小梁切除术分别联合Ologen植入与丝裂霉素C治疗青光眼的有效性和安全性对比分析

目的　对比分析小梁切除术分别联合Ｏｌｏｇｅｎ植入与丝裂霉素Ｃ（ｍｉｔｏｍｙｃｉｎＣ,ＭＭＣ）治疗青光眼的有效性和安全性。方法　利用计算机检索Ｍｅｄｌｉｎｅ、ＥＭＢＡＳＥ、ＷｅｂｏｆＳｃｉｅｎｃｅ、ＣｏｃｈｒａｎｅＣｅｎｔｒａｌｏｆＣｏｎｔｒｏｌｌｅｄＴｒｉａｌｓ、ＧｏｏｇｌｅＳｃｈｏｌａｒ等数据库,检索时间均从建库至２０１４年１月,并追溯纳入文献的参考文献。将获得的临床对照研究,通过纳入和排除标准限定,经质量评价后,采用ＲｅｖＭａｎ５．０软件进行Ｍｅｔａ分析。结果　纳入６篇临床对照研究（小梁切除术联合Ｏｌｏｇｅｎ植入组１１４例,小梁切除术联合ＭＭＣ组１２３例）,质量评分均大于１６分,为高质量文献。Ｍｅｔａ分析结果显示,Ｏｌｏｇｅｎ植入组术后患者眼压减低,但眼压降低百分率与ＭＭＣ治疗组相比无明显差异。两组在青光眼药物种数治疗减少、手术成功率及术后并发症发生率等方面亦无明显差异。结论　小梁切除术联合Ｏｌｏｇｅｎ植入治疗青光眼在长期眼压控制成功率方面与小梁切除术联合ＭＭＣ治疗效果相当,在避免ＭＭＣ治疗引发的术后并发症方面无明显优势。     

用于颅颌面种植外科的三维立体可视化系统

目的论文对在个人PC机上对颅颌面医学图像的可视化进行研究,开发出用于颅颌面种植外科的CT断层图像三维可视化系统。方法应用3D纹理映射的方法对颅颌面CT断层图像进行三维重建,并得到其XYZ方向上的切面图像。然后利用边缘检测的方法得到眼眶的位置,并在眼眶位置进行扇形切割,得到18幅扇形切割图像。结果该系统可以帮助医生进行手术前的骨质、骨量分析,设计种植手术的过程及模拟、预测手术的种植效果。结论建立的颅颌面种植外科三维可视化系统以其硬件配置合理、软件设计新颖、多维视角、便捷快速精确等为特色。具有较强的应用价值。     

Assessment of the position and level of mental nerve for placement of implants using cone-beam computed tomography & panoramic radiograph in the Saudi population

Background and objectiveIn surgical dentistry, shape, location, position, and extent of the anterior loop of mental foramen plays a deliberately imperative landmark during an osteotomy procedure. To evade any neurological disturbance during implant surgery radiological assessment is compulsory. Therefore, the aim of the study was to assess the position and level of mental nerve for placement of implants using Cone-beam computed tomography & Panoramic radiography in the Saudi population.Materials and methodsA total of 150 CBCT and Panoramic radiographs were taken from the patients who visited the Department of Oral Medicine and Radiology. The data collection was done by using the same radiographic pieces of equipment for both CBCT and Panoramic radiographs. CBCT images taken from Kodak 9000 3D, Carestream Health, Inc., New York, USA, and Panoramic Radiographs taken from Panoramic Planmeca ProMax, Helsinki, Finland (Vujanovic-Eskenazi et al., 2015). The Chi-square test student test was used for statistical analysis.ResultsThe most frequent shape and location of mental foramen in both CBCT and Panoramic radiographs were oval and in between the first and second premolar, both in CBCT & PR views. The visibility of mental loop on CBCT & PR view showed that; visibility of mental loop in CBCT was higher with 42(56%) as compared with PR view 26(34.66%) with statistically significant p-value 0.014. The mean length of the mental loop on CBCT was statistically significant (p = 0.001). But the mean distance from the lower point of the mental foramen to the lower border of the mandible was not statistically significant.ConclusionBased on the results of the present study; the visibility of the mental loop and its extension is more in CBCT as compared with PR views. Therefore, we recommended CBCT, during of implant surgery.     

