正畸配合根尖下截骨术治疗严重双牙弓前突的临床研究

目的探讨骨性双牙弓前突患者经正畸正颌联合治疗后,颌面部硬组织、软组织在矢状方向上的变化及其相互关系,为临床矫治方法的选择提供参考。方法临床选择10例安氏Ⅰ类重度骨性双牙弓前突符合正颌手术的患者,术前正畸矫治完成后实施上、下前颌部截骨后退术（术中去除上下第一前磨牙牙骨块）,术后进一步正畸治疗以改善咬合关系。通过手术前后头影测量分析,比较颌面部硬组织,软组织在矢状方向上后退量及其相互关系。结果10例重度骨性双牙弓前突患者,经正畸一正颌联合矫治后,效果非常显著。上颌切牙平均后退7．13mm,上颌牙槽骨平均后退6．48mm,上颌软组织唇突点平均后移5．66nm。上颌硬、软组织后退的比例为1：0．87;下颌切牙平均后退6．62mm,下颌牙槽骨平均后退6．91mm,下颌软组织唇突点平均后移5．89mm。硬软组织后移的比值为1：0．85。结论重度骨性的双牙弓前突患者,应首选正畸正颌联合治疗,可彻底纠正前突的面型,上、下颌的硬软组织显著的内收,达到十分满意的疗效。     

婴儿黑色素性神经外胚瘤1例及临床病理特点分析

婴儿黑色素性神经外胚瘤是发生于婴儿的一种少见肿瘤,临床易误诊.笔者接诊婴儿上颌黑色素性神经外胚瘤1例,局部完整切除肿瘤后随访6个月,未见转移和复发.本文结合文献探讨婴儿黑色素性神经外胚瘤的临床、病理特点.婴儿黑色素性神经外胚瘤病理表现具有特征性,肿瘤由含棕黑色色素的上皮样瘤细胞和呈巢片状分布的神经母细胞样细胞组成,临床表现为蓝黑色肿物,应进行免疫组织化学病理检查确诊,治疗选择局部完整切除.     

双侧下颌升支矢状劈开截骨(BSSRO)后退术对下颌角区的影响

目的:研究BSSRO后退术后下颌角区形态的变化。方法:通过38例骨性下颌前突患者BSSRO后退手术前后头颅定位正侧位片及口腔X线计算机体层摄影(CBCT)片对硬组织结构定点测量。结果:2种测量均显示术后下颌角角度较术前减小,下颌升支坡度亦减小;下颌骨的宽度将增加。结论:BSSRO术后下颌角变小,下颌骨宽度增加;将使患者的面貌变宽,咬合功能有所改善。     

Deglutitive tongue movement after correction of mandibular protrusion: A pilot study

Objective:To investigate any change in deglutitive tongue movement following the correction of malocclusion by orthognathic surgery.Materials and Methods:The subjects were nine patients with mandibular protrusion. A control group consisted of 10 individuals with a similar age range and normal occlusion. Swallowing events before and after mandibular setback via sagittal split ramus osteotomy were recorded by cineradiography, and the tongue movement was analyzed. Time and linear measurements were compared before and after surgical treatment by the Wilcoxon signed rank test; control and test subjects were compared with the Mann-Whitney U-test.Results:Tongue-palate contact and the tongue-tip position changed after orthognathic surgery and became similar to those of the controls. Movements of the anterior and middorsal regions of the tongue did not change after orthognathic surgery and remained different from those of the controls.Conclusion:Our findings suggest that tongue-palate contact and tongue-tip position during deglutition adapted to the corrected oral and maxillofacial morphology, but the anterior and middorsal regions of the tongue during deglutition may have been affected by pharyngeal constrictors rather than by the oral and maxillofacial morphology.     

