无痛微创技术在牙槽外科的临床应用

目的：通过对微创拔牙器械和传统拔牙器械在下颌阻生齿拔除术中的临床应用比较为临床针对性地选择合适的拔牙方法和发展牙槽外科微创治疗提供实验依据。方法：对临床需要拔除的下颌阻生齿210例,随机分为两组,其中微创组107例,传统组103例,分别应用无痛微创器械和传统拔牙器械拔除患牙,比较二者术中断根率、拔牙窝不完整率、敲击增隙率和患者畏惧率及术后第1～3天的局部疼痛和肿胀、张口受限程度,术后下唇麻木、干槽症、关节疼痛和伤口感染情况。结果：微创组的断根率、拔牙窝不完整率、敲击增隙率、患者畏惧率明显低于传统组;微创组手术后下唇麻木、关节区疼痛、干槽症、伤口感染率也均低于传统组。结论：在拔除下颌阻生智齿的手术中,无痛微创器械能明显提高牙槽外科操作效率,因而减少患者术中不适,术后肿胀和疼痛的发生。此外微创技术也可以有效地避免因损伤下齿槽神经而导致下唇麻木等术后并发症的发生。     

CBCT 在拔除下颌第三阻生齿术中的应用

目的 分析锥形束CT（CBCT）在拔除下颌第三阻生齿术中的应用价值。方法 选取2022年 4月-2023年2月于我院行下颌第三阻生齿行拔除术治疗的62例患者为研究对象，随机分为对照组和研究 组，每组31例。对照组行全景曲面体层片检测，研究组行CBCT检测，比较两组拔牙时间、术后恢复情 况、拔除术并发症发病情况及牙根状态检测符合情况。结果 研究组拔牙时间、术后疼痛程度、疼痛时 长、颌面部肿胀程度、肿胀时长、术后出血时长、张口受限度均优于对照组（ P ＜0.05）；研究组并发症发 生率为6.45%，低于对照组的25.81%（ P ＜0.05）；研究组牙根分叉、牙根与邻牙位置关系及牙根、神经管 位置检测符合率均高于对照组（ P ＜0.05）。结论 在下颌第三阻生齿行拔除术中采用CBCT对患者实施检 测，可了解患者的第三阻生齿牙根状态，明确第三阻生齿与邻牙、周围组织关系，有助于保证手术的顺利 实施，提高手术的安全性，对于促进术后恢复具有积极意义。     

Alveolar osteitis following surgical removal of mandibular third molars

The purpose of this study was to evaluate 2 methods that could be used universally to reduce the incidence of alveolar osteitis. In addition, other variables including age and sex of patient, preoperative aspirin use and discomfort, and the use of oral contraceptives (OCs) were studied. A large controlled prospective study was completed with 952 surgical extraction sites in 476 patients. Postoperative dressings included lincomycin hydrochloride (Lincocin)/absorbable gelatin sponge (Gelfoam), oxytetracycline HCL-hydrocortisone acetate (Terra-Cortril)/absorbable gelatin sponge, and absorbable gelatin sponge/saline. Bilaterally impacted mandibular 3rd molars of similar surgical difficulty were selected. Standard accepted surgical technique was used. Patients were seen 1 and 7 days after surgery or as needed. Lincomycin hydrochloride/absorbable gelatin sponge and oxytetracycline HC1-hydrocortisone acetate/absorbable gelatin sponge were effective in reducing the incidence of alveolar osteitis. Lincomycin hydrochloride/absorbable gelatin sponge is preferred because of the increased morbidity associated with dressings containing petrolatum products. Absorbable gelatin sponge alone is not effective in reducing the incidence of alveolar osteitis. Age and OC use were found to be significant factors in the incidence of this problem.     

两种方法在拔除下颌阻生第三磨牙中的疗效比较

目的:观察和比较两种拔除下颌阻生第三磨牙的临床疗效。方法:门诊200例下颌阻生第三磨牙随机分为两组,各100颗。分别采用传统锤凿去骨法和涡轮机去骨法拔除,记录手术时间、术后疼痛、张口受限等情况并进行统计学分析。结果:两种手术方法在手术时间、术后疼痛、张口受限、肿胀程度等方面有统计学差异(P<0.05),传统锤凿去骨组出现干槽症与下唇麻木分别为5例和1例,涡轮机去骨组分别为1例和0例,组间比较差异无统计学意义(P>0.05)。结论:与传统锤凿去骨法相比,采用涡轮机去骨法拔除下颌阻生第三磨牙手术时间短,术后并发症较少,值得临床推广。     