Retinal detachment in eyes treated with Aurolab aqueous drainage implant for refractory glaucoma - Incidence and outcomes

Purpose:To analyze the incidence of rhegmatogenous retinal detachment (RRD) in patients who have undergone prior Aurolab aqueous drainage implant (AADI) surgery and report outcomes in terms of anatomic, visual acuity, and intraocular pressure (IOP) findings.Methods:Case records of all patients who underwent RRD repair after AADI surgery from 2013 to 2019 were retrospectively analyzed. Data collected included patient demographics, ocular examination findings at all visits including IOP and best-corrected visual acuity (BCVA) and clinical findings related to RRD both at baseline and postoperatively.Results:Ten eyes of nine patients were included in study. The mean age of patients was 28.2 years (median: 15 years, range: 6–83 years). Mean duration between AADI and RRD was 14 months (median 2.5 months; range 2 days-72 months). All eyes underwent pars plana vitrectomy with silicon oil injection. The preoperative LogMAR BCVA (logarithm of the minimum angle of resolution) was 2.52 ± 0.15 which improved to 2.29 ± 0.58 at final follow-up; however, only one eye had vision ≥ 20/400 largely due to recurrent RRD and advanced glaucomatous disc damage. Postoperatively retina was attached in 6 eyes (60%) and IOP was ≤ 21 mmHg in 5 out of 6 eyes with anatomic successConclusion:The incidence of RRD following AADI was found to be 0.86% in our study. Pars plana vitrectomy (PPV) with silicon oil tamponade was the preferred approach in the management of these eyes with IOP being well controlled post PPV. However, visual acuity outcomes were largely unsatisfactory due to recurrent RRD and preexisting advanced glaucoma.     

Outcomes of evisceration or enucleation by resident trainees in patients with recalcitrant endophthalmitis or panophthalmitis

To evaluate the surgical outcomes and complications of evisceration or enucleation with primary implantation, performed by ophthalmology resident trainees, in regards to patients with recalcitrant endophthalmitis or panophthalmitis. We also compared the surgical outcomes and complications between resident trainees and experienced staff. In this retrospective analysis, the clinical records of all patients diagnosed with endophthalmitis or panophthalmitis who underwent enucleation or evisceration with primary implantation over a 13-year period were reviewed. The factors predicting implant exposure or extrusion in regards to patients who underwent eye removal by trainees were identified using multivariate analysis. The percentages of successful prosthesis fittings and complications were also reported. Sixty-six patient records, median age of 46.8 years, who underwent eye removal by resident trainees were reviewed. Thirty-six (55%) out of 66 patients were diagnosed with panophthalmitis. Four patients (6%) had implant exposure, and 4 patients (6%) had implant extrusion. Multivariate analysis demonstrated that Pseudomonas aeruginosa infection (P = .02, adjusted odd ratio [aOR] = 33.75) and not receiving intravitreal antimicrobial drugs before the eye removal procedure (P = .02, aOR = 30.11) were associated with implant exposure or extrusion. Patients with panophthalmitis who underwent evisceration had a higher rate of implant exposure or extrusion than those who underwent enucleation (P = .03, aOR 38.38). At the last visit, 65 patients had a successful prosthesis fitting. Furthermore, there were similar rates of complications and successful prosthesis fittings between experienced staff and resident trainees. This study suggests that evisceration or enucleation with primary implant placement in patients with recalcitrant endophthalmitis or panophthalmitis can be performed by resident trainees with acceptable surgical outcomes and a low rate of serious complications.     

The effects of hydroxyapatite implantation with the autogenous sclera cap: A cohort study

