应用双侧唇红黏膜滑行瓣修复双侧唇裂术后唇珠缺失5例报告

目的: 评价双侧唇裂术后唇珠缺失修复中应用双侧唇红黏膜滑行瓣再造唇珠的疗效。方法: 收集我科2015年3月—2017年5月收治的双侧唇裂术后唇珠缺失患者5例,男2例,女3例;年龄7~26岁,中位年龄13岁,平均14岁。于全麻下行双侧唇畸形矫正术,术中同期设计双侧唇红黏膜滑行瓣向下方滑行、转移再造唇珠,以达到再造唇珠、消灭口哨畸形的目的。结果: 术后切口均一期愈合,随访2~26个月,唇珠形态稳定,未再出现口哨畸形。整体上唇形态满意。结论: 双侧唇裂术后继发唇珠缺失、口哨畸形的修复方法较少,在唇红黏膜上保留原来需要被切除的瘢痕组织并通过适当修整、滑行、重建再造唇珠,消灭口哨畸形,可以得到稳定满意的效果,值得临床推广应用。     

Presence of a Nail in the Medullary Canal; Is It Enough to Prevent Femoral Neck Shortening in Trochanteric Fracture?

Purpose

Presence of a cephalomedullary nail (CMN) in the medullary canal has been thought as advantageous in the control of femoral neck shortening (FNS) and lag screw sliding in trochanteric fracture compared to extramedullary fixation system. However, researches on the factors that influence the degree of FNS after cephalomedullary nailing are lacking.

Materials and Methods

We observed 95 patients (mean age, 75±2.8 years) with trochanteric fractures who were treated with a CMN, and evaluated the relationship between FNS and patient factors including age, gender, fracture type (AO/OTA), bone mineral density, medullary canal diameter, canal occupancy ratio (COR=nail size/canal diameter), and tip-apex distance using initial, immediate postoperative, and follow-up radiography.

Results

Univariate regression analyses revealed that the degree of FNS was significantly correlated with fracture type (A1 versus A3, p<0.001), medullary canal diameter (p<0.001), and COR (p<0.001). Multiple regression analyses revealed that FNS was strongly correlated with fracture type (p<0.001) and COR (p<0.001).

Conclusion

Presence of a CMN in the medullary canal could not effectively prevent FNS in patients with low COR and in A3 type fracture.     

基于状态观测器的输入受限不确定系统的滑模控制

研究了控制输入受限情况下不确定系统的滑模控制问题, 其中,系统不确定性同时存在于状态矩阵和控制增益矩阵中。首先,利用状态观测器估计不可测状态;然后,在状态估计空间选择一种积分型切换面;最后,设计一个基于状态估计的滑模控制律以保证系统状态轨迹在有限时间内到达指定的切换面,同时利用等价控制律方法给出了滑模动态渐近稳定的充分条件。数值仿真实验验证了本文算法的有效性。     

无需重建疝囊的无张力修补腹股沟滑动疝手术方式

目的：探讨腹股沟滑动疝新的手术方式,即无需重建疝囊的无张力修补腹股沟滑动疝。方法回顾分析2009—2010年腹股沟滑动疝手术6例,其中2例巨大腹股沟滑动疝患者均因较长肠管及其相应肠系膜构成疝囊壁的大部,而难以分离,无法按照腹股沟滑动疝的经典手术方式即剥离滑动脏器、继而重建疝囊后再行疝修补;而是无需剥离滑动脏器,直接经内环还纳疝囊及其内容物后,补片无张力修补。结果1例术后因大量疝内容物还纳后腹腔高压,膈肌上抬,以致呼吸功能不全,间歇呼吸机辅助呼吸约2个月;2例术后至今均未复发,手术效果满意。结论无需重建疝囊的无张力修补腹股沟滑动疝,是一种简易有效的手术方式。     

