微型钛板联合颌间牵引钉内固定术治疗颌骨骨折疗效观察

目的:探讨微型钛板联合颌间牵引钉内固定术治疗颌骨骨折的临床效果及其在临床的安全性。方法:随机选取颌骨骨折患者共60例,将上述患者随机平均分成对照组与观察组。分别给予与单纯微型钛板坚固内固定治疗和微型钛板联合颌间牵引钉内固定术治疗方法。分析比较这两组患者4周内的临床治疗效果及安全性。结果:术后4周两组间临床治疗效果比较显示:采取微型钛板联合颌间牵引钉内固定术治疗的观察组治疗效果明显好于给予单纯微型钛板坚固内固定治疗的对照组。观察组总有效率为87%,对照组总有效率为53.3%,差异有统计学意义(P0.05).两组手术过程均顺利实施,患者术后均无严重并发症发生,术后恢复情况较好,经比较两组术后不良反应的差异无统计学意义(P0.05)。结论:微型钛板联合颌间牵引钉内固定术是治疗颌骨多发骨折有效安全方法。     

不同颌间牵引固定方案治疗单纯髁状突骨折的临床疗效比较

目的:研究不同颌间牵引固定方案治疗单纯髁状突骨折的临床疗效,为临床治疗提供依据。方法:选取2010年1月到2015年1月我院收治的单纯髁状突骨折患者50例,按照随机数字表法将患者分为A组和B组,A组给予牵引钉植入牵引固定方案治疗,B组给予牙弓夹板行颌间牵引固定方案治疗,比较两组操作时间、术后最大开口度、五个时间点软垢指数(DI)、牙龈指数(GI)以及社区牙周需要治疗指数(CPITN),并比较两组临床疗效。结果:A组操作时间显著短于B组(P0.05);术后最大开口度和颞下颌关节情况无显著差异(P0.05);A组第2次、3次、4次以及5次的DI、GI和CPITN均显著优于B组(P0.05);两组面型偏斜、咀嚼良好、咬合关系、关节弹性、开口偏斜以及关节牙痛比较均无显著差异(P0.05)。结论:牵引钉植入与牙弓夹板颌间牵引固定均可以较好改善患者骨折情况,但牵引钉植入术对患者伤害小,操作时间短,术后患者软垢和牙龈情况均较好。     

医院口腔颌面部骨折患者的临床特征分析及治疗效果调查

目的:调查研究医院口腔颌面部骨折(OMF)患者的临床特征及治疗效果。方法:选取我院2011年2月至2013年2月期间收治的OMF患者135例作为研究对象。对患者临床特征进行全面分析,并根据患者具体情况制定相应治疗方案,分析对比临床疗效情况。结果:患者男女比例为2.14:1,平均年龄为34.6±4.2岁,其中20~30岁所占比例最高,达42.96%。骨折原因主要为交通事故,占45.19%。骨折类型以单纯型下颌骨骨折最高发,占46.67%。切开复位并行钛板钛钉内固定较单纯接受钛钉颌间牵引内固定,前者临床有效率显著高于后者,差异有统计学意义(P0.05)。结论:OMF高发于男性青壮年,主要骨折原因为交通事故,且以单纯型下颌骨骨折类型居多,临床治疗切开复位并行钛板钛钉内固定疗效显著优于单纯接受钛钉颌间牵引内固定。     

不同类型的下颌骨骨折的手术治疗

目的：评估不同类型的下颌骨骨折的手术入路及固定方法。方法：对于52例不同类型下颌骨骨折患者采用不同的口外或口内切口及相应的固定方法。结果：52例患者伤口全部一期愈合,51例咬合关系恢复到伤前咬合关系,1例出现咬合关系不良,X线检查骨折线队位良好。结论：对于不同部位的下颌骨骨折应采用相应的手术切口及固定方法,以获得最好的疗效。     

下颌骨骨折钛板内固定的临床体会

近年来,随着交通事业的发展,下颌骨骨折呈上升趋势,如何使骨折的复位固定更佳,减少患者痛苦,早期恢复口腔功能,在临床上尤为重要。我院自2003年采用钛板内固定治疗下颌骨骨折58例,获得满意疗效,现报告如下。1临床资料1·1一般资料我院自2003~2005年共收治下颌骨骨折病人58例,其     

