方法:对5例老年人唇颊部恶性肿瘤术后致唇颊部大部组织缺损,采用颞浅血管额支蒂皮瓣一期修复.结果:皮瓣全部成活,皮瓣与口角皮肤颜色、质地和外形相近,术后或经二期口角成形术后张口无受限,口角基本恢复正常,临床效果满意.结论:颞浅血管额支蒂皮瓣安全可靠,易于解剖和切取.对于年老且无容貌要求者采用该皮瓣可修复同侧任何部位的面部缺损,临床效果良好.     

胸大肌双叶皮瓣修复颊部洞穿缺损体会

目的:介绍应用胸大肌肌蒂双叶皮瓣同期修复颊癌术后下颊部组织洞穿缺损临床体会。方法:胸大肌肌蒂皮瓣与颈淋巴清扫术的切口同时设计。根据组织缺损部位和大小设计肌蒂皮瓣,依口内外缺损大小及形状,于皮瓣的中上份用取皮刀横行削除表皮1.5cm,制成双叶瓣,以便折叠。待颊癌联合根治术完成,将其转位移植于颊部修复缺损。结果:19例中18例肌蒂皮瓣全部成活,外形、功能均满意。1例部分坏死(口内皮瓣部分感染、裂开),经短期换药二期愈合。结论:胸大肌双叶皮瓣,血供丰富、安全可靠、成功率高。可在联合根治术同时完成,是同期修复颊部洞穿缺损的有效方法。     

胸背动脉穿支皮瓣修复口腔癌复发后软组织缺损的疗效分析

目的:探讨口腔癌复发后软组织缺损采用胸背动脉穿支皮瓣(thoracic dorsal artery perforator flap,TDAP)修复的疗效.方法:回顾性研究方法收集2018年1月～2020年6月口腔癌复发后行TDAP修复术后软组织缺损的患者7例,其中6例穿支血管来自胸背动脉,1例穿支血管来自胸外侧动脉.皮瓣不带或仅携带部分背阔肌,不损伤胸背神经,切取皮瓣面积最小6 cm×12 cm,最大8 cm×15 cm.TDAP修复舌癌术后复发2例,舌癌再发2例,颊癌再发1例,下颌牙龈癌及口底癌术后复发各1例,所有患者无肺、肝等远处转移.结果:7例皮瓣全部成活,皮瓣成活率100％,无1例出现血管危像.受区与供区均一期愈合.术后随访3～10个月,皮瓣质地好,均不臃肿,不需要二期整形,皮瓣供区及肩膀关节功能良好.结论:TDAP质地非常柔软,血管蒂长,组织量大,供区疤痕隐蔽,且供区功能损失小等优点适合用于口腔癌复发后软组织缺损的修复.     

带血管蒂的上斜方肌皮瓣即刻整复颊癌术后缺损

目的 探讨带血管蒂上斜方肌皮瓣即刻整复颊癌术后颊部缺损。方法 采用带蒂的上斜方肌皮瓣即刻修复颊癌术后颊部缺损16例。结果 应用以颈横血管为蒂上斜方肌皮瓣即刻整复颊部缺损16例,全部成功,获得满意效果。结论 该皮瓣运用于颌面部大面积缺损整复,是一种优良皮瓣,是临床值得考虑,效果可靠的手术方法。     

腓肠内侧动脉穿支皮瓣修复舌缺损的疗效评价

目的: 研究运用游离腓肠内侧动脉穿支皮瓣修复半舌缺损的可行性与临床效果,为腓肠内侧动脉穿支皮瓣用于舌部缺损修复提供依据。方法: 选取9例舌癌患者,术前利用CT血管造影（CTA）技术对腓肠内侧动脉穿支进行定位,术中运用腓肠内侧动脉穿支皮瓣行半舌缺损修复。对成功应用该皮瓣进行舌重建的8例患者,术后1个月以及3个月进行随访,评价舌部功能及供区状况。结果: 腓肠内侧动脉穿支皮瓣血管蒂长,管径与颈部血管匹配,对供区损伤小,腓肠内侧动脉穿支皮瓣重建舌丰满,术后语音及咀嚼功能良好,舌部感觉功能欠佳。供区功能良好,仅留存线性瘢痕,供区未见明显并发症。结论: 游离腓肠内侧动脉穿支皮瓣可成为舌缺损修复重建的另一种选择,其供区隐蔽,损伤小,皮瓣厚度适合舌部缺损修复,术后患者语音及咀嚼功能恢复良好。     

