颈清扫术几种改进术式的比较研究

目的 通过两种改进颈清扫术式MRND与RND和FND术后肩功能的比较研究,观察MRND1和MRND2能否较好地保留或恢复斜方肌的功能。方法46例需行颈清扫术的患者,分成4组,分别行RND、FND和MRND1、MRND2,通过肩功能临床检查的主客观评价标准及斜方肌肌电检测进行对比研究。结果MRND1和MRND2均可获得较大程度的斜方肌功能恢复,MRND1和MRND2的上肢平均最大外展角度分别为96.67°和98.13°,50％的患者外展上臂超过90°,两种改进术式的术后肩功能明显优于RND。结论MRND1和MRND2较FND有广泛的适应证,又可较大程度地保存和恢复术后斜方肌的功能,改善传统RND术后的肩综合征,临床上可以用来代替传统RND,以提高患者的生存质量。     

根治性颈淋巴清扫术改善术后肩功能的方法探讨

目的 探讨一种改进根治性颈清扫术式对术后肩功能的影响。方法 随机选择20例需行颈清扫术的患者分为2组，每组10例。试验组行根治性颈清扫术时保留颈丛深支，对照组行常规根治性颈清扫术。术后3周及6个月随访．对术后患侧斜方肌功能进行评价。结果 术后3周两组患者均有不同程度的肩功能受损；术后6个月试验组患者患侧肩部无明显下垂，患侧上肢外展稍超越水平线。对照组患侧肩部有不同程度下垂，肩部疼痛，麻木，上肢外展不能超过水平线。结论 保留颈丛深支的根治性颈淋巴清扫术能明显改善术后患侧的肩臂功能，减轻传统术式术后肩部的疼痛、麻木感。该术式不影响根治颈清扫术的疗效，易于临床开展。     

颈淋巴清扫术后肩综合征的防治

探讨预防颈清扫术后肩综合征的方法。方法观察１１例接受根据治性颈清扫术患者，其中８例切降副神经，保留颈神经丛深支，３例同时切降副神经及颈神经丛深支，术后６月进行肩功能的临床和斜方肌骨电检查。     

颈清扫术中改善术后肩功能方法的初步探讨

目的　观察并论证两种改进颈清扫术式的优越性及改善术后斜方肌功能的效果。方法　 2 4例需行颈清扫术的患者 ,每组 12例 ,分别在颈清扫术中保留颈丛斜方肌分支 (MRND1)或采用颈丛肩胛提肌支与副神经移位吻合 (MRND2 )。结果　手术 6月后 ,MRND1和 MRND2均可获得较大程度的斜方肌功能恢复 ,MRND1和MRND2的上肢平均最大外展角度分别为 96 .6 7°和 98.13°,5 0 %的患者可以外展上臂超过 90°。结论　 MRND1和MRND2均可较大程度地保存和恢复术后斜方肌的功能 ,改善传统颈清扫术 (RND)后的肩综合征 ,既不违反根治肿瘤的原则 ,同时具有简便、无联带运动、利于斜方肌神经再生、功能恢复等优点。临床上可以用来代替传统 RND,以提高患者的生存质量     

颈清扫术不同术式对cN0口腔鳞状细胞癌患者肩功能的影响

目的比较颈清扫术（ND）不同术式对口腔鳞状细胞癌患者术后肩功能的影响.方法将66例临床颈部淋巴结阴性（cN0）口腔鳞状细胞癌患者按接受ND的术式分为根治性颈清扫术（RND）组、改良根治性颈清扫术（MRND）组和择区性颈清扫术（SND）组,采用Constant＇s肩功能量表和ND损伤指数量表对术后肩功能进行评价.结果保留副神经组的患侧肩功能优于RND组（P＜0.01）.在保留副神经组中,SND组的肩功能优于MRND组（P＜0.01）.SND术后的肩部疼痛和功能障碍轻微.结论SND对术后肩功能影响轻微,优于RND和MRND.     

