咬合重建患者的咀嚼效率测量分析

目的:通过对咬合丧失或低位咬合患者咬合重建修复后的咀嚼效率测量分析,讨论分析咬合重建修复治疗的实验室效果.方法:从就诊患者中选取12名需行咬合重建修复者作为实验组,然后进行合理的咬合重建修复.治疗完成1个月后,对其咀嚼效率进行测量,与正常对照组之间进行比较.结果:实验组与对照组之间的咀嚼效率(P<0.01)和咀嚼次数(P<0.01)均存在统计学差别,实验组的咀嚼效率约为对照组的66.39%-86.31%,平均为75.94%;对照组咀嚼效率和咀嚼次数之间不存在线性相关关系(r= 0.1998,P >0.01).结论:咬合重建后,患者满意度较高,其咀嚼效率虽然与对照组之间存在差别,但可达对照组的66.39%-86.31%,效果较理想.咀嚼效率的高低并不完全依赖于咀嚼次数的多少,咬合重建后咀嚼次数与对照组之间的差别可能是患者的适应性所导致的结果.     

咬合垂直距离降低对大鼠髁突软骨和软骨下骨形态学影响的初步研究

目的:探讨咬合垂直距离降低对大鼠颞下颌关节髁突软骨和软骨下骨改变的影响。方法:40只10周龄雄性大鼠随机等分为实验组和操作对照组。实验组通过降低大鼠牙冠高度的方法建立咬合垂直距离降低的动物模型,分别于处理后3、10、20、30d处死取材。30d组大鼠于实验处理前1d、处理后10、30d进行MICRO-CT扫描观察大鼠髁突软骨下骨形态改变。双侧颞下颌关节石蜡包埋、切片,通过HE染色观察大鼠髁突软骨形态学的改变。结果:①实验3d组与10d组髁突软骨中部厚度较操作对照组明显增厚(P<0.05),但实验20d组和30d组软骨中部厚度与操作对照组之间无显著差异(P>0.05)。所有实验组髁突软骨后部厚度在各时间点均较操作对照组显著增厚(P<0.05);②实验3d组髁突软骨增殖层出现了较大面积的胞核固缩,实验10d组部分关节(4/10)髁突软骨中出现了均质样无细胞区域,实验20d组与30d组髁突软骨各层形态基本与对照组相似;③实验30d组于10d时可见髁突软骨下骨后部出现骨质吸收凹陷,实验30d时凹陷变浅,骨表面又趋于光滑流畅。结论:①咬合垂直距离降低可以引起大鼠髁突软骨中后部的适应性改建;②实验早期改建活动较活跃,晚期改建活动趋于稳定。     

Intra-abdominal packing with laparotomy pads and QuikClot™ during damage control laparotomy: A safety analysis

BackgroundIntra-abdominal packing with laparotomy pads (LP) is a common and rapid method for hemorrhage control in critically injured patients. Combat Gauze™ and Trauma Pads™ ([QC] Z-Medica QuikClot^®) are kaolin impregnated hemostatic agents, that in addition to LP, may improve hemorrhage control. While QC packing has been effective in a swine liver injury model, QC remains unstudied for human intra-abdominal use. We hypothesized QC packing during damage control laparotomy (DCL) better controls hemorrhage than standard packing and is safe for intracorporeal use.MethodsA retrospective review (2011–2014) at a Level-I Trauma Center reviewed all patients who underwent DCL with intentionally retained packing. Clinical characteristics, intraoperative and postoperative parameters, and outcomes were compared with respect to packing (LP vs. LP + QC). All complications occurring within the patients’ hospital stays were reviewed. A p ≤ 0.05 was considered significant.Results68 patients underwent DCL with packing; (LP n = 40; LP + QC n = 28). No difference in age, BMI, injury mechanism, ISS, or GCS was detected (Table 1, all p > 0.05). LP + QC patients had a lower systolic blood pressure upon ED presentation and greater blood loss during index laparotomy than LP patients. LP + QC patients received more packed red blood cell and fresh frozen plasma resuscitation during index laparotomy (both p < 0.05). Despite greater physiologic derangement in the LP + QC group, there was no difference in total blood products required after index laparotomy until abdominal closure (LP vs LP + QC; p > 0.05). After a median of 2 days until abdominal closure in both groups, no difference in complications rates attributable to intra-abdominal packing (LP vs LP + QC) was detected.ConclusionWhile the addition of QC to LP packing did not confer additional benefit to standard packing, there was no additional morbidity identified with its use. The surgeons at our institution now select augmented packing with QC for sicker patients, as we believe this may have additional advantage over standard LP packing. A randomized controlled trial is warranted to further evaluate the intra-abdominal use of advanced hemostatic agents, like QC, for both hemostasis and associated morbidity.     

