儿童错牙合畸形正畸治疗结束后微笑美学的主观评价及客观测量指标对其影响分析

目的：比较正畸医生与普通人对儿童错牙合畸形正畸治疗结束后微笑美学的主观评价情况，并探讨客观测量指标对其的影响。方法：选取2019年6月-2021年6月在笔者医院正畸治疗结束后的90例错牙合畸形患儿为研究对象，分别由10名正畸医生与10名普通人对患儿的微笑美学进行主观评价，比较微笑美学满意组(正畸医生主观评分≥5分)与不满意组(正畸医生主观评分<5分)的客观测量指标，采用多因素Logistics回归分析客观测量指标对微笑美学的影响。结果：正畸医生的主观评分[(5.66±1.20)分vs(6.70±1.31)分]明显低于普通人(P<0.05)。微笑美学满意77例(85.56%)，不满意13例(14.44%)；微笑美学满意组的微笑指数明显高于不满意组，微笑高度、牙龈暴露程度、尖牙宽度比、可见牙列宽度比均明显低于微笑美学不满意组，差异均有统计学意义(P<0.05)。高水平微笑指数(OR=1.249,95%CI:1.022～1.615)是患儿微笑美学的保护因素(P<0.05)，高水平微笑高度(OR=1.358,95%CI:1.097～1.704)、牙龈暴露程度(OR=1....     

各项姿势位笑容特征指标审美接受范围的评价

目的 探究人群对各项姿势位笑容特征指标的可接受范围,以补充、完善正畸诊断与治疗.方法 选取男女姿势位微笑时的面下1/3照片各1张,利用Photoshop对各特征指标(切牙暴露量、露龈量、笑弧、颊廊、上颌(牙合)平面倾斜度及上切牙下唇间距)以一定幅度分别进行变动,选择100名正畸医师与100名普通人对其进行审美评价.结果 人群对各项笑容特征指标的接受范围依次为:切牙暴露量,男女均为75％～100％；露龈量,男0～2 mm,女0～3 mm;笑弧,男女均为50％～100％；颊廊,男0％～1 5％,女0％～20％；上颌(牙合)平面倾斜度,男女均为0～6°；上切牙下唇间距,男女均为0 mm.正畸医师与普通人对微笑的审美评价差异有统计学意义(P＜0.05).结论 各项姿势位笑容特征指标均有一定的可接受范围,选择哪种唇齿龈关系作为正畸治疗的目标,将决定矫治计划的制定.     

口腔正畸医师与普通人微笑线美学观点差异性调查分析

目的:制作不同微笑线的视觉模拟评分调查问卷,对正畸医师与普通人群的微笑线美学观点进行调查,评估微笑线对微笑美观的影响,建立微笑唇齿关系美观参数。方法:(1)选取微笑协调的青年女性,拍摄正位姿势位微笑面像及全口牙列像;(2)使用图片处理软件改变微笑线高度,制成6张具有不同微笑线高度的微笑照片,辅助直观类比标度法制成调查问卷;(3)考评调查问卷的信度和效度,并利用调查问卷对30名正畸医师及50名普通人进行微笑线美学观点调查。结果:(1)不同微笑线的美观评分差异有统计学意义(正畸医师:χ~2=109.596,P0.01;普通人群:χ~2=151.230,P0.01);(2)正畸医师与普通人群均认为微笑线在-4.0~2.0mm内的微笑较美观(美观评分均50分),微笑线高于4.0mm的微笑较不美观(美观评分均50分),且随着微笑线高度的增加美观程度逐渐降低;(3)正畸医师对微笑线为0mm的微笑美观评分最高,普通人群对微笑线为-2.0mm的微笑美观评分最高。结论:微笑线影响微笑美观,正畸医师与普通人群均认为微笑时牙龈显露量小于2.0mm较美观,牙龈显露量大于4.0mm较不美观。正畸医师认为微笑时显露上中切牙牙冠全长而没有显露牙龈最美观,普通人群认为微笑时上唇覆盖上中切牙牙冠2.0mm最美观。在临床工作中,正畸医师应该加强与患者及家属的沟通,获得医患双方均满意的最佳美学效果。     

