角膜塑形镜矫治对近视儿童角膜形态及视觉质量的影响

【摘要】目的 探讨角膜塑形镜矫治对近视儿童的角膜形态及视觉质量影响。方法 选取2015年4月～2016年4月期间于我院诊治的200例儿童近视患者,采用回顾性分析方法进行疗效探究,所有患者均采用角膜塑形镜矫正治疗。分别于治疗1d、1周、1月后测定角膜形态变化并进行客观与主观视觉质量测定。结果 戴镜后1周、1月等效屈光度、平均曲率、角膜顶点厚度、对比敏感度情况（AULCSF）、四阶球差、三阶慧差与治疗1d比较差异均有统计学意义（P＜0.05）,但高阶像差异无统计学意义（P＞0.05）;客观视觉质量中,矫正后1周、1月、3月调制传递函数(MTF)截止频率下降（P＜0.05）,客观散射指数(OSI)上升（P＜0.05）,泪膜质量有所降低,但差异无统计学意义（P＞0.05）,9%对比视力、20%对比视力、100%对比视力稍有下降,但与治疗前相比差异无统计学意义（P＞0.05）; 主观视觉质量中,矫正后1周、1月、3月从明处到暗处适应、夜间骑车、夜间光圈、视力波动、眩光评分与治疗前相比差异有统计学意义（P＜0.05）,看电脑屏幕、白天骑车、书籍阅读、日常活动、户外运动、视物变形、总体视力评分与治疗前相比差异无统计学意义（P＞0.05）。结论 角膜塑形镜矫正治疗能显著改善近视儿童的角膜形态,在近视儿童的矫正治疗中具有良好的利用价值,值得临床借鉴。     

数字化导板在手术优先正颌外科中应用的初步探讨

目的 探讨三维打印技术制作的数字化导板用于“手术优先”指导矫正下颌骨不对称畸形的可行性。方法 6例下颌骨不对称畸形患者均进行全头颅三维螺旋CT扫描,将患者的石膏模型扫描数据在Proplan CMF 3.0与头颅CT数据进行拟合。通过该软件对头颅模型进行上下颌的截骨、骨块移动,收集并输出数据,经快速原型机打印形成三维导板。术中先利用三维打印数字化导板进行骨块移动和固定,后应用传统导板检验骨块的新位置,验证三维打印数字化导板的临床实用性。术后3月评估手术效果。 结果 5例患者术前建立的三维打印数字化导板能起到引导手术、预测手术效果的作用。术后3月随访,患者对外形满意。 结论 三维打印数字化导板可以有效引导手术过程,有望代替传统模型外科在牙颌面畸形的作用,为下颌骨不对称畸形的“手术优先”治疗模式提供合理参考。     

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目的探讨微钛板支抗对正畸治疗的有效性。方法选择2003年12月至2006年11月期间,大连市口腔医院应用微钛板矫治的12例患者,分析其治疗前后头颅侧位片、模型等临床资料,评价微钛板对牙齿移动特征及正畸疗效的影响。结果12例正畸矫治患者均取得了满意的治疗效果,12例患者使用的23枚微钛板均由同一外科医生埋入,每个微钛板埋入时间需10min左右。微钛板作为绝对支抗的应用时间为9～20个月。治疗中23枚微钛板均稳定,无脱落。其中9例患者利用微钛板在远、近中方向上调整牙齿位置,其移动方式以整体移动为主,上下颌磨牙远中移动最多可达3.5mm。结论微钛板作为一种绝对支抗,实现了传统正畸手段在牙齿近远中移动、压低方面难以完成的牙齿移动类型,有效地获得了传统正畸方法难以达到的临床效果。     

Some Reflections

Relational psychoanalysis represents the composite of contributions from a variety of psychoanalysts, all of whom found dissatisfaction in their clinical work with patients where the restrictions of the classical psychoanalytic approach led to unsatisfactory or less than optimal outcomes with their patients. While some have emphasized the technical limitations of classical psychoanalysis, others have rejected the classical theory of causality and the central role of insight and interpretation. Whether on the basis of technical or theoretical differences, relational psychoanalysts have placed greater emphasis on the role of the relationship between analyst and patient in accounting for the therapeutic action of psychoanalysis. What has evolved is distinctly different from, indeed, oppositional to, classical psychoanalysis. Therefore, the attempt to homogenize relational and classical approaches risks the possibility of obscuring the significant differences between them. If such a homogenization occurs, psychoanalysis loses the status of a clinical discipline that must stay open to changes in practice that reflect the experience of those who employ it in their clinical work.     