旋髂深动脉穿支嵌合髂骨皮瓣修复下颌骨复合性缺损

目的 探讨旋髂深动脉穿支嵌合髂骨皮瓣（DCIAPF）在下颌骨复合性缺损重建中的应用价值与优缺点。方法 2014年3-7月应用DCIAPF游离移植一期修复6例下颌骨及软组织复合缺损患者。根据术前定位的旋髂深动脉皮肤穿支设计并逆行切取皮岛,随后于腹股沟区顺行解剖血管蒂并切取髂骨瓣,继续解剖旋髂深血管直至终末段与皮岛相续。完成DCIAPF切取后供区分层严密关闭以预防腹疝。结果 6例患者所制备的髂骨瓣长5.0~11.0 cm,皮岛3.5 cm×5.0 cm~7.0 cm×10.0 cm,供区均一期关闭未行植皮。1例皮岛穿支来自旋髂浅血管需另行吻合,其余5例成功制备为DCIAPF。移植的髂骨皮瓣均成活,仅1例因行皮岛修薄处理出现表皮剥脱和少量边缘坏死,经修剪及换药处理后愈合。术后随访3~6个月,牙槽嵴高度恢复满意,供区均未出现明显并发症。结论 DCIAPF血运丰富可靠,能提供足够的骨量供下颌骨重建并恢复牙槽嵴高度,为后期义齿修复创造有利条件;其皮肤穿支解剖较为恒定,携带皮岛组织量大,摆放灵活,供区隐蔽,是下颌骨复合性缺损修复重建的有效方法。     

股前外侧穿支皮瓣的应用解剖研究及临床应用

目的 ：通过对股前外侧穿支皮瓣的解剖学研究,探讨制备股前外侧穿支皮瓣的合理性及稳定性;并对临床上应用股前外侧穿支皮瓣的供区及受区的术后恢复情况等进行随访,评价其在口腔颌面部缺损修复重建中的应用价值。方法 ：选取6例中国成人下肢标本,解剖并记录股前外侧穿支的数目、分布、部分层面血管外径及各段血管长度;并选择9例采用股前外侧穿支皮瓣移植修复口腔颌面部缺损的病例,皮瓣面积5 cm×6 cm～6 cm×12 cm。术后随访观测皮瓣存活情况,评价受区臃肿度及供区功能恢复、术后吞咽及语言功能情况。结果 ：6例下肢标本共测量记录到股前外侧穿支21支,平均3.5支。大腿股前外侧穿支主要出现在髂前上棘至髌骨外侧缘连线中点外1 cm以下约2 cm为圆心、半径约6 cm的圆内,源动脉起始部外径平均为（2.99±0.48）mm,血管蒂总长度平均为（15.83±3.52）cm;9例股前外侧穿支皮瓣,1例发生部分组织坏死, 1例病例失访,术后随访10～47个月（平均24个月）。股前外侧穿支皮瓣存活率较高,供区并发症少,受区皮瓣臃肿程度低,吞咽功能恢复良好。结论 ：股前外侧穿支皮瓣穿支分布稳定,血管蒂较长,穿支的管径完全满足游离皮瓣的要求,临床应用中供区并发症少,受区不臃肿,组织量适中,结合其解剖稳定性,可满足临床修复口腔颌面部组织缺损的需要。     

Evidence of the validity of a model of determinants of quality of restorative dental care

A model describing the relationship between self-reported quality of restorative dentistry and dentist characteristics for 119 Montana general dentists is presented. The best predictors formed a significant model explaining 22% of the variance of the quality measure. Results are contrasted with a previous estimation of the model for 102 Washington general practitioners. Evidence for the external validity of the model is presented.     

