两方向法经嵴顶提升倾斜型上颌窦底的临床效果研究

目的 观察两方向法经嵴顶提升倾斜型上颌窦底的临床效果.方法 对6例拟行上颌后牙区种植修复的病例,用两方向法经嵴顶提升倾斜型上颌窦底.1个种植位点从2个方向进行经嵴顶提升,先行非植入方向骨凿冲顶窦底提升,将较低处黏膜提起,再行常规的植入方向骨凿冲顶窦底提升和种植体植入手术.结果 术后拍摄锥形束CT证实6例患者均获得了良好的上颌窦底提升效果,种植体与邻牙位置关系适当,种植体尖端有黏膜覆盖,术后鼻腔无血性分泌物,无明显疼痛,术后6个月内无种植体脱落.结论 对倾斜型上颌窦底可以考虑使用两方向法经嵴顶提升上颌窦底.     

A Comparative Study of 3-Dimensional Titanium Versus 2-Dimensional Titanium Miniplates for Open Reduction and Fixation of Mandibular Parasymphysis Fracture

Introduction

Three dimensional titanium plating system was developed by Farmand in 1995 to meet the requirements of semi rigid fixation with lesser complication. The purpose of this in vivo prospective study was to evaluate and compare the clinical effectiveness of three dimensional and two dimensional Titanium miniplates for open reduction and fixation of mandibular parasymphysis fracture.

Materials and Methods

Thirty patients with non-comminuted mandibular parasymphysis fractures were divided randomly into two equal groups and were treated with 2 mm 3D and 2D miniplate system respectively. All patients were systematically monitored at 1st, 2nd, 3rd, 6th week, 3rd and 6th month postoperatively. The outcome parameters recorded were severity of pain, infection, mobility, occlusion derangement, paresthesia and implant failure. The data so collected was analyzed using independent t test and Chi square test (α = .05).

Results

The results showed that one patient in each group had post-operative infection, occlusion derangement and mobility (p > .05). In Group A, one patient had paresthesia while in Group B, two patients had paresthesia (p > .05). None of the patients in both the groups had implant failure. There was no statistically significant difference between 3D and 2D miniplate system in all the recorded parameters at all the follow-ups (p > .05).

Conclusion

3D miniplates were found to be better than 2D miniplates in terms of cost, ease of surgery and operative time. However, 3D miniplates were unfavorable for cases where fracture line was oblique and in close proximity to mental foramen, where they were difficult to adapt and more chances for tooth-root damage and inadvertent injury to the mental nerve due to traction.

     

196例腭裂手术的临床分析

１９６例腭裂患者中，单测完全性腭裂１２９例．占６５．８１％，以单侧完全性腭裂为多见．全部病例进行手术治疗，以兰氏（ｌａｎｇｅｎｂｅｃｋ）二瓣术为主．手术的成功率达９８．９８％。１９６例腭裂中有血型鉴定的１６８例，以Ｏ型、Ｂ型为多见，分别为３０．９５％、２９．８％。说明以Ｏ型、Ｂ型患腭裂的机率较高。同时，本文对腭裂发生的病因方面作了粗浅探讨．     

面神经再生微环境的蛋白质分布及针刺对其的影响

目的　探讨面神经再生微环境的蛋白质分布及穴位针刺对该微环境的影响。方法　建立兔面神经再生微环境动物模型 ,采用蛋白质双向凝胶电泳技术对面神经再生微环境中的蛋白质进行了检测和分析。结果　神经再生液中的蛋白质主要分布于相对分子质量 80× 10 3以下 ,等电点 4～ 7之间 ,对照组检测到 80 0± 5 3个蛋白质点 ,针刺组检测到 85 0± 78个蛋白质点 ,在匹配的点中 ,有十几种蛋白质发生了明显变化。结论　尚不能证实针刺对面神经再生微环境有积极的影响作用     