On Reducing Information Asymmetry in U.S. Health Care

Information asymmetry is a significant issue facing the U.S. health care system. In this article, we investigate some methods of reducing this asymmetry. We trace the information asymmetry using the “wicked problem” of the health care distribution system. An information asymmetry reduction method requiring joint responsibilities among health care stakeholders is developed. It is argued that information asymmetry is a contributor to enormous health care inflation. Hence, any reduction in such asymmetry will reduce health care costs. Concepts from both signaling and corrective justice theories are integrated in this article to help reduce the information asymmetry that exists in the U.S. health care system. Getting health care costs in line with other “advanced” nations, is the long-term solution to the wicked problem that currently exists in the U.S. health care system. There is an immediate need for a centralized health care database with adequate provisions for individual privacy. Both processes as well as an outcome-based control system are essential for reducing information asymmetries in the U.S. health care system.     

Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disorders: Mini-open TLIF and Corrective TLIF

Minimally invasive transforaminal lumbar interbody fusion (TLIF) as a short fusion is widely accepted among the spine surgeons. However in the long fusion for degenerative kyphoscoliosis, corrective spinal fixation by an open method is thought to be frequently selected. Our objective is to study whether the mini-open TLIF and corrective TLIF contribute to the improvement of the spinal segmental and global alignment. We divided the patients who performed lumbar fixation surgery into three groups. Group 1 (G1) consisted of mini-open TLIF procedures without complication. Group 2 (G2) consisted of corrective TLIF without complication. Group 3 (G3) consisted of corrective TLIF with instrumentation-related complication postoperatively. In all groups, the lumbar lordosis (LL) highly correlated with developing surgical complications. LL significantly changed postoperatively in all groups, but was not corrected in the normal range in G3. There were statistically significant differences in preoperative and postoperative LL and mean difference between the pelvic incidence (PI) and LL between G3 and other groups. The most important thing not to cause the instrumentation-related failure is proper correction of the sagittal balance. In the cases with minimal sagittal imbalance with or without coronal imbalance, short fusion by mini-open TLIF or long fusion by corrective TLIF contributes to good clinical results if the lesion is short or easily correctable. However, if the patients have apparent sagittal imbalance with or without coronal imbalance, we should perform proper correction of the sagittal spinal alignment introducing various technologies.     

拔除下颌第三磨牙矫治14～23岁骨性Ⅲ类错(牙合)的临床效果观察

目的 分析拔除下颌第三磨牙矫治骨性Ⅲ类错(牙合)畸形后患者牙(牙合)面的变化,探讨该矫治模式的适应证、疗效和临床意义.方法 选择处于生长发育减速期和结束期的骨性Ⅲ类错(牙合)畸形患者19例(女性16例,男性3例),拔除下颌第三磨牙,配合摇椅形弓和短Ⅲ类牵引技术矫治骨性Ⅲ类错(牙合)畸形.通过头影测量对患者治疗前后的骨骼和牙齿变化进行评估,并进行配对t检验.结果 治疗后下颌切牙和磨牙发生明显的舌向移动,下切牙至Y轴的距离由治疗前的65.96 mm减至治疗后的63.98 mm,向远中移动(1.98±1.36)mm.下颌第一磨牙至Y轴的距离由治疗前的43.00 mm减至治疗后的39.84 mm,向远中移动(3.16±1.23)mm.矫治后下颌第一磨牙向远中倾斜(12.37±6.81)°,前牙覆盖增加(2.75±1.65)mm,矫治前后差异有统计学意义(P<0.05).结论 拔除下颌第三磨牙配合摇椅形弓和短Ⅲ类牵引技术可明显远中移动下颌磨牙和切牙.

Abstract：

Objective To assess the skeletodental changes after extracting mandibular third molars in skeletal Class Ⅲ patients in both post-puberty and adult.Methods Nineteen skeletal Class Ⅲ patients in post-puberty or adult(16 female,3 male)successfully treated with extracting mandibular third molars were included in the study.Cephalograms were analyzed to assess the skeletal and dental changes before and after treatment.Paired t-test was performed for statistical analysis of the data.Results The results revealed that the main changes were upright[(12.37±6.81)°]and distal movement[(3.16±1.23)mm]of the mandibular molars,and retraction[(1.98 ±1.36)mm]of the mandibular incisors.There was a significant improvement in overjet[(2.75±1.65)mm].Conclusions The lower molars and incisors could be distalized significantly with extraction of the lower third molars.     

牙周维护在固定正畸中的临床意义

目的 探讨牙周维护在固定正畸中的临床意义.方法 将该院口腔科近4年固定正畸患者36例随机分为A、B两组.A组为对照组,仅进行家庭常规口腔护理;B组为实验组,在正畸期间定期进行牙周维护.分不同时期观察两组各项矛周指标变化情况 结果 B组固定正畸矫治后与矫治前牙周各项指标比较无明显差异,但比A组牙周各项指标评分低,差异有统计学意义(P＜0.05) 结论 定期牙周维护可以降低患者固定正畸过程中牙周疾病的发生.