老年人颌面创伤的临床特点与治疗

目的　分析老年人颌面创伤的临床特点 ,为提高救治成功率提供依据。　方法　选择第四军医大学口腔医学院 1992年 1月至 2 0 0 2年 12月就诊的 12 6例老年颌面创伤患者 ,对创伤的原因、部位、合并伤及治疗方法等进行回顾性分析 ,并与同期的随机抽取的 2 0 0例非老年组患者进行比较。　结果　 12 6例中 ,交通事故和暴力致伤为主要创伤原因 ,分别占 6 1 1%和 2 5 4 %。损伤特点为多发性骨折 ,面下部是最易受伤的部位。 6 9 1%的患者并存系统疾病 ,35 7%的老年颌面骨折患者未治疗 ,与非老年组比较 ,差异有显著性 (P <0 0 5 ) ;老年组的治疗天数和ICU天数〔(16 5± 10 9)和(4 3± 3 3)d〕均较非老年组长〔(4 3± 3 3)和 (2 3± 3 0 )d ,P <0 0 5〕 ,损伤严重度评分与非老年组差异无显著性。　结论　应加强对老年人颌面创伤的预防 ,救治中注意其并存症多的特点及降低病死率和致畸率。     

老年急性心肌梗死心性死亡患者的临床特征

目的　对比分析老年急性心肌梗死心性死亡患者的临床表现、并发症、治疗与非老年患者的异同。方法　以 1993年 1月至 2 0 0 2年 12月因急性心肌梗死相继收住解放军总医院冠心病监护病房的 2 0 0例心性死亡患者为对象 ,≥ 6 5岁者 16 6例 (称老年组 ) ,<6 5岁者 34例 (称非老年组 ) ,比较两组的临床特征。结果　 (1)两组冠心病、高血压病、饮酒史 (P <0 .0 1)、高血压病合并糖尿病史 (P <0 .0 5 )均有显著性差异 ;(2 )梗死前心绞痛及心肌梗死部位差异无显著性 ;(3)收缩压、脉压、左心室射血分数 ,有显著性差异 (P <0 .0 1或P <0 .0 0 1) ;(4)老年组应用阿斯匹林治疗者及应用血管紧张素转换酶抑制剂治疗比例高于非老年组 (分别为 5 4 %比 2 4 %P <0 .0 1及 32 %比12 %P <0 .0 5 ) ;(5 )老年组左室射血分数低于 5 0 %者多 (82 %比 5 5 % ,P <0 .0 5 ) ;死于急性肺水肿者高于非老年组 (2 9%比 15 % ,P <0 .0 5 ) ,死于心脏破裂者较非老年组少 (8%比 2 4 % ,P <0 .0 5 )。结论　老年急性心肌梗死心性死亡患者心血管合并症多 ,收缩压高 ,脉压差大 ,左心室射血分数低 ,并发症发生率高 ,死于急性肺水肿者多。因此 ,积极有效治疗 ,减少并发症 ,保护心功能是改善老年急性心肌梗死患者预后的重要环节。     

纯钛种植体在老年人严重吸收下颌骨的临床应用

目的探讨纯钛种植体在老年人严重吸收下颌骨的临床应用。方法162颗Branemark种植体植入32例下颌严重吸收全牙列缺失老年患者的颌骨内,完成修复体32件,临床观察28～32个月。结果修复后2年累积成功率为96．3％,种植失败多数发生在种植早期。结论纯钛种植体对老年人严重吸收下颌骨具有良好的修复效果。     