The family and childhood psychosomatic disorders

A major recent advance in the understanding of the maintenance of psychosomatic disorders has been the development of a theoretical model utilizing the concepts of General Systems Theory. The model directly addresses the impact of contextual factors upon an individual's physiologic and emotional functioning. Familial and extrafamilial influences appear to be related to psychosomatic symptoms in a circular feedback fashion. Research carried out at the Philadelphia Child Guidance Clinic has identified characteristic dysfunctional patterns of family interaction in families with a psychosomatic member. These include enmeshment, overprotectiveness, rigidity, lack of effective conflict resolution, and involvement of the affected child in marital conflict. Structural Family Therapy, systemically based family treatment incorporating goal directed interventions in family interaction, has been applied to the treatment of psychosomatic disorders in children, adolescents, and young adults with highly successful results. Therapeutic techniques are specifically designed and implemented to transform dysfunctional patterns of family interaction and provide family members with methods of effectively responding to psychosomatic symptoms while encouraging developmentally appropriate function for family members and improved overall family function. Of major importance in this work is the establishment of a collaborative medical-psychiatric team providing integrated and consistent treatment.     

Groin hernias in elderly patients: Management and prognosis

In a 10 year period, 1,496 patients aged 65 years or older were treated for groin hernias. A total of 1,755 hernias were diagnosed, of which 243 were incarcerated and 1,279 were surgically repaired. Emergency operations were performed in 235 patients with a mortality rate of 7.5 percent, compared with 1.3 percent for the elective cases. The postoperative morbidity rate was 56 percent in emergency cases and 20 percent in the elective cases. Patients with cardiovascular and pulmonary diseases had the worst prognosis. Local anesthesia had the least sequelae. We conclude that groin hernias in elderly patients should be repaired under elective conditions in the properly prepared patient, preferably while under local anesthesia.     

Kinematics of a selectively constrained radiolucent anterior lumbar disc: Comparisons to hybrid and circumferential fusion

Background

Despite encouraging clinical outcomes of one-level total disc replacements reported in literature, there is no compelling evidence regarding the stability following two-level disc replacement and hybrid constructs. The current study is aimed at evaluating the multidirectional kinematics of a two-level disc arthroplasty and hybrid construct with disc replacement adjacent to rigid circumferential fusion, compared to two-level fusion using a novel selectively constrained radiolucent anterior lumbar disc.

Methods

Nine osteoligamentous lumbosacral spines (L1–S1) were tested in the following sequence: 1) Intact; 2) One-level disc replacement; 3) Hybrid; 4) Two-level disc replacement; and 5) Two-level fusion. Range of motion (at both implanted and adjacent level), and center of rotation in sagittal plane were recorded and calculated.

Findings

At the level of implantation, motion was restored when one-level disc replacement was used but tended to decrease with two-level disc arthroplasty. The findings also revealed that both one-level and two-level disc replacement and hybrid constructs did not significantly change adjacent level kinematics compared to the intact condition, whereas the two-level fusion construct demonstrated a significant increase in flexibility at the adjacent level. The location of center of rotation in the sagittal plane at L4–L5 for the one-level disc replacement construct was similar to that of the intact condition.

Interpretation

The one-level disc arthroplasty tended to mimic a motion profile similar to the intact spine. However, the two-level disc replacement construct tended to reduce motion and clinical stability of a two-level disc arthroplasty requires additional investigation. Hybrid constructs may be used as a surgical alternative for treating two-level lumbar degenerative disc disease.     

彩色多普勒超声心动图诊断新生儿心下型肺静脉异位引流

目的 探讨彩色多普勒超声心动图在心下型肺静脉异位引流诊断中的价值。方法 患者为３例出生６天、７天及２５天的新生儿。采用Ｈｐ Ｓｏｎｏｓ５５００型彩色多普勒超声诊断仪,探头频率１２ＭＨｚ,经胸行二维超声心动图及彩色多普勒血流图检测。结果 心下型肺静脉异位引流的超声心图特征为左房明显小,房水平右向左分流,其后方见肺总静脉、与左房无交通,追踪其瞳向右下穿过膈肌、于肝右叶后方入门静脉或肝静脉。剑下主动脉短