根治性颈清扫术与改良根治性颈清扫术

根治性颈清扫术（radical neck dissection，RND）与改良根治性颈清扫术（modified radical neck dissection，MRND）同属全颈清扫术（comprehensive neck dissection，CND）的范畴，即术中清扫一侧颈部Ⅰ～Ⅴ区的全部淋巴结。RND术中同时牺牲副神经、颈内静脉和胸锁乳突肌，而MRND则保留了一个或数个上述结构。虽然近年来选区性颈清扫术（selective neck dissection，SND）在头颈癌N＋颈部处理的应用已经越来越多，特别是N1颈部，但是，RND和MRND仍然是目前处理头颈部淋巴结转移（N＋）的主流和经典术式，特别是MRND。     

233例根治性颈淋巴结清扫术的并发症及其处理

如何防止和减少手术的并发症是一个值得探讨的重要课题，北京口腔医院自１９８０－１９９０年共收治颌面部恶性肿瘤９５５人次，其中做根治性颈淋巴结清扫术的２３３例。作者对其癌瘤的发病部位、手术种类和并发症发生的原因及处理原则分别予以讨论，目的是从失败中总结出经验教训，降低并发症的发生率，从而提高颈淋巴结清扫术的成功率和患者的生存率。     

颈淋巴清扫术后肩功能研究之现状

根治性颈淋巴清扫术由于切除了副神经等结构,常发生肩(胛)综合征。本文概述了根治性和功能性颈淋巴清扫术后的肩功能研究现状,肩综合征的可能发生机制,以及近年来解决根治性颈淋巴清扫术后肩综合征的一些办法。     

保存颈内静脉的改良根治性颈淋巴清扫术的临床评价

目的 :对口腔癌及口咽癌颈淋巴清扫术中保存颈内静脉术式的临床效果进行评价。方法 :回顾分析本院近 10年内所行的根治性颈淋巴清扫术和保存颈内静脉的改良根治性颈淋巴清扫术病例资料。比较 2种术式的术后面部水肿和颅内高压持续时间及程度、2组患者的术后局部复发情况和生存时间。结果 :保存颈内静脉的改良根治性颈淋巴清扫术的术后颌面部水肿和头晕症状程度轻于根治性颈淋巴清扫术 ,持续时间缩短。改良根治性颈淋巴清扫术 3年和 5年生存率分别是 72 .6%和 5 3 .3 % ,局部复发率 5 .1% ;而根治性颈淋巴清扫术 3年和 5年生存率分别是 75 .2 %和 5 7.8% ,局部复发率 4.8%。二者 3组指标差异均无显著性 (P >0 .0 5 )。结论 :保存颈内静脉的改良根治性颈淋巴清扫术和经典的根治性颈淋巴清扫术临床疗效相近 ,术后并发症轻 ,且能保存颈内静脉 ,为可能的再次手术治疗创造了条件 ,值得临床推广。     

应用CT评价正常发音者的腭咽闭合功能

目的　建立CT客观评价腭咽闭合功能的方法。方法　应用CT对30例正常发音者在静止和发/i/音时腭咽腔的三维形态结构进行观察分析,并对腭咽腔的线距和面积进行了测量。结果　发/i/音时腭咽腔最小面积为（11.92±11.73）mm     

Assessment of shoulder function after functional neck dissection and selective neck dissection (Levels I, II, III) in patients with carcinoma of tongue: a comparative study

Background and objectives  

To compare shoulder function with respect to pain and disability in patients who have undergone nerve sparing neck dissection i.e. selective neck dissection (levels I, II, III) and functional neck dissection as a part of their treatment modality for carcinoma tongue on a follow up of minimum six months.     

调节T淋巴细胞功能治疗口腔黏膜扁平苔藓的临床观察

目的：寻求治疗口腔黏膜扁平苔藓的有效方法。方法：以137名扁平苔藓患者作为研究对象,随机分为两组,一组采用传统方法治疗,另一组采用调节T淋巴细胞功能,改善局部环境等方法治疗,治疗半年后观察两组的疗效与复发情况,并采用χ2检验分析。结果：临床观察结果经χ2分析后表明：实验组在疗效与复发控制上均明显优于对照组。结论：作者提出的调节T淋巴细胞功能治疗口腔黏膜扁平苔藓在临床上是一种有效的治疗方法。     

Translation and validation of a Chinese version of the Mandibular Function Impairment Questionnaire