活动翼矫治技术治疗高角型双颌前突的临床研究

目的研究活动翼矫治技术治疗高角型双颌前突的临床疗效方法选择54例拔除4颗第一前磨牙的双颌前突患者,根据治疗前的SN/MP角将患者分为2组,高角组27例,SN/MP≥40°。均角组27例,29°﹤SN/MP﹤40°。使用活动翼矫治技术进行矫治。对2组治疗前后的X线头影测量数据进行统计学分析。结果①活动翼矫治技术治疗的高角型双颌前突上下颌骨在矢状方向上无明显变化。②高角型双颌前突治疗后上下颌磨牙伸长量分别为1.04和0.99 mm。上下颌磨牙前移量分别为2.74和2.37 mm。下颌平面未发生顺时针旋转。活动翼矫治技术治疗的高角型双颌前突平面能够保持稳定③高角组的U1-PP、U1-V、L1-V、U1/NA、U1-NAmm、L1/NB和L1-NBmm治疗前后变化均有统计学意义。④高角型双颌前突治疗后的上下唇突度明显减小,上下唇长度变小,软组织突度减小。⑤高角组的上颌中切牙与上唇内收的比例为1∶0.357,下颌中切牙与下唇内收的比例为1∶0.879 9。结论活动翼矫治技术治疗的高角型双颌前突垂直向和矢状向支抗可以达到很好的控制,上下颌骨在矢状关系上更加协调,上下颌前牙突度和倾斜度明显减小,软组织侧貌有明显改善,临床疗效较好。     

Protrusion of an Artificial Femoral Head : A Rare Complication of Chronic Dislocation of the Prosthetic Hip

Chronic dislocation is considered a rare complication after total hip arthroplasty. We have treated a patient with a complication related to chronic dislocation—protrusion of the prosthetic femoral head through the skin. This 86-year-old bedridden patient with a known dislocated total hip arthroplasty presented with fever and protrusion of an artificial femoral head after 2 months of a nonhealing pressure sore. The care of this patient was partial removal of the prosthetic components and intravenous antibiotics. Chronic dislocation is rarely reported, yet it may cause severe complications in debilitated and demented patients. Special attention should be warranted to these patients as they might benefit from earlier surgical treatment.     

Quantitative assessment of interradicular bone density in the maxilla and mandible: implications in clinical orthodontics

Background

Bone density at the interradicular area plays an important role during orthodontic treatment. In view of this fact, the study was designed to quantitatively evaluate the bone density at the interradicular areas of the alveolar and basal bones of maxilla and mandible by computed tomography.

Methods

One hundred and nine computed tomographic images were randomly selected, and bone density was measured in Hounsfield units (HU) with bone mineral density software (Siemens VA20A_SP3A). The sample consisted of 78 males (mean age 29.5 years, range 20 to 40 years) and 31 females (mean age 27.6 years, range 20 to 40 years). Cortical and cancellous bone density was measured at the interradicular areas at the alveolar and basal bone levels of the maxilla and mandible, and the data was subjected to statistical analysis for comparisons.

Results

The highest cortical bone density was observed between the second premolar and first molar at the alveolar bone level and between the first and second molars at the basal bone level in the maxilla. Maxillary tuberosity showed the least bone density. The density of the cortical bone was greater in the mandible than in the maxilla and showed a progressive increase from the incisor to the retromolar area. The basal bone showed a higher density thanthe alveolar bone.

Conclusion

Different qualities of the bone were found in the anatomic regions studied, which confirms the importance of knowledge of site-specific bone tissue density to correlate with various clinical findings.     

经皮腰间盘切割术中髓核造影的X线分析

20例腰椎间盘脱出的患者在行经皮腰椎间盘切割术(PLD)前进行了髓核造影。28个髓核造影有三种表现:蕈伞征占28.6%,团块征占39.3%,纤维环破裂征占32.1％。髓核造影能直接显示髓核的变化,椎间盘脱出的方向和程度,以及纤维环破裂的直接征象.因此我们认为当X线检查与临床体征部位不一致时,行PLD前作髓核造影可起到进一步确诊的作用。     

3D打印钛网预成形联合术后严密护理对眼眶爆裂骨折患者预后的影响

目的:探讨3D打印钛网预成形联合术后严密护理对眼眶爆裂骨折患者预后情况的影响。方法:选取笔者医院收治的眼眶爆裂性骨折患者122例,随机分为对照组和观察组,分别62例和60例。对照组患者予以常规钛网置入术,观察组患者予以3D打印钛网预成形,术后均予以视力监测、眼肌运动训练等严密护理。观察并比较两组患者钛网贴合度,复视、眼球运动及眼球突出等症状的改善情况。结果:观察组患者CT矢状位上修复眼眶底的钛网呈S形,对照组患者呈弯向眼眶内的弧形。术后3个月、6个月,观察组患者复视、眼球运动受限情况治愈率均高于对照组,差异具有统计学意义(P<0.05);术后,两组患者患眼眼球突出度差值均降低,观察组显著低于对照组,差异具有统计学意义(P<0.05)。结论:3D打印钛网预成形与眼眶爆裂性骨折患者眶底契合度更高,联合术后严密护理对复视、眼球运动受限及眼球突出等症状的改善作用更好,患者预后更好。