拔除下颌低位阻生第三磨牙的临床研究

目的：了解高速涡轮牙钻磨裂沟法（斜磨、纵磨、横磨）加牙挺多点楔入与常规劈冠法在拔除下颌低位阻生第三磨牙的临床效果,评价磨裂沟法加牙挺多点楔入的临床可行性和优越性。方法：实验组195颗阻生齿,用磨裂沟法加牙挺多点楔入,对照组165颗阻生齿,采用常规劈冠法,分别拔除。记录手术时间、术后疼痛、面部水肿、张口受限及干槽症发病情况。结果：实验组与对照组拔除下颌低位阻生第三磨牙的手术时间、术后疼痛、面部水肿、张口受限及干槽症发病情况有明显差异（P〈0．05）。结论：磨裂沟法加牙挺多点楔入是将复杂的操作简单,手术时间短,术后并发症少,为拔除下颌低位阻生第三磨牙,初步建立简单化、标准化、规范化、微创化、起到抛砖引玉的作用。     

下颌阻生智齿拔出中采用涡轮机法与锤凿劈冠法疗效及安全性分析

目的探讨对下颌阻生智齿患者采用涡轮机法与锤凿劈冠法治疗的疗效及术后并发症情况,为临床上下颌阻生颌智齿拔出提供参考建议。方法随机将本院口腔门诊收治的86例（126颗牙）由于下颌阻生智齿实施拔出术的患者分成观察组和对照组各63牙,对两组患者手术时间、术中反应、术后并发症及术后口腔复诊情况进行比较。结果观察组的拔牙时间为（18.1±3.2）分钟明显低于对照组的（31.4±5.3）分钟,差异具有统计学意义（P〈0.05）;观察组术中的压根折断、邻牙损伤、颌骨骨折、颞下颌关节脱位术中并发症均明显低于对照组,且差异均具有统计学意义（P〈0.05）;对两组患者术后VAS评分、下唇麻木、干槽症、张口受限、颊面部肿胀五项术后并发症情况进行统计分析,结果：观察组的VAS评分（3.4±1.2）分明显低于对照组的（4.8±1.4）,观察组的下唇麻木、干槽症、张口受限、颊面部肿胀发生例数均明显低于对照组且差异均具有统计学意义（P〈0.05）。结论采用涡轮机法拔出下颌阻生智齿具有比锤凿劈冠法更短的手术时间,术中术后并发症更少,术后疼痛程度更低,采用涡轮机法拔出下颌阻生智齿在临床上值得推广。     

微创两步截冠法拔除水平阻生齿的术后反应临床观察

目的:观察微创两步截冠法拔除水平阻生齿的术后反应。方法:门诊患者随机分为两组,实验组(40例)采用微创两步截冠法,对照组(41例)则常规去骨劈冠后拔除。两组术后局部疼痛、肿胀情况的比较均采用卡方检验。结果:微创两步截冠法拔除水平阻生齿的成功率为97.5%。与常规去骨劈冠拔除法(对照组)比较,微创两步截冠法(实验组)的疼痛和肿胀程度明显较低(P<0.05)。结论:采用微创两步截冠法拔除水平阻生齿能够减少患者术后的创伤反应。     

Absorbable laparoscopic cigarette sponge.

OBJECTIVES: Minor intraoperative bleeding during laparoscopy poses a significant challenge to the minimally invasive urologist. We report on our improvement of the previously reported laparoscopic cigarette sponge with absorbable materials. METHODS: The sponge was constructed from a strip of absorbable gelatin sponge wrapped in oxidized regenerated cellulose and secured with absorbable suture. This device can be inserted into the laparoscopic field through a standard 12-mm laparoscopic port and similarly removed. It can also remain intracorporeally if left behind following surgery. RESULTS: The sponge has proven to be very effective at controlling minor hemorrhage and aiding with dissection and retraction. CONCLUSION: This device has improved operative safety and provides a useful alternative when laparoscopic bleeding occurs.     