老年冠心病患者介入治疗术后随访期症状限制性运动试验评估研究

目的　通过运动试验方法评估老年人介入治疗后随访结果。　方法　对成功介入治疗后的患者在随访期间进行症状限制性自行车运动试验 ,分为老年组与非老年组 ,对运动量及心电图等参数进行比较。　结果　老年组和非老年组分别有 2 3例及 30例 ,患者于术后 (1 4 8± 1 2 0 )个月和(1 2 4± 1 2 1 )个月进行了运动试验。老年组和非老年组运动中的心率增加分别为 (92 1± 1 2 6 )次 /min和 (96 5± 1 3 8)次 /min(P >0 0 5 ) ,收缩压增加分别为 (5 9± 1 7)mmHg和 (6 9± 1 6 )mmHg(P >0 0 5 )。老年组和非老年组的最大运动量分别为 (5 8± 1 5 )代谢当量和 (7 2± 1 4)代谢当量 (P <0 0 1 ) ,运动时间为 (6 5± 2 2 )min和 (8 9± 2 6 )min(P <0 0 1 ) ,老年组较非老年组在运动中更易出现症状 (2 1 7%对 3 3% ,P <0 0 5 )及心电图改变 (43 5 %对 1 6 7% ,P <0 0 5 )。　结论　老年人介入治疗后运动量及运动时间均小于非老年人 ,运动中易出现症状及心电图心肌缺血表现。采用症状限制性运动试验进行随访观察是有价值的     

纯钛种植体在老年人严重吸收下颌骨的临床应用

目的探讨纯钛种植体在老年人严重吸收下颌骨的临床应用。方法１６２颗Ｂｒａｎｅｍａｒｋ种植体植入３２例下颌严重吸收全牙列缺失老年患者的颌骨内,完成修复体３２件,临床观察２８～３２个月。结果修复后２年累积成功率为９６．３％,种植失败多数发生在种植早期。结论纯钛种植体对老年人严重吸收下颌骨具有良好的修复效果。     

老年人原发性干燥综合征的腺外表现

目的　探讨老年人原发性干燥综合征 (PSS)的腺外表现特点。　方法　分析 10 6例老年PSS患者腺外表现的临床特点及实验室检查结果 ,并与 12 0例非老年PSS患者进行比较。　结果　老年组 10 6例 ( 10 0 0 % )和非老年组 97例 ( 80 8% )有腺外表现。老年组出现低钾性心律失常、末梢神经炎 (P <0 0 5 )、低钾性肌麻痹、继发性糖尿病、病理性骨折、三叉神经痛、面神经麻痹者明显多于非老年组 (P <0 0 1) ;超敏性血管炎、无菌性尿道刺激综合征者与非老年组差异无显著性 (P >0 0 5 ) ,非侵蚀性关节炎和关节痛者低于非老年组 (P <0 0 1)。　结论　原发性干燥综合征是一系统性疾病 ,患者常以腺外表现为突出特点就诊 ,特别是老年患者 ,因此应加以鉴别 ,以免误诊或漏诊。     

76例老年患者经桡动脉穿刺冠状动脉成形术临床观察

目的　探讨老年人经桡动脉穿刺冠状动脉成形术的安全性及成功率。　方法　老年组76例 ,对照组 15 4例 ,2组患者均首选经桡动脉穿刺冠状动脉成形术 ,对比观察其成功率、并发症、手术时间、X线照射时间及造影剂用量等。　结果　老年组桡动脉穿刺及插管成功率为 94 7%,冠脉成形术成功率为 93 3%,并发症发生率为 5 3%;对照组分别为 97 4 %、94 1%、5 2 %,2组间差异均无显著性 (P >0 0 5 ) ;手术时间、X线照射时间及造影剂用量分别为 (30 5± 12 5 )min与 (2 9 5± 11 6 )min、(2 0 6± 5 8)min与 (19 3± 7 5 )min、(90 8± 2 0 3)ml与 (89 4± 2 1 9)ml,2组之间差异均无显著性 (P >0 0 5 )。　结论　对于桡动脉搏动好、Allen试验无缺血、不需要大直径旋磨导管旋磨及定向斑块旋切技术治疗的老年患者 ,经桡动脉穿刺冠状动脉成形术安全、有效。     