正畸治疗中两种关闭拔牙间隙方法的临床比较

目的比较两种方法关闭拔牙间隙的速度:颊侧镍钛丝拉簧加舌侧弹性牵引和颊侧镍钛丝拉簧。方法选取40例进行拔牙正畸治疗的病人,随机分成两组:颊侧镍钛丝拉簧加舌侧弹性牵引组为实验组共20例80个区,颊侧镍钛丝拉簧组为对照组共20例80个区。结果经过4个月的治疗,最后纳入统计的实验组有68个区,对照组有64个区;实验组每月关闭量为(0.99±0.03)mm,对照组每月关闭量为(0.80±0.02)mm,两组间比较差异具有高度显著性(P<0.01)。结论使用颊侧镍钛丝拉簧加舌侧弹性牵引更能有效地关闭拔牙间隙。     

卡式瓶硅化及硅油含量的确定方法

卡式瓶水针在生产过程中必须对其内包材瓶子进行硅化,以满足滑动性的需求。在硅化过程中所用硅油本身是一种异物,卡式瓶内壁硅油量的大小直接影响药品的质量,故药品生产企业在对卡式瓶进行硅化时必须根据瓶子大小找出一个最佳硅油量,保证其在满足滑动性的前提下,尽量减少硅油量,使所喷硅油对药液造成影响减到最小,确保药品质量。通过对滑动性的评价介绍一种简单的卡式瓶硅化方法（减重法）及硅油量的测定方法。     

Active and passive self-ligation—a myth?

Objective:To compare the frictional behavior of several self-ligating brackets with that of normal brackets both with and without tipping force-moments and in combination with different archwire dimensions.Materials and Methods:The resistance to sliding (RS) of seven self-ligating brackets, a conventional bracket, and a ceramic bracket with a low-friction clip were evaluated in combination with three different archwires and tipping force-moments of 0 and 10 Nmm. The center of rotation for the measurements was set within the center of the bracket or with a 10-mm offset. Resistance to sliding was measured using an Instron 3344 at a cross-head speed of 10 mm/min at a temperature of 36°C.Results:Without a tipping moment, RS increased with the active self-ligating brackets with increasing archwire size. No RS was found for any of the passive self-ligating brackets. The 10-Nmm tipping moment resulted in more RS and was similar for all bracket and archwire combinations. RS was approximately doubled when the center of rotation was located at the bracket rather than with a 10-mm offset.Conclusions:RS between brackets and archwires is highly dependent on the experimental setup. Different setups can result in contradictory results. Almost 1 N of traction force is lost in RS when a moment of 10 Nmm is placed at a rotational center 10 mm from the bracket.     

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目的探讨直丝弓矫治技术滑动法与关闭曲法关闭拔牙间隙对支抗磨牙位置及疗程的影响。方法选择2006年1月至2009年3月在中国医科大学口腔医学院正畸科拔除4颗第一前磨牙或2颗上颌第一前磨牙的安氏Ⅱ1或安氏Ⅰ类双颌前突患者33例,使用0.46mm(0.018英寸)直丝弓矫治装置充分排齐整平上下牙列后采用两步法关闭拔牙间隙,将上颌第二磨牙纳入矫治序列,且均未采用特殊加强支抗方法。拉尖牙向远中完成后,随机分为滑动法组(17例)和关闭曲法组(16例),分别使用滑动法或关闭曲法关闭剩余间隙,对关闭间隙前后的X线头颅侧位片进行测量分析。结果滑动法组和关闭曲法组的上颌第一磨牙分别近中移动(3.4±1.4)mm和(3.0±1.8)mm,两组差异无统计学意义(P>0.05)。内收4颗前牙,滑动法组疗程为(6.0±2.4)个月,关闭曲法组疗程为(6.4±2.2)个月,两组差异无统计学意义(P>0.05)。结论使用0.46mm(0.018英寸)直丝弓矫治装置排齐整平上下牙列,并在矫治初期即将上颌第二磨牙纳入矫治序列的拔牙病例,正畸医生可根据个人习惯使用滑动法或关闭曲法回收前牙。