上颌中切牙与侧切牙切端垂直距离的变化对正面观微笑美学的影响

目的:根据口腔正畸医生及普通受访者的评分,探讨上颌中切牙和侧切牙切端垂直距离的变化对正面观微笑美学的影响。方法:收集安徽地区一男一女的正面观姿势位微笑照,上颌中切牙及侧切牙切端垂直距离以0.5mm为变量,从0~2mm进行数字化改变;对露龈与否也进行数字化改变,最后得到20张照片。选取80名安徽地区的评价者,分成正畸医生组和普通受访者两组,分别对20张照片的微笑魅力值进行打分。结果:正畸医生组和普通受访者组对微笑美评分的差异有统计学意义,上颌切牙切端垂直距离的变化值比较,P0.05,说明切端垂直距离的变化对笑容评分有统计学意义。结论:普通受访者组和正畸医生组均认为上颌切牙切端垂直距离为0.5mm时的笑容是美观的,露龈会影响对微笑美的感知。两组评价者对男、女微笑美的评价也有显著性差异。因此,在安徽地区临床正畸治疗中,可以参照如上研究所获得的数值,进行美学参考。     

正畸配合肌功能训练改善骨性错患者微笑美的临床研究

目的:评价正畸配合相关肌功能训练改善骨性错患者微笑美的临床效果。方法:30例骨性错患者(男11例、女19例),其中安氏Ⅱ类24例(ANB角5°~8°),安氏Ⅲ类6例(ANB角0°~-6°)。年龄13~34岁,平均(21.08±6.67)岁,拔牙设计26例,非拔牙设计4例。随机分为实验组、对照组各15例,实验组正畸治疗中配合微笑美相关肌功能训练。两组矫治技术、矫治原则相同,基线条件进行了一致性检验。正畸治疗前后分别拍正面微笑像以评价两组矫治前后微笑指标变化的差异。应用SPSS16.0统计软件对所有数据进行统计分析。结果:实验组矫治前后口角高度、微笑宽度、颊廊比例变化差异有统计学意义(P0.05);实验组矫治前后理想笑弧例数、平行笑弧例数变化也有统计学意义(P0.05)。对照组矫治前后各微笑指标变化差异无统计学意义(P0.05)。实验组、对照组矫治后口角高度、上颌牙龈暴露量、下前牙平均暴露量、颊廊比例及笑弧形态变化差异有统计学意义(P0.05)。结论:正畸同时配合微笑美肌功能训练,可使骨性错患者口周组织改建与正畸牙颌变化同步、协调,使骨性错患者在矫治错畸形的同时,微笑美也能得到不同程度的改善。     

正常汉族青年人微笑特征的计算机测量研究

目的：研究汉族正常he青年人的微笑特征，为正畸临床提供参考。方法：在头颅定位仪辅助定位下，利用数码相机采集90名18～24岁学生(男44人，女46人)正面休息位及微笑位照片，进行计算机辅助测量分析，得到29项有关微笑特征的测量指标。结果：正常he男女面部软组织特征有显著差异，软组织动态变化无明显差异；下唇上缘与上切牙切缘距．微笑线比率及左上中切牙临床冠长三项反映微笑时唇齿关系的指标，男女之间有显著性差异；微笑类型具有性别差异。结论：姿势性微笑位是研究微笑的标准像位；微笑特征中的部分指标显示出性别差异，因此男女应分别进行研究；正常he女性的中位微笑更接近理想微笑的标准。     

不同垂直颅面结构年轻女性嚼肌超声厚度及肌电活动的相关性研究

目的:探讨不同垂直颅面结构的嚼肌超声厚度和肌电活动之间的关系.方法:选取30名女大学生(高角14例、低角16例),应用B超测量姿势位和紧咬位的嚼肌厚度及表面电极测量姿势位和紧咬位的嚼肌肌电活动.结果:低角组浅层嚼肌厚度在姿势位和紧咬位均大于高角组,具有明显统计学差异;在姿势位低角组与高角组之间嚼肌肌电活动差异无统计学意义；在最大紧咬位低角组的肌电活动显著大于高角组的肌电活动,差异有统计学意义;姿势位和紧咬位时嚼肌厚度与最大紧咬位肌电活动均呈正相关.结论:不同垂直骨面型的嚼肌形态功能不同；低角骨面型的嚼肌超声厚度与肌电活动均大于高角组.     