Cpn慢性感染与老年呼吸道疾病的血清学相关性研究

目的　观察肺炎衣原体 (Cpn)慢性感染与老年呼吸道疾病相关的血清学证据。　 方法 　采用间接免疫荧光法检测Cpn特异性抗体IgA、IgG、IgM。　 结果 　老年组、非老年组和健康对照组的慢性感染率分别为60 .0 %、3 3 3 %和 2 0 4% ,既往感染率分别为 71 1%、48 3 %和 47 2 % ,差异均具有显著性 (均为P <0 0 1)。在慢性感染方面 ,老年组和非老年组间、老年组和健康对照组间差异有显著性 (均为P <0 0 1) ;非老年组和健康对照组间差异无显著性 (P >0 0 5 ) ;在既往感染方面 ,3组的统计结果同慢性感染相一致。　 结论 　Cpn是老年呼吸道感染的重要病原菌之一 ,Cpn慢性感染与老年人肺癌、慢性阻塞性肺疾病 (COPD)等密切相关。     

中老年人阻塞性睡眠呼吸暂停低通气综合征白天嗜睡的临床分析

目的　通过对阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者白天嗜睡的测评 ,探讨白天嗜睡在不同年龄、病情之间的发生率。　方法　采用Epworth嗜睡量表 ,对经过多导睡眠监测(PSG)诊断为OSAHS的患者进行测评。　结果　OSAHS患者白天嗜睡的发生率为 5 4 3% ,且不同年龄组 (老年组和非老年组 )、不同病情组 (按睡眠呼吸紊乱指数 ,即AHI大小划分 )的发生率差异无显著性 ,嗜睡程度以非老年组高于老年组 (P <0 0 5 ) ,重度组高于轻、中度组 (P <0 0 5 )。　结论　中老年OSAHS患者白天嗜睡的发生率 5 4 3% ,老年患者的发生率与非老年患者没有差别。     

老年人原发性肝癌临床特点分析

目的　探讨老年人原发性肝癌 (PL C)临床特点及疗效。方法　对 36例老年治疗组、30例老年未治疗组及 74例非老年治疗组患者进行对比分析。结果　老年治疗组及未治疗组的肿瘤类型、肝功能分级与非老年组相近。老年组无症状或症状不典型者明显高于非老年组 (P<0 .0 5) ,AFP升高者低于非老年组 (P<0 .0 5) ,且并存疾病多 (P<0 .0 1 )。老年治疗组半年、1年、2年生存率与非老年组相似 ,但显著高于老年未治疗组 (P<0 .0 5)。结论　老年人 PL C临床表现不典型者居多 ,积极采用以手术或 TACE为主的综合治疗可获得与非老年人相似的治疗效果。     

老年人急性心肌梗死急诊冠状动脉内支架治疗

目的　评价急诊冠状动脉 (冠脉 )内支架治疗老年人急性心肌梗死 (AMI)的临床疗效。方法　对比分析 84例老年与 88例非老年人AMI急诊冠脉内支架术结果。结果　老年组 84支梗死相关血管 ,置入支架 86枚 ,围手术期死亡 2例 ,手术成功率为 97 6 % ;非老年组 88支梗死相关血管 ,置入支架 88枚 ,围手术期死亡 1例 ,手术成功率 98 9%。老年组与非老年组支架特点及出院时左室射血分数差异无显著性。两组均无严重的出血并发症。结论　老年人AMI急诊冠脉内支架治疗安全有效。     