达米弱刺激通气型口垫在全身麻醉患者苏醒期的应用

目的观察达米弱刺激通气型口垫(达米口垫)作为一种创新型过渡性口咽通气道在麻醉苏醒期的安全性和有效性。方法选取行气管插管全身麻醉腹部手术且拔管后出现意识未完全恢复清醒、伴有舌后坠或呼吸不畅的患者200例,男153例,女47例,年龄26～66岁,体重42～91 kg,ASAⅠ—Ⅲ级。随机分为四组:达米口垫组(D组)、口咽通气道组(K组)、鼻咽通气管组(B组)和传统托颌组(C组),每组50例。拔管后气道管理措施:D组经口置入达米弱刺激通气型口垫;K组置入口咽通气道;B组经鼻置入鼻咽通气道;C组出现气道梗阻情况时予以托颌通气处理。记录拔除气管导管前即刻(T_0)、拔管后5 min(T_1)、拔管后10 min(T_2)、拔管后15 min(T_3)的血流动力学指标(HR、BP、SpO_2)、血气分析指标(PaCO_2、PaO_2、pH值);记录通气道留置时间、调整通气道次数,以及PACU停留时间、拔管后通气过程中舒适度。记录不良反应的发生情况。结果与D组比较,T_1时C组HR明显增快(P0.05),T_2时K组、C组HR明显增快(P0.05),T_3时K组HR明显增快(P0.05),T_2、T_3时K组、B组MAP明显升高(P0.05),T_3时B组、C组PaCO_2明显升高(P0.05),T_1—T_3时K组、B组、C组PaO_2明显降低(P0.05),T_2时C组、T_3时B、C组pH值明显升高(P0.05)。与T_0时比较,T_1时四组HR明显减慢,MAP明显降低(P0.05),T_2时D组HR减慢,D组、B组MAP明显降低(P0.05),T_3时K组、B组HR明显增快,MAP明显升高(P0.05),T_1—T_3时四组PaO_2、pH值明显降低,PaCO_2明显升高(P0.05)。四组不同时点SpO_2差异无统计学意义。与D组比较,K组通气道留置时间和调整通气道次数明显增多(P0.05),C组PACU停留时间明显延长(P0.05),K组、C组拔管后舒适度明显降低(P0.05)。C组躁动发生率明显升高(P0.05)。结论达米弱刺激通气型口垫在气管插管全身麻醉恢复期能够有效维持呼吸道的通畅,具有循环影响小、舒适度高、不良反应小等优点,优于传统口咽、鼻咽通气道。     

联合应用压力手套及压力垫治疗手背烧伤后瘢痕的疗效观察

目的：观察联合应用压力手套和压力垫对手背侧烧伤后瘢痕增生的预防和治疗作用。方法：对58只烧伤后愈合患手分别采用单纯压力手套和联合应用定制压力手套及压力垫进行干预,用Sawada评分方法对两组治疗前、治疗3个月及治疗6个月手背瘢痕色泽、厚度、硬度及敏感度进行定量评分,比较其治疗差异。结果：联合治疗组在治疗6个月后效果优于单纯治疗组,具有统计学差异（P〈0．05）。结论：联合治疗组较单纯治疗组更有效控制瘢痕增生及因瘢痕增生引起的继发畸形,外观改善明显。     

牙齿重度磨耗伴牙列缺损咬合重建固定义齿修复的临床观察

目的：观察临床重度磨耗伴牙列缺损咬合重建应用固定义齿修复的临床效果。方法：选取2009～2011年在我院收治的牙齿重度磨耗伴牙列缺损患者31例,根据患者口腔健康环境,在适宜的时间先后对其进行咬合重建与固定修复。修复6个月、1年、2年,对患者进行随访观察患者口颌生理功能,义齿固位、稳定情况,面容、牙齿、牙龈美观情况。结果：经过咬合重建以及固定义齿修复后,患者义齿的固位良好,咀嚼、发音功能,牙齿、面容美观显著改善,牙周及咀嚼肌群疲劳均有明显好转。结论：通过对患者进行咬合重建以及固定义齿修复治疗后,对改善患者的咀嚼、发音功能、颜面美观以及口颌系统其他功能均有良好疗效,值得进行医疗推广。     

棉垫吸附浓缩法在脂肪移植隆胸中的临床应用

目的 评价棉垫吸附浓缩法纯化脂肪填充乳房的手术效果.方法 2012年至2014年,随机选取20名小乳症患者,以棉垫吸附浓缩法处理纯化的自体脂肪组织,并进行乳房填充.术后随访6个月,测量患者胸围改变,Axisthree三维立体模拟成像评估乳房体积变化,MRI检查有无囊肿与肿块形成,问卷随访患者满意度.结果 术后乳房外形自...     

全牙列牙合垫结合弹性吊颌帽治疗替牙期下颌骨髁状突骨折

目的：探讨全牙列牙合垫式保持器及吊颌帽弹性牵引在替牙期儿童髁状突骨折治疗的价值。方法：选取19例替牙期下颌骨髁状突骨折合并上颌前牙外伤性松动的患者,用全牙列牙合垫式保持器结合吊颌帽弹性牵引进行治疗。结果：所有患儿松动牙固定良好,咬合关系正常,无张口受限。X线片骨折复位良好。结论：全牙列牙合垫式保持器结合吊颌帽弹性牵引是一种治疗替牙期儿童下颌骨髁状突状突骨折的有效方法。     

Heel fat pad syndrome beyond acute plantar fascitis

Heel pain is a frequent cause of pain and disability in adult active population. In patients with this clinical presentation, several causes must be ruled out, among them plantar fasciitis the most common. Other etiologies of plantar heel pain are the entrapment of muscular branch of the lateral plantar nerve (Baxter nerve) or fat pad atrophy, being the last one the second cause of heel pain after plantar fasciitis.A case series of patients with pathological findings of the heel fat pad area using MRI and US to provide a differential diagnosis of heel pain.Observational case series study. Nine patients visited presented with pain in the plantar aspect of the heel.The plantar aspect of the heel was evaluated in detail with US and MRI. Main inclusion criteria were to present acute or chronic pain on the plantar aspect.In five cases the right heel was affected, in three cases the left heel. One case presented bilateral complaints. All patients presented mechanical pain. Specifically, four of them also described a constant clunk during footstep. Heel fat pad lesion was confirmed with MRI and US in the medial aspect, observed in five patients. In four patients, the heel fat pad was globally affected respectively.This case series tries to put some light on other heel conflicts beside plantar fasciitis that should be ruled out, being one of those, heel fat pad atrophy. Our presentation highlight the role that bed side ultrasound can play in the definition of a specific pattern confirmed with MRI after the US.