Central renal stab wounds: treatment with augmented fibrin sealant in a porcine model

PURPOSE: We determined whether fibrin sealant augmented by an absorbable bolster could salvage kidneys with major, centrally located stab wounds. MATERIALS AND METHODS: A grade 4 renal injury was created in 16 commercial swine via a 1.5 cm sagittal, centrally located, through-and-through right renal laceration. Animals were randomized to 1 of 4 treatment arms, including control groups that received conventional renal capsule suture repair with an absorbable gelatin sponge bolster (3 in group 1) or a microfibrillar collagen sheet (3 in group 2) and experimental groups that received sutureless treatment entailing fibrin sealant instillation into the knife tract augmented by an external gelatin sponge (5 in group 3) or an external microfibrillar collagen sheet (5 in group 4). Arterial occlusion was not performed. Blood loss and time to hemostasis were recorded. Abdominal computerized tomography was performed at 1 week and necropsy was done at 6 weeks. RESULTS: Renal reconstruction with fibrin sealant resulted in significantly lower blood loss (62 vs 155 ml, p <0.05) and time to hemostasis (3.5 vs 6.5 minutes, p <0.05) than in the conventional suture groups. There was no radiographic or gross evidence of significant postoperative bleeding, urinoma formation or abnormal tissue healing in the recovery period. Gelatin sponge and collagen sheet demonstrated similar hemostatic efficacy. CONCLUSIONS: In this porcine renal trauma model fibrin sealant augmented by absorbable gelatin sponge or a microfibrillar collagen sheet effectively promoted hemostasis and renal salvage. Because of its safety, ease of use and efficiency, fibrin sealant appears to be an appropriate adjunct for managing challenging renal injuries.     

两种方法拔除下颌水平阻生智齿182例并发症分析

目的:探讨两种不同方法拔除术后并发症的发生原因及防治方法,为探索新的下颌阻生智齿拔除方法提供借鉴。方法:选择我科4年多诊治的182例下颌水平阻生智齿作为研究对象。随机分成两组,其中一组采用涡轮钻法拔除,另一组采用骨凿法拔除,对比分析两种不同方法拔除术后并发症发生情况。结果:涡轮钻组治疗时间较骨凿组短(P<0.05),颞下颌关节紊乱病发生率低于骨凿组,但骨凿组的术后反应较涡轮钻组轻(P<0.05)。结论:除术后反应外,涡轮钻法可以减少患者手术时间,降低了下颌水平阻生智齿拔除术后并发症发生率。     

CGF在需切开翻瓣拔除的阻生牙中止血效果

观察浓缩生长因子（CGF）在切开翻瓣拔除阻生牙创口中的止血效果。方法 选取我院 2021年8月-2022年7月行经切开翻瓣拔除阻生牙的120例患者为研究对象，随机分为观察组和对照组，各 60例。对照组拔牙创口不放置任何物质，予以常规缝合治疗；观察组拔牙创口内填塞CGF并缝合治疗，比 较两组阻生牙拔除30 min后创口出血率及出血时间。结果 观察组出血率为18.33%，低于对照组的46.67%， 差异有统计学意义（P ＜0.05）；观察组出血时间短于对照组，差异有统计学意义（P ＜0.05）。结论 针对 行经切开翻瓣拔除阻生牙患者，置入CGF并缝合较常规缝合创口的止血效果更好，可有效缩短阻生牙拔牙 术后的出血时间，减少阻生牙拔牙术后出血量。     

Effect on hemostasis of an absorbable hemostatic gelatin sponge after transrectal prostate needle biopsy

Objectives

To examine the usefulness of an absorbable hemostatic gelatin sponge for hemostasis after transrectal prostate needle biopsy.

Subjects and Methods

The subjects comprised 278 participants who underwent transrectal prostate needle biopsy. They were randomly allocated to the gelatin sponge insertion group (group A: 148 participants) and to the non-insertion group (group B: 130 participants). In group A, the gelatin sponge was inserted into the rectum immediately after biopsy. A biopsy-induced hemorrhage was defined as a case in which a subject complained of bleeding from the rectum, and excretion of blood clots was confirmed. A blood test was performed before and after biopsy, and a questionnaire survey was given after the biopsy.

Results

Significantly fewer participants in group A required hemostasis after biopsy compared to group B (3 (2.0%) vs. 11 (8.5%), P=0.029). The results of the blood tests and the responses from the questionnaire did not differ significantly between the two groups. In multivariate analysis, only “insertion of a gelatin sponge into the rectum” emerged as a significant predictor of hemostasis.

Conclusion

Insertion of a gelatin sponge into the rectum after transrectal prostate needle biopsy significantly increases hemostasis without increasing patient symptoms, such as pain and a sense of discomfort.     