老年糖尿病住院患者病死率及死因分析

目的：了解老年糖尿住院患者病死率及主要死亡原因,方法：回顾和总结１９９２年至１９９９年间的住院患者中,老年糖尿病患者住院情况及２４８例死亡病例的死亡时间和原因,并与非老年糖尿病患者比较,结果：８年中,老年糖尿病病患者占糖尿病住院患者的比例呈显著增加趋势（１９９２－１９９５年为５９．９３％,１９９６－１９９９年为６７．６３％,Ｐ＜０．００１）,老年糖尿病死亡病例占有所有糖尿病死亡病例的８５．８％,老年糖尿病患者病死率（７．８％）明显高于非老年糖尿病患者（２．３％,Ｐ＜０．００１）,并随年龄增加而显著上升（６０－６９岁组４．７２％,７０－７９岁组１１．３４％,８０岁以上组２３．６０％,Ｐ＜０．００１）,男性病死率（９．６１％）显著高于女性（５．８２％,Ｐ＜０．００１）,老年糖尿中层得前５位死因顺序是：心血管疾病,脑血管疾病,胖发肿瘤,糖尿病肾病,感染,死于心,脑,肾疾病的病例中,７６．６％伴高血压,结论：老年糖尿病患者病死率随年龄增长而增高,男性显著高于女性,心,脑,肾并发症是其最重要的死亡原因,高血压是其主要危险因素,严格控制高血糖的早期控制血压,对防治糖尿病并发症和降低病死率有重要意义。     

Radiographic Analysis of Graft Dimensional Changes in Transcrestal Maxillary Sinus Augmentation: A Retrospective Study

Background. The maxillary sinus lift is a popular and predictable technique associated with implant-supported rehabilitation of the severely atrophic maxilla. The aim of the present retrospective study was to investigate the effectiveness of transcrestal maxillary sinus augmentation and the graft resorption pattern using different heterologous bone substitutes. Methods. A total of 75 sinus-grafting procedures were performed and 89 implants were placed in 66 patients, 24 males and 42 females, with mean age 67.9 ± 10.64 years (range 43–84 years). Nineteen subjects were smokers. The mean follow-up period was 93.33 ± 54.71 months (range 14–240 months). Clinical and radiographical evaluations were performed. Graft height and width were measured at baseline and at the latest follow-up. Results. Mesiodistal and vertical resorption averaged 9.3 ± 20.7% (standard deviation), and 5.04 ± 9.9% of the postoperative size, respectively, considering the graft as the unit. Linear regression analysis showed that graft resorption in both the vertical and the mesiodistal dimension is independent of the follow-up time. Conversely, there was a trend for greater resorption when increasing the postoperative graft size, in both vertical (p = 0.001) and horizontal (p = 0.007) dimensions. When grouping the dimensional changes by graft particle size (only small (<300 μm) particles, combination of small and medium (>500 μm)/large (>1000 μm) particles, and only medium/large particles), there was a trend for greater resorption associated with smaller particles, but it was not significant; neither in the mesiodistal nor in the vertical dimension (p = 0.17 and p = 0.25, respectively). No implant was lost during the observation period. In conclusion, the transcrestal technique for maxillary sinus augmentation documented a high level of predictability. The low clinical morbidity and the contextual dental implant positioning is clinically useful in relation to a significant reduction of the time required for implant restoration, a consistent decrease of the number of surgical phases, and a cost-effectiveness approach for the rehabilitation. The graft resorption pattern in all cases was compatible with persistent implant protection and support.     

老年人原发性甲状旁腺功能亢进症临床特征分析

目的 比较老年与非老年患者原发性甲状旁腺功能亢进症(甲旁亢)的临床特点. 方法 回顾性分析58例原发甲旁亢患者的临床资料,按年龄分为老年组和非老年组,对两组患者临床资料进行分析. 结果 老年组20例,非老年组38例;与非老年组比较,老年组甲状旁腺激素((173.6±40.0)ng/L和(377.6±87.4)ng/L)、碱性磷酸酶[(235.5±75.3)U/L和(517.8±84.1)U/L]等水平均较低;尿路结石(15%和42%)、骨骼疼痛(25%和50%)的发生率亦低于非老年组(P＜0.05).对手术确诊者的影像学资料进行分析,B超、CT(平扫或平扫加增强)、核素扫描检出的阳性率均较高,两组差异无统计学意义.术后老年组与非老年组患者的血钙水平较术前明显降低,有1例非老年组患者术后发生永久性低血钙. 结论 与非老年组比较,老年甲旁亢患者缺乏特异临床表现;手术治疗对于老年患者同样具有较高的有效性及安全性.     