We performed a novel hydroxyapatite (HA) prosthesis implantation method in which an HA implant was implanted into the scleral shell with an autogenous scleral cap.Twenty-six patients who had undergone the novel HA prosthesis implantation method and 32 patients who had undergone traditional HA prosthesis implantation were retrospectively reviewed. The postoperative activity of the artificial eye was measured by the Hirschberg test combined with arc perimetry. The visual analog score (VAS) was used to evaluate 2-month postoperative pain and 2-month postoperative discomfort. HA implant vascularization was measured with enhanced magnetic resonance imaging (MRI) 2 and 6 months after the operation. The enhancement volume (V_E) and the volume of the HA implant (V_HA) were measured. All cases were followed up for 2 years. Measurement data were processed using SAS 6.12.There was a statistically significant difference (P = .016) between the percentages of excellent grade in the two groups. Two months after implantation, the median pain scores of the study and control groups were 2 and 2.5, respectively, and there was a statistically significant difference (W = 585.0, P = .004); there was a statistically significant difference (W = 535.5, P = .000) between the median discomfort scores of the study group (score = 1) and control group (score = 2); the mean VE/VHA values of the study and control groups were 0.3075 and 0.1535, respectively, and there was a statistically significant difference (t = −8.196, P = .000). Six months after implantation, the V_E/V_HA values of the study and control groups were 0.9686 and 0.5934, respectively, and there was a statistically significant difference (W = 549.0, P = .000). Within 2 years of postoperative follow-up, there were no serious complications in the study group.In the study group, in which the hydroxyapatite implant was implanted into a preserved scleral shell with unaltered muscles and covered with an autogenous scleral cap, postoperative activity and the fibrovascularization of the HA implant were significantly increased, and postoperative pain and discomfort were significantly reduced.     

A Comparative Evaluation of the Strain Transmitted through Prostheses on Implants with Two Different Macro-Structures and Connection during Insertion and Loading Phase: An In Vitro Study

Background: The purpose of this study was to measure and compare the strain levels in the peri-implant bone as generated by the blade-like implant (BLI) and the screw-type implant (STI) with two different internal connections (hexagonal and conical) and with a 1:1 and 2:1 crown/implant (C/I) ratio. Methods: The implants (BLI and STI) were placed into sawbones according to the manufacturer’s protocol. Two strain gauges, horizontal and vertical to the implant axis, were placed around each implant on the bone surface 1 mm from the cervical part. Each implant was loaded by a material testing machine at a force of 100 N. Micro-strains (με) generated in the surrounding bone were measured by a strain gauge and recorded. Results: Recorded micro-strains were not significant in both the insertion and loading phases (p < 0.0625). The average recorded micro-strain values were lower in the horizontal dimension of STI with hexagonal connection when the C/I ratio was 2:1 compared with BLI, 210 με and 443 με, respectively. Conclusion: Within the limitations of this study, implant design, implant-abutment connection and C/I ratio did not influence strain values in bone and there is no statistically significant effect of these parameters on bone.     

假体周围骨折与骨质疏松

骨质疏松与假体周围骨折的发生密切相关。骨质疏松状态下假体周围骨折的预防需从改善局部骨量和预防跌倒入手。检测关节假体周围的骨密度可用于评估假体周围骨折的风险。在对骨质疏松状态下假体周围骨折进行手术治疗时,可使用骨移植替代材料来增加骨折部位固定的强度,也可使用改进型的内固定材料或翻修假体来提高手术的成功率。     

微孔涂层植入物与骨组织界面骨小梁的疲劳微观损伤

目的　探讨微孔涂层植入物界面骨小梁的疲劳微观损伤规律。方法　将钛合金微孔涂层试件植入犬股骨大粗隆 ,6月后材取 ,分别行静态拉伸剪切试验测定界面静态剪切应力强度极限 ,用配置疲劳台的扫描电镜动态观察在周期交变载荷下 ,界面骨小梁的疲劳损伤规律。结果　微孔涂层植入物界面静态剪切应力强度极限为 4 2 6 1± 0 372Mpa。骨小梁疲劳损伤规律表现为早期微孔内骨小梁的板层骨变形和裂纹形成 ,中期的应力转移 ,界面外 1mm处的骨小梁损伤 ,晚期的微孔内、外骨小梁碎化 ,胶原纤维脱粘、断裂。结论　 6月后微孔涂层生物学固定界面结合牢固 ,界面强度高。疲劳损伤的应力转移现象 ,为损伤修复提供了机会。     

数字化口腔种植外科导板的精确度研究

目的 本研究通过分析种植体术前设计和术后的三维位置,来评估数字化口腔种植导板的精确度.方法 根据修复体的生物学功能和美学要求,使用3D种植软件对种植体位置进行设计.将设计的种植导板转化为手术用种植导板,指导47颗种植体植入合适位置.通过重叠术前和术后的CT扫描图像,分析植体肩部和根部的线性误差以及植体长轴的角度误差,比...