正畸舌侧固定保持器的临床效果观察

目的:与压膜保持器做比较,探讨正畸舌侧固定保持器1年后的保持效果,以期为临床应用提供理论依据。方法:回顾性的选择固定正畸治疗结束的患者65例(男31例,女34例),年龄(14.57±0.35)岁,其中33例接受了下颌舌侧麻花丝保持器,32例使用压膜保持器。分别测量65例患者固定正畸结束时和1年后的模型,测量项目主要包括下颌尖牙间宽度、磨牙间宽度、牙弓长度以及Little前牙不齐指数。采用SPSS17.0软件包对数据进行Wilcoxon秩和检验分析。结果:65例患者戴用正畸舌侧固定保持器和压膜保持器一年后起到了良好的保持效果,且两者差别无统计学差异。结论:正畸舌侧固定保持器能有效防止下颌牙齿的复发,临床上正畸医生应根据患者的具体情况选择合适的保持器类型。     

改良式热压膜透明联冠保持器与Hawley保持器临床效果对比的Meta分析

目的:比较改良式热压膜透明联冠保持器和Hawley保持器的差异,从而为正畸医生寻找合适的矫治器提供指导。方法:检索ISI Web ofScience、PubMed、Cochrane Library、CNKI、维普、万方等多个数据库,检索时间截止于2019年5月,检索时没有任何语言限制,所有正畸杂志和相关参考文献都被检索,两位作者独立完成文献筛选、数据提取及质量评价;采用软件Stata/MP 14.0进行数据处理;用Cochrane偏倚风险评估工具进行偏倚风险评估。结果:最终1008个对象12篇研究被纳入,对比两种保持器在上、下颌Little指数变化方面,差异有统计学意义;而在尖牙间宽度、磨牙间宽度方面,差异无统计学意义。结论:改良式热压膜透明联冠保持器比Hawley保持器对前牙位置固位效果好,而在尖牙宽度和磨牙宽度方面,效果几乎无差别。     

热压膜透明联冠保持器的临床应用研究

目的：综合评价热压膜透明联冠保持器的临床应用特点及疗效.方法：将通过固定矫治技术完成矫治后的各类错（牙合）80例随机分为实验组、对照组,每组40例.实验组用热压膜透明联冠保持器,对照组用改良式Hawley＇s保持器,观察时间6个月.观察指标：①对保持器的主观认同感;②保持疗效;③因保持器本身问题的复诊率;④技工室、临床操作时间、操作工序比较.结果：①主观认同感方面无论是对美观、发音的影响,还是戴用舒适度、保持器固位情况、及取戴难易程度方面,二者均存在显著性差异;②临床、技工室制作所需时间,二者也存在显著性差异;③因保持器本身问题的复诊率及保持疗效方面,二者虽有差异,但差异无显著性.结论：热压膜透明联冠保持器较改良式Hawley＇s保持器无论在患者认同感,还是临床、技工室操作方面均表现出明显优越性,且保持疗效确切,适宜临床普及推广.     

哈利氏保持器与压膜式保持器的临床比较研究

目的：通过观察哈利氏保持器与压膜式保持器在临床应用的情况,分析比较两种保持器的优缺点。方法：选择结束治疗期的正畸患者60例（拔牙患者）,分成两组（哈利氏保持器组和压膜式保持器组）,各自采用哈利氏保持器与压膜式保持器进行保持,分别对患者和医师在使用和制作保持器时6个方面的感受进行评分,评价两种保持器各自的优缺点。结果：佩戴舒适度方面、使用便利度方面、制作方便度上,压模式保持器更有优势,两组有统计学差异。耐用度上,哈利氏保持器更耐用。戴用时隐形度方面、牙列保持度方面,两组无差别。结论：两种保持器各有优缺点,除了开患者只能选择哈利氏保持器外,其它类型患者两种保持器都可使用。     

改良式Hawley保持器应用于深覆殆患者的疗效观察

目的：比较改良式Hawley保持器与常规Hawley保持器对深覆（牙合）患者矫治结束后的保持效果。方法：选择36例重度深覆（牙合）矫治完成病例，随机分为两组，各18例。实验组采用改良式Hawley保持器进行保持，对照组采用常规Hawley保持器进行保持。戴用保持器2年后，制取模型，测量保持前后的PAR指数7项指标。结果：戴用保持器2年后，实验组与对照组在覆（牙合）指标上有统计学差异（P〈0．05），其余各指标无统计学差异。结论：深覆（牙合）患者经过矫治后深覆豁容易复发，戴用改良式Hawley保持器可以有效防止深覆（牙合）的复发。     