Effects of Osseodensification on Immediate Implant Placement: Retrospective Analysis of 211 Implants

Osseodensification is a new method of bone instrumentation for dental implant placement that preserves bulk bone and increases primary implant stability, and may accelerate the implant rehabilitation treatment period and provide higher success and survival rates than conventional methods. The aim of this retrospective study was to evaluate and discuss results obtained on immediate implant placement with immediate and delayed loading protocols under Osseodensification bone instrumentation. This study included private practice patients that required dental implant rehabilitation, between February 2017 and October 2019. All implants were placed under Osseodensification and had to be in function for at least 12 months to be included on the study. A total of 211 implants were included in the study, with a 98.1% total survival rate (97.9% in the maxilla and 98.5% in the mandible). For immediate implants with immediate load, 99.2% survival rate was achieved, and 100% survival rate for immediate implant placement without immediate load cases. A total of four implants were lost during this period, and all of them were lost within two months after placement. Within the limitations of this study, it can be concluded that Osseodensification bone instrumentation provided similar or better results on survival rates than conventional bone instrumentation.     

Biomechanical Evaluation of Bone Atrophy and Implant Length in Four Implants Supporting Mandibular Full-Arch-Fixed Dentures

Residual alveolar ridge resorption often occurs after tooth extraction, which causes issues requiring further prothesis rehabilitation. A treatment concept referred to as all-on-four, involving fixed dentures supported with four implants, was recently developed. The current study aimed to determine the effect of changing bone atrophy and implant length in all-on-four treatments on stress and strain in the surrounding bone of the implant. A three-dimensional finite element method was used in this research. The stress analysis was conducted with von Mises stress values. Two types of synthetic jawbone models with mild and moderate atrophy were used. Furthermore, two different implant lengths with a similar implant design and diameter were selected, and they were classified into eight models. Then, the bone model was assessed via a computed tomography (CT) scan and was transformed into a virtual model in Geomagic and SolidWorks with implant rebuilding. After modifying bone atrophy, the von Mises stresses in the surrounding bone of the implant were as follows: mild type 2 < mild type 3 < moderate type 3 < moderate type 4. The bone quantity change rate increased more than when bone conditions were limited. Compared with changes in implant lengths, the stresses in the peri-implant surrounding bone were generally higher in the 9 mm implant length group than in the 11.5 mm group. However, the results did not significantly differ. In conclusion, the von Mises stress and strain increased in the models with moderate atrophy and low-density trabecular bone. Hence, bone atrophy and its presurgical diagnosis in long-term implant prognosis are crucial.     

Histological and Histomorphometric Evaluation of Post-Extractive Sites Filled with a New Bone Substitute with or without Autologous Plate Concentrates: One-Year Randomized Controlled Trial

The purpose of the present study was to evaluate the histological and histomorphometric characteristics of post-extraction sites grafted with decellularized bovine compact bone from bovine femur, mixed and unmixed with leukocyte- and platelet-rich fibrin after four months of healing. This study was designed as a randomized controlled trial of parallel groups. Patients in need of a single, implant-supported restoration to replace a hopeless tooth were recruited for tooth extraction and implant placement four months after socket preservation procedure. After tooth extraction, patients were randomly allocated to receive decellularized bovine compact bone from bovine femur, mixed and unmixed with leukocyte- and platelet-rich fibrin. After four months of healing, tapered implants were inserted with an insertion torque between 35 and 45 Ncm. Two months later, implants were loaded with screw-retained definitive crowns. Outcome measures were implant (ISR) and prosthesis (PSR) survival rates, complications, histological and histomorphometric analyses, radiographic marginal bone-level changes, and patients’ satisfaction. Clinical data were collected up to one year after tooth extraction and socket preservation procedures. Thirty patients were consecutively enrolled in the trial (15 in each group). Unfortunately, due to the COVID-19 pandemic, bone samples were collected only in 19 patients. Two implants failed before definitive prosthesis delivery (ISR 93.3%). No prosthesis failed (PSR 100%). Three complications were experienced in the control group. The mean bone percentage was 40.64 ± 18.76 in the test group and 33.40 ± 22.38 in the control group. The difference was not statistically significant (p = 0.4846). The mean soft tissue percentage was 32.55 ± 19.45 in the test group and 55.23 ± 17.64 in the control group. The difference was statistically significant (p = 0.0235). The mean residual graft was 24.59 ± 18.39 in the test group and 11.37 ± 12.12 in the control group. The difference was not statistically significant (p = 0.0992). Mean marginal bone loss, as well as patient satisfaction, showed no differences between groups. With the limitations of the present study, socket preservation with L-PRF mixed with decellularized bovine compact bone demonstrated favorable results, comparing with decellularized bovine compact bone from bovine femur alone. Further studies with larger sample size and longer follow-up are needed to confirm these preliminary results.     