可吸收棒与微型钛板在桡骨小头骨折治疗中的应用价值

目的:探讨可吸收棒与微型钛板在桡骨小头骨折治疗中的临床效果和应用价值的研究。方法:回顾性选取2014年1月-2017年1月于医院骨科诊治的桡骨小头骨折患者58例,根据不同的治疗方式分为两组,其中对照组28例患者采用微型钛板治疗;研究组30例患者采取可吸收棒治疗,患者术后均以石膏固定4周后,采用X射线复查恢复情况,统计两组患者的骨性愈合时间、肘关节HHS评分及并发症发生情况。结果:(1)两组患者在2年内骨折均愈合,研究组患者的骨性愈合时间(13.86±2.05)周明显少于对照组患者的骨性愈合时间(15.54±2.71)周(P0.05);(2)治疗后4周,研究组患者的肘关节HHS评分为(95.32±4.14)分明显高于对照组患者的(82.48±5.27)分(P均0.05);(3)研究组患者中仅有1例发生骨延迟愈合,对照组患者中2例肘关节活动范围缺失、2例骨折位移、1例肘关节骨关节炎,并发症发生率分别为3.33%和17.85%存在显著差异(P均0.05)。结论:桡骨小头骨折患者肘关节损伤严重,采用可吸收棒治疗能取得与微型钛板相似的治疗效果,并且患者的骨性愈合时间短、肘关节功能恢复较快,同时避免并发症的发生。     

新疆垦区607例颌面部骨折临床病例回顾性研究

目的:研究发生在新疆垦区颌面部创伤患者的损伤特点及诊治方法状况.方法:通过病案资料对新疆垦区五家医院收治的607例颌面部骨折患者性别、年龄、原因、全身损伤、骨折类型、治疗方法及术后疗效进行调查分析.结果:本组病例颌面部骨折男性占85.83%,20-40岁年龄段占68.04%,交通事故伤占54.04%,发生下颌骨骨折占75.45%,伴有全身损伤占18.62%和外伤性昏迷占20.76%;下颌运动受限(51.07%)、咬合紊乱(38.22%)和颜面畸形(40.69%)是颌骨骨折的三个主要体征;349例的骨折行手术复位和钛板坚固内固定(57.50%),均获满意疗效.结论:颌面部骨折中年轻男性多见,交通事故伤是其最主要原因,直接复位和固定是骨折治疗的有效方法,颌间牵引在新疆各垦区的颌面部骨折患者治疗中作用不可忽视,坚固内固定技术促进了颌骨骨折的治疗发展.     

应用坚固内固定技术治疗颌骨骨折的效果分析

目的：探究坚固内固定技术对颌骨骨折的治疗运用,为颌骨骨折的治疗方法选择提供理论指导。方法：选取我科自2009年4月-2012年7月收治的80例下颌骨骨折患者行手术切开复位、小型和微型钛板坚固内固定术治疗,纳入内固定组,并选取同期80例行颌间固定的颌骨骨折患者,纳入颌间固定组,对比两组患者治疗效果。结果：两组患者术后3个月张口度及张口型均得到明显改善,内固定组改善程度较颌间固定组更为显著（P〈0．05）;内固定组治疗周数、口臭及咬合错乱发生率均低于颌间固定组（P〈0．05）;内固定组疗效评价优43例,良26例,有效率86．3％,颌间固定组分别为31例和17例,有效率60．0％,内固定组治疗效果显著优于颌间固定组（P〈0．05）。结论：坚固内固定技术具有组织相容性高、口功能恢复快、不良反应发生率低等优势,是治疗颌骨骨折的安全、可靠、简便的治疗方案,能够有效保证患者的预后和生活质量,值得临床普遍应用。     