三种常用正畸保持器的临床应用现状及相关研究进展

正畸保持是在正畸治疗后使用正畸保持器将牙齿、颌骨、肌肉维持在平衡稳定的美学和功能位置,防止复发。目前临床常用的正畸保持器主要有Hawley保持器、压膜保持器和舌侧固定保持器。本文将从这三种正畸常用保持器的临床应用特点、并发症以及最新研究进展三个方面进行综述,以期为后续的研究提供新思路。     

唐山地区混合牙列期正常牙合青少年下颌牙弓及双侧第一磨牙三维方向生长发育变化研究

目的:探究唐山地区年龄为10岁处于混合牙列期正常牙合青少年下颌牙弓及下颌双侧第一磨牙在三维方向上的生长发育变化。方法:对唐山地区某小学年龄为10岁的正常牙合青少年进行筛选,按照标准筛选出研究样本40例(男20例,女20例)。每年取石膏模型一副,连续跟踪两年,应用3-shape扫描仪扫描石膏模型,将其转化为数字模型。在数字模型上进行牙弓及第一磨牙三维方向上的生长发育变化的研究。结果:过去两年中,下颌前部牙弓长度(LAAL)增加了0.556mm,下颌全部牙弓长度(LTAL)增加了2.067mm,下颌乳尖牙或恒尖牙间牙弓宽度(LICW)增加了2.904mm,下颌第一磨牙间牙弓宽度(LIMW)增加了2.172mm。年龄为12岁的男性LIMW大于女性。右下第一磨牙颊舌向倾斜度(LR6BL)和左下第一磨牙颊舌向倾斜度(LL6BL)分别增加了2.841°和5.410°。结论:10～12岁正常牙合青少年的下颌前部牙弓长度(LAAL)、下颌全部牙弓长度(LTAL)、下颌乳尖牙或恒尖牙间牙弓宽度(LICW)、下颌第一磨牙间牙弓宽度(LIMW)均随年龄增长而增加。年龄为12岁的男性第一磨牙间牙弓宽度均大于女性。下颌双侧第一磨牙随年龄的增加呈颊向倾斜,而近远中向倾斜度无明显变化。年龄为12岁的男女下颌第一磨牙的近远中和颊舌向倾斜度无性别差异。     

骨性Ⅲ类错非拔牙矫治后牙弓与基骨弓变化的分析研究

目的:了解恒牙列骨性Ⅲ类错非拔牙矫治后牙弓与基骨弓形态的变化。方法:23例恒牙列骨性Ⅲ类错非拔牙矫治患者,收集矫治前后记存模型,测量矫治前后上下颌牙弓长度、基骨弓长度,尖牙区、第一、二前磨牙区,第一磨牙区的牙弓宽度、基骨弓宽度,比较矫治前后牙弓、基骨弓各测量值的变化及两者间的相关性。结果:(1)矫治后上颌牙弓前段长度增加,上颌尖牙间、第一、二前磨牙间牙弓宽度减小;下颌尖牙间牙弓宽度减小、第一磨牙间牙弓宽度增加;矫治前后差异有统计学意义(P0.05);(2)矫治后上颌基骨弓长度增加,下颌基骨弓长度减小,矫治前后差异有统计学意义(P0.05);(3)矫治后上下颌牙弓长度、宽度的变化量与对应的基骨弓长度、宽度的变化量呈正相关,尤以下颌尖牙区、上下颌第一磨牙区明显。结论:恒牙列骨性Ⅲ类错非拔牙正畸掩饰性矫治后牙弓代偿性变化可引起相应区域基骨弓的顺应性改建,利于骨性Ⅲ类错单纯正畸掩饰性治疗及稳定疗效。     

安氏I类错牙合拔牙与非拔牙矫治前后牙弓宽度变化的对比研究

目的:通过对拔牙组和非拔牙组恒牙期安氏I类错牙合畸形患者矫治前后的模型进行测量,分析拔牙组和非拔牙组病例治疗前后牙弓宽度的变化。方法:随机选择恒牙牙合患者40例,其中20例接受了拔牙矫治,均拔除4个第一前磨牙,20例接受了非拔牙矫治,分别在矫治前后的上下颌模型上第一磨牙近中颊尖点、尖牙牙尖点做标记,测量磨牙和尖牙间的牙弓宽度,进行方差分析。结果:拔牙组矫治前后比较上下颌尖牙间宽度均增加,差异有统计学意义(P0.05);拔牙组磨牙矫治前后牙弓宽度变化无统计学差异(P0.05);非拔牙组矫治前后上颌第一磨牙间宽度增加,差异有统计学意义(P0.05);非拔牙组矫治前后上下颌尖牙间宽度、下颌第一磨牙间宽度变化无统计学差异(P0.05)。结论:与非拔牙矫治相比,拔牙矫治并不会引起牙弓的缩窄。     