Experimental evidence of formation of imines in the course of reduction of hydrazones

The reduction of hydrazones is generally suggested to proceed through a reductive cleavage of the nitrogen–nitrogen bond followed by a reduction of the carbon–nitrogen bond. This sequence of reduction processes is here supported for fluorenone (V) and benzophenone (VI) hydrazones as well as by a comparison of the reduction of fluorenone and benzophenone hydrazonium ions (I,III) with corresponding imines (II,IV). Another proof of the presence of imines as intermediates is the splitting of four-electron waves of hydrazones V and VI and hydrazonium ions I and VIII into two waves at pH < 2. This has been interpreted as due to differences in slopes dE_1/2/dpH and pK_a-values of protonated hydrazine derivatives on one side and corresponding imines on the other. In this pH-range imines formed in reductions of VI and VIII are reduced in a single two-electron wave, those of I and V in two one-electron steps. Fluorenone imine (II) is sufficiently stable to allow recording of time-independent current–voltage curves between pH 6 and 11. In this pH-range the imine (II) is reduced in two one-electron steps. Benzophenone imine (IV) has been found stable between pH 4.6 and 12. At pH 4.6–8 the reduction of the imine IV takes place in a single two-electron step, at pH 8–12 in two one-electron steps. Final proof of the initial cleavage of the N–N bond is presented by comparison with the reduction of nitrones.     

不同剂型玻璃离子水门汀溶解性比较研究

目的:研究、比较不同剂型玻璃离子水门汀的溶解性和表面微观形态改变,为临床使用提供依据.方法:将3M树脂加强型玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(水粉剂型)及GC玻璃离子水门汀(双糊剂型)分别在人工唾液中浸泡30 d,冷热循环15000次,烘干测重,比较前后质量变化,计算溶解率,并用扫描电镜观察表面微观改变.结果:不同剂型的玻璃离子水门汀溶解率由高到低分别为3M树脂加强型玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(双糊剂型).3种玻璃离子水门汀经浸泡溶解后,SEM扫描表面微观形态可观察到GE玻璃离子水门汀(双糊剂型)表面形态改变较少,其他2组玻璃离子水门汀表面微观改变较多.结论:双糊剂型玻璃离子水门汀理化性能及溶解率均低于传统水粉剂型,是未来临床修复治疗的的良好选择.     

Evaluation of efficacy of chemiluminescence for diagnosis of leukoplakia

ObjectiveLeukoplakia is the most common potentially malignant disorder preceding oral cancer. Chemiluminescence has been developed as an adjunct to conventional examination for the diagnosis of these potentially malignant disorders. This study was conducted to assess the efficacy of chemiluminescence in the diagnosis of leukoplakia and to compare the results with histopathological examination.Study designA total of 50 patients with leukoplakia were included from the outpatients attending the Department of Oral Medicine and Radiology, Dental Hospital, Bengaluru, Karnataka, India. These patients were subjected to conventional oral examination followed by chemiluminescent examination with Vizilite (Zila, Fort Collins, CO, USA) and biopsy for histopathological confirmation.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of chemiluminescence were 93.75%, 55.56%, 78.95%, and 83.3%, respectively. The overall accuracy of chemiluminescence was 80%. A statistically significant association was observed between histopathology results and chemiluminescence results.ConclusionAlthough it is an easy, safe, minimal time consuming, and noninvasive technique, it has only adjunctive utility and it does not replace biopsy for the diagnosis of leukoplakia.     

颌骨动静脉畸形的栓塞治疗

目的：总结直接穿刺结合经血管内介入栓塞治疗颌骨动静脉静脉畸形的经验。方法：收治凳骨动静脉畸形患者6例,均进行了介入栓塞治疗。采用的栓塞材料为附凝血棉纤毛的螺圈,聚乙烯醇泡沫微粒和二氰基丙烯酸对丁酯。数字减影颈动脉造影在PHILIPSV300下完成。结果6例颌骨动静脉畸形患者中4,例急性出血得到了快速、有效控制,1例慢性渗血的右下 骨动静脉畸形患者,介入栓塞治疗,拔除松动的右下凳第一磨牙,有效地控制了出血,另1例伴局部软组织搏动性膨隆的上凳骨动静脉畸形患者,介入治疗后膨隆的搏动性得到明显改善,栓塞治疗后分别随访3－24个月,均未发现有口腔内渗血或出血。随访的X线片上,病灶区可见新骨形成。结论：局部穿刺结合经血管内介入栓塞治疗颌骨动静畸形是一种安全、有效的治疗方法。     