To adapt the English version of the Mandibular Function Impairment Questionnaire (MFIQ) for Chinese‐speaking patients with temporomandibular disorder (TMD) and to evaluate its validity and reliability. In total, 352 patients diagnosed with TMD according to the research diagnostic criteria for TMD (RDC/TMD) Axis I were included in this study. The psychometric evaluation included reliability, which was evaluated by internal consistency (Cronbach's alpha coefficient), and test–retest reliability and validity, which were tested by content and construct validity. Because the content validity of item 11 (kissing) was low (0·12), this item was excluded in subsequent analyses. For exploratory factor analysis, three factors were extracted, accounting for 63·6% of the variance. All items had factor loadings above 0·4. Two models were tested by confirmatory factor analysis, and the two‐factor model was adopted (χ²/df = 2·279, root mean square error of approximation (RMSEA) = 0·086, comparative fit index (CFI) = 0·910). Internal reliability (coefficient alpha values of 0·925 and 0·720 for each factor) and test–retest reliability (ICC_factor1 = 0·895, 95% CI_factor1 = 0·869–0·918, ICC_factor2 = 0·720, 95% CI_factor2 = 0·645–0·783) of the Chinese MFIQ were excellent. A reliable and valid Chinese version of the MFIQ was constructed for the evaluation of Chinese patients with TMD after some modification of the English version of the MFIQ.     

Validity and reliability of the Portuguese version of Mandibular Function Impairment Questionnaire

The aim of this study is to evaluate the validity and reliability of the Mandibular Function Impairment Questionnaire (MFIQ) (Portuguese version). Face and content validity of the Portuguese version were performed. To assess reproducibility of the data gathered with MFIQ, it was applied to 62 individuals who completed the questionnaire on two occasions. Validity and reliability of the data gathered with MFIQ were evaluated in a sample of 249 patients. Construct-related validity was assessed through factorial validity (by means of a confirmatory factor analysis), and convergent and discriminant validities were assessed, respectively, by the average variance extracted (AVE), composite reliability (CC) and bivariate correlations between factors. The internal consistency was estimated by the standardised Cronbach's alpha coefficient (α) and reproducibility by the intra-class correlation coefficient (ICC). All the items of MFIQ showed content validity. Reproducibility was excellent in both the 'functional capacity' dimension (D1) (ICC(D1) =0·895, 95% CI=0·832 to 0·935) and the 'feeding' dimension (D2) (ICC(D2) =0·825, 95% CI= 0·726 to 0·891). Items 1, 2, 6 and 7 of D1 had factor weights below the desired cut-off (0·5), and overall fit of the original bifactorial structure of the MFIQ was poor [(confirmatory fit index) CFI= 0·850, (goodness of fit index) GFI= 0·781, (root mean square error of approximation) RMSEA= 0·118]. Thus, these items were excluded, and the new, reduced version of the MFIQ showed good fit (CFI=0·933, GFI=0·879, RMSEA=0·099). The convergent validity was adequate (AVE≥0·5, CC≥0·7) for both factors. However, their discriminant validity was low (AVE(D1) = 0·51 and AVE(D2) = 0·66 <ρ(2) (D1D2) =0·70). The internal consistency was excellent (α(D1) =0·874; α(D2) =0·918). The Portuguese version of the reduced MFIQ produced data with good validity and reliability.     

血管化腓骨移植后供区并发症及功能评价

目的 通过对血管化腓骨移植后供区的恢复情况及并发症的研究,探讨制备血管化腓骨瓣的注意事项以及预防供区并发症的措施.方法 选取我院口腔颌面外科病房70例接受腓骨瓣下颌骨重建患者.通过踝关节外侧不稳定评分系统、Enneking下肢功能评价表等进行综合分析和评价.结果 下肢疼痛、功能活动受限者占所有患者的75％,这些患者均存在行走能力下降,极个别患者存在步态改变,老年患者下肢功能恢复能力下降.结论 所有患者供区并发症均较轻,患者主要问题为足趾背伸障碍和感觉障碍,并未发生其他严重影响生活的并发症.     