正畸掩饰性治疗骨性Ⅲ类错(牙合)畸形的疗效及对外貌美观性的影响分析

目的：探讨骨性Ⅲ类错(牙合)畸形患者正畸掩饰性治疗的效果及对外貌美观性的影响。方法：选取2018年8月-2020年11月笔者医院收治的骨性Ⅲ类错(牙合)畸形患者52例。所有患者均接受正畸掩饰治疗，记录治疗前后患者的软组织、硬组织指标，并选取普通人和正畸医生作为美观评价者对患者的侧貌美观性进行评分。结果：治疗后，患者Z角、H角、UL-Sn-Pogs均大于治疗前，Cm-Sn-UL、LL-Sn-Pogs均小于治疗前，差异有统计学意义（P<0.05），而治疗前后患者软组织面角、Si-LL-Pogs差异无统计学意义（P>0.05）。治疗后，患者SNA、ANB、Wits、NP-FH、U1-SN、U1-NA均大于治疗前，SNB、U1-L1均小于治疗前，差异有统计学意义（P<0.05），而治疗前后患者MP-SN、OP-SN、L1-MP、L1-NB比较差异无统计学意义（P>0.05）。治疗后，普通人及正畸医生对患者的美观性评分均高于治疗前，差异有统计学意义（P<0.05）。结论：正畸掩饰治疗对骨性Ⅲ类错(牙合)畸形患者具有较好的效果，可改善软硬组织条件，增加外貌美观性。     

Larson术式重建膝关节后外侧结构的治疗体会

目的探讨采用Larson术式重建膝关节后外侧结构的临床疗效。方法 2014年4月至2018年8月,安徽医科大学附属六安医院骨科收治膝关节后外侧结构损伤患者18例,其中男11例,女7例;年龄29～49岁,平均(37.7±6.3)岁。膝关节Lysholm评分为(52.3±7.0)分。国际膝关节文献委员会(the international knee documentation committee knee evaluation form,IKDC)评分综合评分均为D级。Fanelli分型为C型损伤。切取自体半腱肌,关节镜辅助下,后外侧切口切开重建后外侧结构。结果 18例患者均获随访,随访时间12～14个月,平均13个月。膝关节稳定性,屈膝0°位无内翻不稳;屈膝30°位内翻不稳3例,均为Ⅱ度,伴有硬性终止点。屈膝30°、90°位外旋试验,与健侧比较,屈膝90°位无明显异常。胫骨外旋角度为(1.6±1.3)°,与术前比较差异有统计学意义(t=7.472,P=0.000);屈膝30°位外旋不稳2例(均10°),胫骨外旋角度为(2.3±2.2)°,与术前比较差异有统计学意义(t=8.008,P=0.000)。膝关节Lysholm评分为(88.4±4.8)分,与术前比较差异有统计学意义(t=11.469,P=0.000)。IKDC综合评分:A级10例,B级5例,C级3例;与术前比较差异有统计学意义(Z=4.285,P=0.000)。结论采用Larson术式重建膝关节后外侧复合体(posterolateral complex,PLC),患者膝关节稳定性大大提高,膝关节功能评分优良,获得了满意的临床疗效。     

134名云南籍大学生微笑特征分析

目的:分析云南籍大学生微笑特征,为口腔临床治疗及效果评价提供参考。方法:采用数码相机记录134例大学生(男61例,女73例,平均年龄19岁)静息位和最大微笑位的正面像,用Photoshop CS3软件分析微笑特征的定性和定量指标。结果:牙齿显露情况和微笑协调性等定性指标在男女性别间无统计学差异,定量指标颊隙率和上唇动度性别差异有显著性。高、中、低位笑线组的微笑指数间有统计学差异,但上唇动度无统计学差异。结论:云南籍大学生的微笑特征测量分析结果对口腔及颌面美学临床治疗具有一定参考价值。     

美貌人群微笑美学的颊间隙定量分析

目的：对美貌微笑人群的颊间隙进行线距和面积的定量分析，以期为正畸临床动态微笑美学的评价和治疗提供依据。方法：由3位正畸医师对50张时尚期刊杂志上微笑照片分别进行评判，选择3人全部认为美观微笑的照片共20张作为最后的研究样本。将照片扫描输入计算机，采用专门设计的测量软件测量计算颊间隙与微笑间隙的宽度之比和面积之比。结果：单侧颊间隙宽度与微笑宽度的比值为9．85％±1．26％；单侧颊间隙与微笑间隙的面积之比为4．86％±1．82％。结论：颊间隙的定量测量分析可为正畸临床评判微笑是否美观协调提供诊断依据，也为临床矫治方案的制定和治疗效果评估提供客观参考。     