胶原海绵止血功能的实验研究

目的 验证国产胶原海绵的止血性能。方法 选用健康成年SD大鼠20只,随机分为二组,行肝脏和切口,分别用胶原及明胶少绵止血,观察止血情况;切除肝左前叶造成标准肝创伤模型,分别用二种海绵止血,观察止血情况,并记录即时止血时间及出血量。术后7、14及20天剖腹观察腹腔内粘连、腹腔内感染及肝脏愈合情况,并切除部分再生肝组织进行组织学检查。结果 胶原海绵下肝创面粘附良好,即时止因时间及出血量均明显优于对照组（P＜0.05）。组织切片显示胶原海绵吸收、降解快,可诱导肝细胞再生。结论 胶原海绵止血性能良好,能有效导肝再生,吸收降解快,使用方便,有应用、推广价值。     

比较两种切口行下颌第三磨牙拔除术的临床效果

比较采用封套瓣切口与角形切口在拔出下颌中位阻生第三磨牙中的临床效果。方法 选取 2022年1月-6月于蚌埠医学院第一附属医院口腔颌面外科行下颌第三磨牙拔除术的60例患者为研究对象， 随机分为对照组和观察组，每组30例。对照组采用角形切口行下颌第三磨牙拔除术，观察组采用封套瓣切 口行下颌第三磨牙拔除术，比较两组手术时间、出血程度、牙周探诊深度、疼痛程度、伤口愈合情况、肿 胀程度及张口度。结果 两组手术时间、出血程度及牙周探诊深度比较，差异无统计学意义（P ＞0.05）； 观察组术后7 d V AS评分低于对照组（P ＜0 .0 5）；观察组术后3、7 d L a n d r y评分均高于对照组 （P ＜0.05）；观察组术后3 d肿胀程度低于对照组，张口度高于对照组（P ＜0.05）。结论 相比于角形切 口，采用封套瓣切口行下颌第三磨牙拔除术在减轻疼痛和肿胀、促进早期张口和伤口愈合方面的效果更为 理想，有利于促进患者恢复。     

两种止血材料在颈椎单开门椎管扩大成形术中的止血效果观察

目的:比较可吸收止血流体明胶(HFG)和可吸收明胶海绵(GS)在颈椎后路单开门椎管扩大成形术中的止血效果。方法:回顾性分析2014年2月至2016年5月接受颈椎后路单开门椎管扩大成形术治疗的患者83例,根据患者术中使用不同止血材料分两组:HFG组41例,男30例,女11例;年龄29~81岁,平均(55.6±11.6)岁;其中14例为单纯颈椎管狭窄症,9例合并后纵韧带骨化,18例合并多节段颈椎间盘突出。GS组42例,男32例,女10例;年龄36~78岁,平均(55.4±11.1)岁;其中12例为单纯颈椎管狭窄症,10例合并后纵韧带骨化,20例合并多节段颈椎间盘突出。两组患者性别、年龄及病变类型等一般资料比较,差异均无统计学意义(P0.05)。比较两组手术时间、术中出血量、术后引流量、术后不良事件及术后并发症。结果:HFG组和GS组患者手术时间分别为(137.2±30.0)、(154.8±33.5)min(P0.05);术中出血量分别为(156.1±74.6)、(242.9±120.7)ml(P0.001);术后引流量分别为(212.1±67.6)、(303.3±115.5)ml(P0.001)。HFG组手术时间、术中出血量及术后引流量均少于GS组。两组患者均未发生术后切口急性血肿及其他止血相关并发症。结论:颈椎后路单开门椎管扩大成形术中,HFG操作简单,可以减少手术时间、术中出血量和术后引流量,是一种安全并且效果优于传统止血方式的止血材料。     

婴儿期腭裂修复术松弛切口不同处理方法的临床对比观察

目的 探讨婴儿期腭裂von Langenbeck术式修复术松弛切口裸露疗法及放置可吸收止血纱布两种方法 的比较观察.方法 以118例先天性腭裂的5～8个月婴儿为研究对象,随机分为两组,A组为松弛切口裸露疗法组,B组为松弛切口内以可吸收止血纱布堵塞组.观察术后创面出血、体温、术口复裂穿孔及饮食情况等项临床指标,并经过统计学处理.结果 两组患儿术后体温、饮食及术口愈合情况对比,差异无统计学意义（P〉0.05）;A组的术后创面出血为4例,B组为0例,两组相比差异有统计学意义（P〈0.05）.结论 无论裸露疗法还是放置可吸收止血纱条堵塞法,对于患儿术后的全身及局部反应均影响轻微.裸露疗法具有经济负担轻,创面刺激小等优点.     