Design of clinical trials of traditional therapies of periodontitis

The present paper on the design of clinical trials of periodontal therapy first addresses the issue of the etiology of periodontal disease. It is suggested that most if not all forms of destructive periodontal disease are caused by microorganisms and that there are different forms of disease with different microbial etiologies. The progressive nature of destructive periodontal disease is subsequently discussed and it is emphasized that, in a given patient, periodontal sites which show signs of inflammation and attachment loss may not over a period of several months and years show further sign of attachment loss. The present methods of assessing periodontal disease do not allow us to discriminate between potentially active and inactive sites in untreated patients. The significance and variability of indicators of periodontal disease such as bleeding on probing, probing pocket depth and probing attachment level measurements are discussed. The errors inherent in the various measurements are analyzed and suggestions are presented describing how alterations in any of the above parameters could be identified and presented in a clinical trial. Of concern for the statistical analysis of clinical data of periodontal disease is the definition of the "experimental unit". For a number of years, the "experimental unit" in periodontal trials was the patient. It is clear, however, that different sites within the same individual show different patterns of disease progression and lesion morphology and often respond differently to periodontal therapy. Statistical analyses must consequently be designed which recognize differences in site-to-site infection and lesion morphology within a common host. Until such analyses are available, the investigator should be wary of pooling data within the same individual, since such pooling may obscure meaningful alternatives which may take place in individual periodontal sites. Some goals of periodontal therapy are subsequently identified. 4 goals are discussed more in detail, namely: to establish conditions which will allow the patient to maintain a dentition without further breakdown of the periodontium; to reduce pocket depth to establish an anatomy in the dentogingival region which with proper maintainance care will prevent the re-establishment of the subgingival infection; to gain attachment as a result of treatment; to assess the effect of a certain chemotherapeutic agent on periodontal disease.     

正畸患者切牙影像失真发生情况分析

目的研究正畸患者曲面体层片上的切牙影像失真发生情况，并分析其原因。 方法从中山大学附属口腔医院放射科影像数据库中选取500例正畸患者的曲面体层片和头影测量侧位片，所有曲面体层片均采用咬合杆投照，分别从切牙牙体影像放大、缩小、牙根变短、根尖模糊等评价指标分析上下颌切牙影像失真的发生情况，在头影测量侧位片上测量中切牙根尖-对颌切牙切缘的距离，探讨切牙影像失真发生的原因。采用SPSS 19.0统计软件对所得数据进行统计学检验。 结果500例患者中，切牙牙体影像正常者共417例，切牙牙体影像失真者共83例，影像失真发生率16.6%，其中切牙牙体影像放大17例、牙体影像缩小0例、牙根变短30例，牙根影像变短伴模糊36例。影像失真患者的根尖-切缘距离大于影像正常的患者，差异有统计学意义（F = 5 187.18，P = 0）；影像失真患者的覆盖值大于影像正常的患者，差异有统计学意义（F>477，P = 0）。 结论严重牙颌面畸形如反 、深覆盖是导致曲面体层片的切牙影像失真的主要原因之一。     

正常青年Monson球面半径的测量研究

目的测量正常青年Monson球面半径。方法选择60名(男30名,女30名)正常青年制取全口印模,应用立体摄影成像的原理与方法对Monson球面半径进行测量和统计学处理。结果Monson球面的半径平均为10.173 cm,大于理论值10.160 cm,差异有显著性(P<0.01);男、女性球面半径差异无显著性。结论本实验所得到的数据可作为全口义齿修复中记录颌位关系的一个参量。     

鼻测量法的进展

唇裂术后继发畸形是指唇裂修复术后,仍遗留或继发于手术操作和生长发育变化而表现出来的一类畸形[1]。包括唇畸形、鼻畸形和颌骨畸形。其修复较原发性唇裂修复更复杂,更灵活多变。而导致其修复复杂性的一个重要原因即是局部组织结构复杂变异和缺乏可靠的三维测量手段[2],鼻畸形     

口底癌34例临床分析

目的探讨口底癌的临床特性、治疗方法及预后。方法对我院自1992—2002年住院治疗的34例口底癌患者进行回顾性分析。结果34例口底癌患者中,男28例(82.4%),女6例(17.6%),男女比为4.7∶1,平均发病年龄58岁。发病部位:前口底22例(64.7%),后口底12例(35.3%)。淋巴结转移率41.2%。单纯手术组、化疗加手术组、放疗加手术组、化疗加手术加放疗组的5年生存率分别为45.5%、60.0%、50.0%、62.5%。结论口底癌以中老年患者好发,男性居多。易发生淋巴结转移,综合疗法疗效较好。