Three-Dimensional Finite Element Investigation into Effects of Implant Thread Design and Loading Rate on Stress Distribution in Dental Implants and Anisotropic Bone

Variations in the implant thread shape and occlusal load behavior may result in significant changes in the biological and mechanical properties of dental implants and surrounding bone tissue. Most previous studies consider a single implant thread design, an isotropic bone structure, and a static occlusal load. However, the effects of different thread designs, bone material properties, and loading conditions are important concerns in clinical practice. Accordingly, the present study performs Finite Element Analysis (FEA) simulations to investigate the static, quasi-static and dynamic response of the implant and implanted bone material under various thread designs and occlusal loading directions (buccal-lingual, mesiodistal and apical). The simulations focus specifically on the von Mises stress, displacement, shear stress, compressive stress, and tensile stress within the implant and the surrounding bone. The results show that the thread design and occlusal loading rate have a significant effect on the stress distribution and deformation of the implant and bone structure during clinical applications. Overall, the results provide a useful insight into the design of enhanced dental implants for an improved load transfer efficiency and success rate.     

Immediate implant placement following minimally invasive extraction: a case report with a 6-year follow-up

Single tooth replacement with a dental implant has become an increasingly favored treatment option in the anterior maxilla; however, bone resorption following maxillary anterior tooth extraction is very common and often compromises gingival tissue for the implant restoration. Achieving predictable peri-implant esthetics requires a proper understanding and preservation of the osseous and gingival tissue surrounding the failing tooth. Therefore, the key to maintaining the interproximal papillae is to preserve the osseous support with minimally invasive extraction. An immediate implant insertion after tooth extraction may maintain the crest bone and the interdental papillae, thus achieving peri-implant esthetics. This article describes the detailed treatment planning and meticulous techniques in immediate implant placement that reduce treatment time and maintain functional as well as esthetic results through a 6-year follow-up.     

Novel Design and Finite Element Analysis of Diamond-like Porous Implants with Low Stiffness

The purpose of this study was to design porous implants with low stiffness and evaluate their biomechanical behavior. Thus, two types of porous implants were designed (Type I: a combined structure of diamond-like porous scaffold and traditional tapered thread. Type II: a cylindrical porous scaffold filled by arrayed basic diamond-like pore units). Three implant-supported prosthesis models were constructed from Type I, Type II and commercial implants (control group) and were evaluated by finite element analysis (FEA). The stress distribution pattern of the porous implants were assessed and compared with the control group. In addition, the stiffness of the cylindrical specimens simplified from three types of implants was calculated. The Type I implant exhibited better stress distribution than the Type II implant. The maximum stress between the cortical bone–Type I implant interface was 12.9 and 19.0% lower than the other two groups. The peak stress at the cancellous bone–Type I implant interface was also reduced by 16.8 and 38.7%. Compared with the solid cylinder, the stiffness of diamond-like pore cylinders simplified from the two porous implants geometry was reduced by 61.5 to 76.1%. This construction method of porous implant can effectively lower its stiffness and optimize the stress distribution at the implant–bone interface.