Effect of steroids on edema, ecchymosis, and intraoperative bleeding in rhinoplasty

A double-blind, randomized study was designed to determine the efficacy of dexamethasone in decreasing periorbital edema and ecchymosis after rhinoplasty. Sixty rhinoplasty patients undergoing hump resection and lateral osteotomy were included in the study and were divided into 6 groups: group 1 (n = 10), single dose of 8 mg intravenous (IV) dexamethasone 1 hour before the operation; group 2 (n = 10), single dose of 8 mg IV dexamethasone at the beginning of the operation; group 3 (n = 10), 3 doses of 8 mg IV dexamethasone 1 hour before the operation, and 24 and 48 hours after the operation; group 4 (n = 10), 3 doses of 8 mg IV dexamethasone at the beginning of the operation, and 24 and 48 hour after the operation; group 5 (n = 10), 3 doses of 8 mg IV dexamethasone immediately after the operation, and 24 and 48 hours after the operation; group 6 (n = 10), control, no dexamethasone administration before or after the operation. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and days 2, 5, 7, and 10. For the postoperative evaluation of periorbital ecchymosis and edema, a scale of 0 to 4 points was used. There was no significant difference between groups in terms of bleeding (P > 0.05). In the groups using steroid before osteotomy, edema and ecchymosis were significantly lower during the first 2 days compared with the control group (P < 0.05). No significant difference was seen between groups 1 and 2. When patients were evaluated on day 5, edema and ecchymosis were significantly lower in groups 3 and 4 (P < 0.05) compared with other groups, but there was no difference between them. Group 5 had a significantly higher level of edema and ecchymosis compared with groups 1 through 4 at 24 hours and at days 2, 5, and 7 (P > 0.05). There was no significant difference between groups on day 10. In conclusion, if the first dose is given before osteotomy, triple-dose steroid application is the best bet for decreasing postoperative edema and ecchymosis. None of the patients had any complications related to the use of dexamethasone.     

Bupivacaine-soaked absorbable gelatin sponges in caesarean section wounds: effect on postoperative pain,analgesic requirement and haemodynamic profile

BackgroundPain is a common distressing adverse effect in the early postoperative period following caesarean section. The aim of this study was to investigate the effect on postoperative pain, analgesic requirement and haemodynamic profile of placing a suprafacial bupivacaine-soaked absorbable gelatin sponge in the caesarean section wound.MethodsA total of 164 healthy patients scheduled to undergo general anaesthesia for elective caesarean section were randomised to a study group (n=81) or a control group (n=83). In the study group, a bupivacaine-soaked absorbable gelatin sponge was placed subcutaneously in the caesarean section wound. Intramuscular diclofenac 75 mg was given to all patients at 8-h intervals during the first 24 h. Postoperatively, visual analogue scale pain scores, requirement for pethidine and diclofenac and changes in blood pressure and heart rate were compared between groups.ResultsPain scores were lower in the study group compared to the control group at all assessments (P <0.001). During the first eight hours after surgery, fewer patients in the study group required rescue pethidine compared with the control group (4 vs. 33, P <0.001). In the study group, total opioid and diclofenac consumption was lower (P <0.001), and blood pressure and heart rate were lower (P <0.001) compared to the control group.ConclusionSuprafascial wound placement of a bupivacaine-soaked absorbable gelatin sponge improved postoperative analgesia and decreased opioid consumption following caesarean section.     

微动力系统及人工骨粉移植在下颌阻生智齿拔除术中的临床应用

目的：研究人工骨粉移植对下颌智齿拔除后第二磨牙远中牙槽骨缺损的修复及降低牙敏感发生的应用。方法：对73例存在近中牙槽间隔缺损的下颌近中低位阻生智齿采用微动力系统进行微创拔除术,对拔牙后的拔牙窝随机分为二组,植骨组38颗患牙采用微创拔牙后即刻植入Bio-OsSC01legen骨胶原质并缝合,对照组35颗患牙采用微创拔牙后常规复位缝合,对比两组的术中并发症、术后1周愈合情况、术后1、3个月第二磨牙远中牙槽嵴高度、下颌第二磨牙牙本质敏感发生率。结果：术中、术后1周两组无明显差异。术后1、3个月下颌第二磨牙牙本质敏感发生率在植骨组比对照组低,在统计学上有显著性差别（P〈0．05）;在植骨组不良反应明显比对照组少（P〈0．05）。应用微动力系统拔除下颌阻生智齿术中术后严重并发症发生率较低,对硬组织的损伤较小。结论：人工骨粉移植与人体相容性好,且可以有效降低下颌阻生智齿术后邻牙松动、牙本质敏感的发生。     

The effect of absorbable gelatin sponge on experimental microvascular anastomoses

Following a pilot study a controlled trial was carried out to assess the effect of absorbable gelatin sponge on reducing the bleeding from microvascular anastomoses of the femoral arteries and veins of rats. A model was used which approximated to the clinical situation and the bleeding time was significantly reduced in arteries and veins. There was no significant difference in patency rates or wound infection.