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目的    探讨固定矫治技术矫治上颌前牙埋伏阻生临床效果。方法    选取2006—2008年就诊于江苏省泰州市人民医院口腔医学专科的13例14颗上颌前牙埋伏阻生的正畸患者,采用固定矫治技术轻力牵引导萌进行矫治。结果    12例患者13颗埋伏上颌前牙被牵引入正常牙列。结论    在上颌前牙埋伏阻生的患者中,采用固定矫治技术,既保存了患牙,改善美观,又防止形成牙源性囊肿的可能,是一种较理想的矫治方法。     

Anthropometric analysis of maxillary anterior buccal bone of Korean adults using cone-beam CT

PURPOSE

The aim of this study was to evaluate the thickness of buccal and palatal alveolar bone and buccal bony curvature below root apex in maxillary anterior teeth of Korean adults using Cone-beam CT images.

MATERIALS AND METHODS

The 3D image was reconstructed with dicom file obtained through CBCT from 20 - 39 year old Korean subjects (n = 20). The thickness of buccal and palatal plate, root diameter, the buccal bony curvature angle below root apex and the distance from root apex to the deepest point of buccal bony curvature were measured on maxillary anterior teeth area using OnDemand3D program.

RESULTS

Mean thickness of buccal plate 3 mm below CEJ was 0.68 ± 0.29 mm at central incisor, 0.76 ± 0.59 mm at lateral incisor, and 1.07 ± 0.80 mm at canine. Mean thickness of palatal plate 3 mm below CEJ was 1.53 ± 0.55 mm of central incisor, 1.18 ± 0.66 mm of lateral incisor, 1.42 ± 0.77 mm of canine. Bucco-lingual diameter 3 mm below CEJ was 5.13 ± 0.37 mm of central incisor, 4.58 ± 0.46 mm of lateral incisor, and 5.93 ± 0.47 mm of canine. Buccal bony curvature angle below root apex was 134.7 ± 17.5° at central incisor, 151.0 ± 13.9° at lateral incisor, 153.0 ± 9.5° at canine. Distance between root apex and the deepest point of buccal bony curvature of central incisor was 3.67 ± 1.28 mm at central incisor, 3.90 ± 1.51 mm at lateral incisor, and 5.13 ± 1.70 mm at canine.

CONCLUSION

Within the limitation of this study in Korean adults, the thickness of maxillary anterior buccal plate was very thin within 1mm and the thickness of palatal plate was thick, relatively. The buccal bony curvature below root apex of maxillary central incisor was higher than that of lateral incisor and canine and it seems that the buccal bony plate below root apex of central incisor is most curved.     

后路椎间盘镜治疗中央型腰椎间盘突出症的疗效分析

目的分析后路椎间盘镜治疗中央型腰椎间盘突出症的临床效果及可行性。方法回顾分析于2005年7月至2007年9月经后路椎间盘镜治疗的53例中央型腰椎间盘突出症病例,探讨后路椎间盘镜在中央型腰椎间盘突出症的治疗情况。按改良MacNab标准评价手术效果。结果49例患者得到随访,其中优38例,良9例,可1例,优良率为95.9%。结论后路椎间盘镜治疗中央型腰椎间盘突出症效果良好。     

罗哌卡因用于腰椎间盘摘除、腰椎管减压术最佳浓度探讨

目的探讨一种镇痛、肌松效果好,不良反应少,适用于腰椎间盘摘除、腰椎管减压术,椎管内麻醉用药的最佳浓度。方法选择腰椎间盘突出、腰椎管狭窄患者60例,ASA Ⅰ～Ⅱ级,随机分成3组,每组20例,均选择硬膜外麻醉。A组:硬膜外用0.4%罗哌卡因;B组:硬膜外用0.5%罗哌卡因;C组:硬膜外用0.75%罗哌卡因。对麻醉效果欠佳者,静脉滴注芬太尼0.05mg。结果A组患者镇痛效果欠佳,应用芬太尼例数较多;B组患者镇痛效果好,肌松效果满意,不良反应少;C组患者镇痛、肌松效果较强,不良反应多。结论B组药物浓度是腰椎间盘摘除、腰椎管减压术最佳浓度。     

经阴道后路悬吊术治疗子宫及阴道壁脱垂不良结局分析

目的通过对经阴道后路悬吊术（PIVS）治疗子宫及阴道壁脱垂引起的不良结局进行分析,探讨PIVS的利弊以及提出可能解决问题的有效方法。方法对行PIVS后出现不良结局的7例患者的临床资料进行回顾性分析。首次术式以PIVS为主,术后7例患者均出现阴道前壁Ⅲ度膨出;再次或第三次手术时加用前盆腔悬吊术。结果随访24～36个月,平均30．5个月,患者无复发及其他并发症。结论忽视盆底修补手术的受力点,在软组织间寻找修补手术的支撑是导致复发的重要原因;手术的关键受力点应在骨盆骨,而非盆底组织中已经受损的韧带或筋膜。     

前路减压植骨内固定治疗胸腰椎骨折(附56例报告)