Reproducibility of Two Four-Point Clinical Severity Scores for Lateral Canthal Lines (Crow''s Feet)

BACKGROUND: Several clinical scoring systems have been used to evaluate the efficacy of botulinum toxin A in the treatment of hyperkinetic wrinkles. So far very few have been investigated for their reproducibility. OBJECTIVE: The aim of this study was to investigate the reproducibility of two clinical four-point scales for lateral canthal lines (crow's feet), at rest and at maximum smile. MATERIAL AND METHODS: Based on standardized photographs, a consensus atlas depicting the different severity grades [from 0 (none) to 3 (severe)] was developed. After training based on the atlas, 49 photographs at rest and 48 at maximum smile were graded by the same group of investigators on 2 consecutive days (n=9 on Day 1; n=8 on Day 2). The scores were compared for reproducibility using kappa statistics. RESULTS: Overall, reproducibility was good for both scales. Interobserver reproducibility showed an agreement of 0.6 at rest and 0.58 at maximum smile (unweighted kappa). Intraobserver reproducibility showed an agreement between 0.47 and 0.86 at rest and between 0.62 and 0.81 at maximum smile (unweighted kappa). Using weighted kappa analysis, the agreement ranged between 0.63 and 0.91 at rest and between 0.71 and 0.85 at maximum smile. CONCLUSION: The clinical scales using scores of 0 to 3 for crow's feet, both at rest and at maximum smile, show a good inter- and intraobserver reproducibility. The use of these scores in clinical trials can be recommended.     

上颌前部骨切开术改善上唇软组织与微笑的美学效果

目的 通过分析上颌前部骨切开术矫正上颌前突畸形软、硬组织侧貌的变化特点,探讨正畸正颌等多学科联合治疗改善上唇软组织和微笑的美学效果,为手术设计和预测提供参考.方法 16例行上颌前部骨切开术的上颌前突患者,术前1周和术后6个月拍摄X线头颅侧位定位片,对相关软、硬组织的变化进行测量和统计学分析.结果 术后上切牙倾斜角平均减少8.8°,上唇高度平均增大2.44 mm,两者呈负相关(r=-0.807);上前牙槽高度、唇间隙、露齿距分别平均减少2.17、4.62、3.33mm,三者呈正相关(r=0.863或0.949).结论 上颌前部骨切开术,可根据患者的容貌特征并结合软组织与微笑的审美要求进行设计,通过术前正畸的调整及牙周、整形的辅助治疗,在矫正牙颌畸形的同时改善上唇软组织和微笑形态的美观.     

中国美貌汉族女性的微笑特征研究

目的:初步对中国汉族美貌女性微笑的相关指标进行测量分析,为正畸、正颌外科临床微笑美学的评估和治疗提供依据。方法:选取2008~2013年中国电影、电视剧及时尚期刊杂志中面型协调美观的中国美貌汉族女性65例,年龄18~30岁,对所有研究对象采用Photoshop CS3图像处理软件进行定点测量,并运用spss17.0进行统计分析。结果:获得中国美貌汉族女性微笑的相关数据,单侧颊旁间隙宽度与微笑宽度的比值为8.95%±1.24%;单侧颊旁间隙与微笑间隙的面积之比为4.00%±1.12%;高位、中位、低位微笑分别为6.1%、73.9%、20.0%;笑容指数与牙龈暴露指数分别为7.21±1.8和0.11±0.04。结论:中国美貌汉族女性微笑的相关指标测量分析结果可为正畸、正颌临床治疗方案的制定和疗效评估提供美学参考依据。     