摆式矫治器远移上颌第一磨牙对上颌牙弓形态变化的影响

目的:研究摆式矫治器远中移动上颌第一磨牙对上颌牙弓形态的影响。方法:选择混合牙列或恒牙列早期的牙源性安氏Ⅱ类错伴发上颌牙列轻中度拥挤的病例16例,应用摆式矫治器远中移动上颌第一磨牙至上下颌第一磨牙呈中性偏近中关系,测量矫治前后模型,对其结果进行配对t检验。结果:①远中移动时间平均(5.1±1.4)月,拥挤度平均减少(8.40±2.01)mm;前牙覆盖较矫治前平均增加0.43mm;前牙覆平均减小0.32mm②上颌尖牙、前磨牙、第一磨牙间牙弓宽度有不同程度的增加,其中以前磨牙间增加最多,第一磨牙次之,尖牙间增加最少;③上颌第一、第二前磨牙、第一磨牙间牙槽弓、基骨弓宽度均有增加,第一磨牙间增加最多,前磨牙次之,上颌尖牙间增加最少;④牙弓长度方面:牙弓前段无明显改变,仅增加0.10mm(P>0.05),而牙弓后段长度与矫治前相比增加了3.12mm(P<0.001),上颌的牙槽弓长度与基骨弓长度分别增加了3.23mm(P<0.01),3.50mm(P<0.01)。结论:①应用摆式矫治器远中移动上颌第一磨牙使上颌牙槽弓及基骨有一定的扩宽趋势,有利于牙弓前段拥挤的解除及安氏Ⅱ类错的矫治,进而为非拔牙矫治提供有利依据;②远移上颌第一磨牙同时伴随少量的支抗丧失,临床应用中应予注意。     

臂丛神经卡压对颈交感神经节超微结构的影响

目的 研究不同类型臂丛神经卡压及松解后对颈交感神经节超微结构的影响规律.方法 取SD大鼠24只,分为臂丛上干卡压组、下干卡压组、上干松解组和下干松解组,每组各6只.臂丛上干和下干卡压组在卡压术后3个月,取材颈中交感神经节.臂丛上干和下干松解组在卡压术后3个月、神经松解1个月后,取材颈中交感神经节.电镜观察颈中神经节超微结构.结果 电镜下见臂丛上干和下干卡压组的主要表现为线粒体明显肿胀、嵴缺失呈空泡样改变;上干和下干松解组的主要表现为粗面内质网扩张明显,线粒体体积缩小,数量增多.结论 不同类型臂丛神经卡压后,颈中交感神经节的主要变化可能与神经元的代谢障碍有关;而神经松解后,颈中交感神经节主要变化可能与神经元的分泌功能有关,同时线粒体有可逆性的变化.     

Early cementing does not increase debond energy of grit blasted interfaces.

A fracture mechanics based approach was used to determine the debond energy or fracture toughness of the stem-cement interface for a variety of conditions. The goals of the study were to determine if early cementing of stems increased the debond energy of grit blasted stem-cement interfaces and if debond energy was dependent on mold type. Early (2 min) and late (6 min) times of cementation were considered for two different grit blasted surface finishes (16 and 60 grit, Ra=5.7 or 2.3 microm). Specimen fabrication was performed using a relatively simple, unconstrained rectangular mold and a mold that more closely simulated in vivo conditions. The rectangular mold was used with all components at room temperature whereas the in vivo simulated mold had a body that resembled the femoral canal in shape and was warmed to body temperature. Early cementing did not increase the debond energy using the in vivo simulated mold. Extensive porosity was found at the interface, and porosity had a strong negative effect on debond energy. When the simpler, rectangular mold was used, early cementing did result in higher debond energies, but few voids were found at the interface. It appears that porosity at the interface was the major factor affecting the debond energy. The results from this study do not support the concept that improved stem-cement interface strength can be obtained by application of the cement while it is in a low viscosity state.     

Review of the treatment of thalidomide children with limb defeciency in Great Britain

Thalidomide-induced deformities, affecting some 400 British children, caused various combinations of malformations. Classified by type of defect and whether confined to upper and/or lower limbs, the malformations can be treated on a radional basis. The treatment from infancy to the present time includes the fitting of carbon dioxide gas-powered upper limb prostheses, initially in their simplest form and finally in the most sophisticated form. For a baby with bilateral lower phocomelia, a special "sitting socket" was devised to enable sitting in an upright position. When each child was about 12 to 15 months of age, extension protheses were supplied and the effects on walking when upper limbs are malformed or absent were noted. The methods of achieving personal independence and developing constructive youngests' pastimes are important. One patient was so well rehabilitated that she was able to marry and start a healthy family.     