目的探讨前路减压、植骨融合内固定治疗胸腰椎骨折的临床效果。方法2003年1月～2008年12月,采用前路减压、植骨内固定术治疗胸腰椎骨折56例,其中合并不全截瘫44例,椎管骨性占位,硬膜受压,但无神经症状12例。观察其神经功能的恢复情况和脊柱的稳定性。结果56例随访7个月～5年,平均2.6年。伤椎高度恢复90%以上35例,恢复80%～90%16例,恢复80%以下5例。X线片显示植骨融合,无钢板螺钉断裂和松动现象。44例不全截瘫者术后脊髓神经功能按Frankel分级,除A级3例未能恢复外,其余恢复1～2级。结论对来自椎管前方压迫的胸腰椎骨折,前路减压植骨钛板固定具有减压彻底、神经功能改善率高、一期固定融合成功率高及脊柱稳定性好等优点,是治疗胸腰椎骨折的有效方法之一。     

关节镜下多股自体腘绳肌腱双束双隧道重建膝前交叉韧带

目的：探讨膝关节镜下应用多股腘绳肌腱双束双隧道重建前交叉韧带(anterior cruciate ligament,ACL)的方法及疗效。方法：ACL损伤患者21例,男性13例,女性8例,平均年龄25.4（17～50）岁,全部经膝关节镜最后确诊。并在关节镜下分别于ACL股骨胫骨附着处建立两骨隧道,重建ACL的前内侧束及后外侧束;股骨侧以带袢钢板（Endo-buttons）悬吊固定,胫骨侧以生物型阻滞螺钉固定。结果：术后随访15.8（13～23）月。术前所有患者前抽屉试验均为阳性,Lachman试验19例阳性。术后屈膝90°时前抽屉试验20例阴性,1例阳性;Lachman试验19例阴性,1例弱阳性,1例阳性。Lysholm评分术前36~58分,术后71~95分,术后总优良率95.2%。结论：双隧道多股自体腘绳肌腱重建ACL能更好地有效恢复膝关节动态稳定性,疗效满意。     

腰椎间盘摘除和假体置换对相邻近端节段椎间载荷的影响

目的：研究椎间盘摘除和假体置换（artificial disc replacement, ADR）前后对相邻节段内载荷的影响,分析椎间盘摘除后相邻节段失稳及退变原因;为评价ADR长期疗效及对脊柱整体的影响提供依据。方法：采用新鲜尸体保留韧带结构的完整腰段脊柱标本,设计3种模型：完整组,椎间盘摘除组及ADR组。模拟生理型载荷作用特点,标本各向运动都受垂直压力载荷,由小范围内变动的偏心性压力提供下压及各向弯曲载荷。结果：椎间盘切除后相邻近节段椎间载荷变化,引起相邻近节段压力性负荷增加; ADR明显减少各向运动时相邻节段的压力负荷;正常组与ADR组间压力负荷无明显统计学差异。结论：椎间盘摘除使近端节段的压力性负荷增加,机制与脊柱载荷重分布有关。ADR明显减少各向运动时相邻近节段内压力性负荷。相邻近节段压力性负荷低,表明假体的长期应用导致相邻节段退变的风险较低。     

铱192放射治疗结合腔内手术治疗短段前尿道狭窄的探讨

目的：探讨铱192放射治疗结合腔内手术治疗短段前尿道狭窄,降低腔内手术术后复发率。方法：短段前尿道狭窄患者286例,均行尿道内切开术,再将其随机分为两组,一组为173例,术后尽早行狭窄段铱192放射治疗;另一组为113例,未行放疗。术后随访1年,比较两组之间的复发率（X^2检验）。结果：286例均手术成功,放疗组1年内19例复发,复发率为10．98%;未放疗组1年内62例复发,复发率为54．86％。两组之间比较差异有统计学意义（P=0．003）。结论：腔内手术治疗短段前尿道狭窄术后尽早行狭窄段铱192放射治疗是预防狭窄术后复发的有效手段。     

Expressions of connexin and par-3 in the distal margin of rectal cancer after ultra-low anterior resection

This study examined the expression of connexin and protease-activated receptor 3 （par-3） in the distal resection margin of rectal cancer and the correlation of the expression of the two proteins with tumor relapse. A total of 40 patients with rectal cancer underwent ultra-low anterior resection with curved cutter stapler. The pathological specimens were divided into 3 groups in terms of sampling sites： tumor group, 2.0-cm group （in which the tissues were harvested 2.0 cm distal to the tumor tissues）, 3.0-cm group （in which the tissues were taken 3.0 cm away from the tumor tissues）. All the samples were pathologically observed and then measured for the expression of connexin and par-3 by employing immunohistochemistry and Western blotting. The operations in this series went uneventfully. No anastomotic stoma bleeding, stenosis and death occurred postoperatively. Histopathologically, in the tumor group, epithelial cells lost normal pattern of arrangement and polarity, and were loosely connected and even detached. In the 3.0-cm group, the epithelia had normal appearance, obvious cell polarity and essentially intact cell junction. Immunohistochemistry and Western blotting indicated that the 3.0-cm group had the strongest expression of connexin and par-3, and the expression in the 2.0-cm group and the tumor group was relatively weak. There existed significant difference in the expression of the two proteins among the three groups （P〈0.05 for all）. It was concluded that the down-regulated connexin and par-3 in the distal margin of rectal cancer tissues may indicate the progression of the disease and high likelihood of recurrence and metastasis. Although no tumor cells were found in the sections of the 2.0cm group, the decreased expression of connexin and par-3 may suggest the development of anaplasia and the increased odds of tumor relapse. Therefore, we are led to speculate that tumor resection only including 2.0 cm of unaffected rectum could not completely avoid the distant metastasis and local relapse.