经皮与开放椎弓根螺钉固定治疗胸腰椎骨折的比较研究

目的比较经皮椎弓根螺钉内固定与开放切开椎弓根螺钉内固定治疗无神经症状胸腰椎爆裂性骨折的临床疗效。方法回顾分析60例无神经症状的胸腰椎爆裂性骨折手术患者,其中微创经皮组和开放切开组各30例患者。比较两组围手术期参数、影像学指标、视觉模拟疼痛评分及Oswestry功能障碍指数。结果经皮组与开放切开组在术中出血量、术后引流量、住院日均有显著性差异（P〈0．05）,而在手术时间上无明显差异（P〉0．05）,术前、术后及随访影像学观察椎体前缘高度、后凸Cobb角、矢状面指数及椎管堵塞指数等恢复无显著性差异（P〈0．05）;两组疼痛评分在术后和术后3个月内有显著性差异（P〈0．05）,但3个月以后评分无显著性差异。2年随访时两组功能评分无显著性差异（P〉0．05）。结论经皮椎弓根螺钉内固定是治疗无神经症状胸腰椎骨折的理想微创手术方法,但远期疗效与传统开放手术相近。     

Interobserver agreement and consensus over the esthetic evaluation of conservative treatment for breast cancer

Twenty-four experts from 13 different countries were asked to evaluate photographs taken of 60 women following conservative breast cancer treatment. The esthetic result of each case was classified as poor, fair, good or excellent. Agreement was evaluated using the kappa (k) and weighted kappa (wk) statistics, for all observers, male and female participants, those younger and older than 50 years, those seeing more than 250 cases a year, and those with previous publications in this area. Consensus was obtained by way of a modified Delphi approach, when more than 50% of participants provided the same classification. In a second round, consensual cases were disclosed and a revised opinion was asked in non-consensual ones. Agreement between all participants was fair (k=0.24, wk=0.37) and remained within the same range (k=0.20-0.31, wk=0.31-0.45) in the subgroups analyzed. First round consensus was obtained in 46 out of 60 cases (77%) and in the second round in 59 out of 60 cases (98%). Evaluation of the esthetic results of conservative treatment for breast cancer is only fairly reproducible when performed by experts working in different geographical areas. Consensus is obtainable if a relatively low threshold of agreement is considered acceptable.     

Facial attractiveness and abnormality of nasal reconstruction patients and controls assessed by laypersons.

BACKGROUND: The goal of nasal reconstruction after a partial or total amputation is to achieve a nasal appearance as natural and normal as possible. It is assumed that laypersons' opinion on facial appearance could affect patient satisfaction or self-concept. The aim of this study was to assess laypersons' opinions on aesthetic outcome of nasal reconstruction. This was compared with the opinion of a professional panel. Second, the effect of informing laypersons about the previous nasal reconstruction of patients on their assessment of facial attractiveness and abnormality was studied. Third, the effects of individual facial features on the assessment of facial attractiveness and abnormality were determined. METHODS: A total of 39 consecutive patients treated between November 2001 and May 2005 for (sub) total nasal defects were included, together with a control group of 39 persons without a facial deformity. A group of 20 randomly selected laypersons (10 men and 10 women) assessed facial appearance and abnormality of all 78 persons using standardised colour slides, not knowing who was a patient and who control. Two weeks later they were informed about the true study design and the same questions were asked. In addition, they assessed final treatment results of 39 patients. RESULTS: No differences existed between assessment of aesthetic outcome after nasal reconstruction by laypersons and professionals (54% good to excellent). Patients were perceived significantly less attractive and more abnormal than controls. Prior knowledge had a significant positive effect on mean facial attractiveness and abnormality scores. High positive correlations were found between facial attractiveness and abnormality scores and the frequency of the item 'nothing in particular', meaning if no particular facial feature was judged to be striking, a face was perceived more attractive and less abnormal. CONCLUSION: Nasal reconstruction patients were perceived significantly less attractive and more abnormal by laypersons than controls. Since faces without striking features were judged to be more attractive, the goal of nasal reconstruction would not only be to create a nose as normal as possible, but also as inconspicuous as possible.     

精子功能指标在辅助生殖助孕方式选择中的作用

目的 评估精子功能参数对精子常规体外受精能力的预测价值,探寻有效选择受精方式的新指标.方法 回顾性分析2017年1月至2019年12月于我院首次行体外受精-胚胎移植(IVF-ET)短时受精的429个周期的临床资料,根据受精结局不同分为2组:受精失败或受精率＜30％的患者为早补救卵胞浆内单精子注射(R-ICSI)组(n=...