颞下颌关节区疼痛患者全身伴随症状的初步研究

目的调查与颞下颌关节(TMJ)区疼痛伴随出现的全身症状的发生情况。方法选取TMJ区疼痛患者51例及TMJ区无疼痛的对照者31人,调查其TMJ症状及全身伴随症状。治疗半年后对TMJ区疼痛患者进行复查。应用一元线性回归和卡方检验对TMJ区疼痛与全身症状的相关性及伴随性进行统计学分析。结果与TMJ疼痛有相关性的症状包括头痛、背痛、手麻抖、肩颈痛、失眠、目眩、听力下降、眼痛和易疲劳(P<0.05)。患者组部分症状(头痛、肩颈痛、眼痛、耳鸣、目眩、眼下抽搐、易疲劳、手脚发凉、易烦躁、注意力不集中和消化不良)发生的比例显著高于对照组(P<0.01)。半年后与TMJ区疼痛伴随改善的症状有头痛、肩颈痛和易疲劳(P<0.05)。结论头部、肩颈等口腔颌面邻近器官的症状是TMJ区疼痛的主要伴随症状,与TMJ症状的改善有伴随关系。     

Klippel-Trenaunay-Weber Syndrome: A clinical case report

Klippel-Trenaunay-Weber Syndrome (KTWS) is a rare condition and presents the main characteristics of cutaneous hemangiomas, the presence of varicose veins, and hyperplasia of the soft and hard tissues on different parts of the body. This syndrome is characterized by an extreme individual variability, given that the majority of patients do not clearly present this classic trio. This condition is diagnosed at birth or in the first years of life, defined as a non-hereditary, but congenital, abnormality caused by a gene mutation in one autosomal dominant or recessive gene. The clinical signs are present at birth and are highly variable according to their severity. A female patient, 6 years of age, sought out an orthodontist, complaining of a facial asymmetry and presenting a history of ectopic eruptions. In the anamnesis, the patient's guardian reported that the child suffers from KTWS. This condition is characterized by an extreme degree of variability when it affects the craniofacial region, with the majority of patients not showing the classic trio of signs. KTWS is a rare and unknown condition; however, it does require interdisciplinary knowledge, considering, first and foremost, the diverse vascular changes associated with other maxillofacial and dental needs.     

上颌骨三维重建术后患者咀嚼功能的评价

目的　评价三维重建上颌骨大型缺损术后患者咀嚼功能的恢复程度。方法　选择2001年3月~2002年 6月经上海第二医科大学附属第九人民医院口腔颌面外科治疗的大型上颌骨缺损患者10例为研究对象。运用个 体化钛网支架结合前臂皮瓣或串联腓骨肌瓣的新术式行大型上颌骨缺损即刻重建,术后3~6个月常规可摘局部 义齿修复。采用美国Tekscan公司生产的T-ScanⅡ诊断系统行患者术前、术后的力与咬合测定分析。结果　患 者术前、术后力不对称指数与接触面积不对称指数均存在显著差异(P<0·05);义齿恢复咬合后,全口力恢 复率在27·05%~74·06%,平均力恢复率为(50·15±14·59)%。结论　本术式可使大型上颌骨缺损即刻重建的患 者获得外形与功能较为满意的效果,可有效地恢复患者的咀嚼功能,具有一定的推广和应用价值。     

经腋前线进路的延长节段性胸大肌肌皮瓣与常规方法修复口腔口咽癌缺损的疗效比较

目的: 比较经腋前线进路的延长节段性胸大肌肌皮瓣和常规方法制备胸大肌肌皮瓣在修复口腔口咽癌术区缺损的效果。方法: 纳入口腔、口咽癌患者91例,所有患者均实施肿瘤根治手术,并采用经腋前线进路的延长节段性胸大肌肌皮瓣（51例）或常规方法制备胸大肌肌皮瓣（40例）转移修复术区缺损组织。结果: 经腋前线进路的延长节段性胸大肌肌皮瓣和常规方法制备胸大肌肌皮瓣的血管蒂长度分别为22~28 cm和18~22 cm,皮岛大小分别为5 cm×8 cm~7 cm×14 cm和6 cm×7 cm~8 cm×17 cm。术后随访6~36个月,经腋前线进路的延长节段性胸大肌肌皮瓣组患者的肩部活动度明显优于常规组,并且供区的美观性更佳。结论: 与常规方法相比,延长节段性胸大肌肌皮瓣的蒂部更长,术后患者的肩部活动度与供区更美观,在口腔口咽癌术区组织缺损修复中值得推广应用。