Erfahrungen mit der gefäßgestielten Fibula in der Rekonstruktion von ossären Defekten bei primär malignen Knochentumoren

To bridge large bone defects after resection of primary malignant bone tumors, an autologous free vascularized fibular graft was used in 31 patients (15 x upper limb, 16 x lower limb). The median bone defect measured 16 cm (7-29.5 cm). At the lower extremity the vascularized fibular transplant was reinforced with an allograft and different osteosyntheses. At the upper limb stabilization of the transplant was obtained exclusively by plate osteosynthesis or condylar plate. Applications and the authors' experiences are described and discussed in terms of clinical outcome, graft union, functional outcome, and complications for each localization. After a median of 48 months, ten complications at the upper limb and eight complications at the lower limb, respectively, were seen requiring secondary surgical revision. Major complications such as perioperative deaths or secondary amputations were not observed. Functional evaluation showed better results for the lower than for the upper extremity, due mainly to en bloc resection of proportionally large amounts of soft tissues around the shoulder girdle for local tumor control. Despite the demanding operative procedure and a large number of controllable complications, the good functional outcome and high patient satisfaction indicate that the free vascularized fibular graft is an option for limb-sparing surgery of primary malignant bone tumors.     

Three-dimensional assessment of nose and lip morphology in subjects with down syndrome

Nasolabial morphology was assessed 3-dimensionally in 28 subjects with Down syndrome aged 12-45 years and in 449 sex- and age-matched controls. Subject and reference data were compared by computing z scores and calculating Student's t tests. The nose was significantly smaller (volume, area) in the subjects with Down syndrome than in the reference subjects, and it had a different shape (more flat angle of alar slope, more acute nasal tip angle). The vertical (length of the nasal bridge, height of the nose) and anteroposterior (nasal tip protrusion) dimensions were reduced, while the horizontal dimensions (alar base width, superior and inferior widths of the nostrils) were increased. The lower lip was significantly smaller (volume, area, vermilion height), while the upper lip was larger (area, vermilion height) in the subjects with Down syndrome. The mouth width was also significantly smaller. In conclusion, the analyzed subjects with Down syndrome had a hypoplastic nose and different upper and lower lips than reference, normal subjects.     

上下位颈椎多发伤的治疗

目的 探讨上下位颈椎多发伤的治疗策略.方法 2000年3月至2008年3月共收治9例上下位颈椎多发伤患者,男5例,女4例;年龄18～67岁,平均39.3岁;受伤至就诊时间为2 h～7d,平均3.2 d.有颈脊髓或神经根损伤症状者5例,只表现为颈部局部疼痛、运动功能受限者3例.采用牵引及Dick夹板或头颈胸石膏固定治疗2例;于术治疗7例:单独上颈椎固定1例,单独下颈椎固定3例,上下位颈椎联合固定3例,术后给予Dick夹板或颈托固定.结果 除1例术后6个月死于肺部感染外,其余8例患者获6～32个月(平均19个月)随访.无牵引及手术并发症,5例神经症状减轻或消失,所有患者骨折愈合或植骨融合良好,无假关节形成及颈椎不稳.结论 上下位颈椎多发伤需要根据稳定性和神经损伤程度确定保守治疗或手术治疗,手术治疗时应先稳定下位颈椎.     

Experimental study of cementless fixation of pearl-surfaced hip arthroplasties

Femoral head replacement with pearl-surfaced prosthesis was performed on one side of each of 33 mongrel dogs. 30 of the implants inserted were without cement fixation while the other 3 with for comparison. The specimens were taken out in times of 2 weeks, 1,2,4,6, and 8 months after implantation for radiologic, histologic and biomechanical studies. In 2 weeks' specimens, quite an amount of new bone tissues were found in the interspaces among the pearls on the surface of the prosthesis; by the end of the first month, the interspaces were full of new bone, commencing lamination and progressing to become denser and denser up to 2 months when it appeared as dense as that of cortex. Biochemically the combination strength in the cementless group as a rule, was stronger than that in the control group. Some specimens, the portion in which the prosthetic stem had been embedded, were equally divided into 3 segments, upper middle and lower, to measure the combination strength at different sites. The tested values showed that the strength ratio was 4:2:1 corresponding to the upper, middle and lower segment. It is convincible that the pearl-surfaced hip prosthesis provides reliable stability without cement and it could be safely applied in clinical use.