两种不同内固定手术对髌骨骨折患者术后膝关节功能恢复的影响

目的:探讨两种不同的手术方式(钛制空心钉结合张力带内固定手术)对髌骨骨折患者的临床疗效和安全性比较。方法:选择2016年6月-2017年10月治疗的髌骨骨折患者72例作为对象,使用随机数字表,随机分为对照组(n=36)和观察组(n=36)。对照组给予常规的克氏针张力带内固定进行手术,观察组则使用空心钉张力带进行固定。治疗后对患者效果进行统计和评估,比较两组患者的术后骨折的愈合时间,功能恢复(最大屈曲角度),髌骨评分以及并发症等指标。结果:根据不同的治疗方式后,观察组(空心钉张力带固定组)在骨折的愈合时间,功能恢复,髌骨评分以及并发症等比较指标中较对照组均有显著优势,其结果具备统计学意义(P<0.05)。结论:将钛制空心钉结合张力带内固定手术用于髌骨骨折与传统的克氏针张力带固定方法相比较,具有操作简便,骨折愈合率高,功能恢复确实,并发症发生率低等诸多优点,值得在临床中进一步推广应用。     

29例髁状突骨折游离再植钛板坚固内固定治疗的临床观察

目的:探讨钛板坚固内固定在髁状突骨折游离再植治疗中的作用及影响因素.方法:对29例31侧髁状突骨折游离再植坚固内固定的患者术后复诊及X线片检查临床观察,对骨折类型、固定方式、愈合和并发症状况进行分析.结果:髁状突骨折单线形19侧,多线形和碎性12侧.单板固定24侧,双板固定7侧.疗效评价总满意率83.9%;不满意率占16.1%,其中张口受限2例,髁状突移位并伴骨折缝感染吸收3例.结论:钛板坚固内固定是颌后切口入路游离再植治疗髁状突中高位及复杂性骨折满意疗效的保证,双板固定能保障髁状突多线形和碎性骨折稳定性愈合,坚持张口训练能减少术后并发症出现.     

Oral health and oral implant status in edentulous patients with implant‐supported dental prostheses who are receiving long‐term nursing care

Aim: The aim of this study was to investigate oral health and oral implant status in a group of edentulous patients receiving long‐term residential or nursing care (LTC), all of whom had implant‐supported fixed or removable dental prostheses. Material and methods: A dental examination was performed on a total of 3310 patients receiving LTC and from this population 35 edentulous patients in whom dental implants had been placed formed the cohort for this study. All examinations were performed by a specialist in hospital dentistry and took place in the patients’ own home environment. Oral health was assessed by means of a protocol which evaluated oral hygiene status, possible oral mucosal inflammation and oral mucosal friction levels. Any problems with the implant‐supported prosthesis, implant mobility or other complications were also assessed. In addition, patients were asked about any oral symptoms and their usual oral hygiene procedures. Results: About half of the subjects (17/35) were registered as having no/mild inflammation with 18 of 35 having moderate/severe inflammation. Twelve of the 35 patients had good/acceptable oral hygiene and 23 of 35 had poor/bad oral hygiene. Twenty‐one of the 35 patients depended on help from the nursing personnel for their daily oral hygiene procedures. Obvious problems with food impaction were noted in 11 patients. A total of 229 implants had been placed in 43 jaws supporting 40 full arch‐fixed prostheses and three implant‐borne overdentures. There was no evidence of mobility or fractures of either the implants or the prostheses. Fifteen implants showed some exposed screw threads. Pus was exuding from one implant site and general peri‐implant gingival hyperplasia was noted in two patients. Twenty‐four patients were completely satisfied with the function and appearance of their implant‐supported prostheses. Two patients were totally dissatisfied. Conclusion: This study indicates that oral implant therapy can be considered as a treatment of choice in elderly patients, even if oral hygiene is sub‐optimal.     

Application of minimal-access techniques in lag screw fixation of fractures of the anterior mandible

A modification of the traditional open methods for the surgical management of anterior mandibular fractures using the principles of minimal-access surgery is presented; it was successfully performed in five patients. This technique incorporates the use of lag screws introduced through small incisions transmucosally or percutaneously after anatomic reduction of the fracture, and it relies on accurate preoperative radiologic assessment of the fracture pattern and location. This technique is indicated for any favorable fracture in the anterior mandibular arch that could achieve osteosynthesis with lag screw fixation, and it depends on the use of a dental arch bar as a tension band. Contraindications include unfavorable fracture patterns (long oblique, comminuted, or flat mandibular plane), inadequate dental support to maintain an arch bar due to missing or loose teeth, the inability to determine the fracture pattern preoperatively, and operator inexperience. Potential advantages include a shorter operative time, economic savings, decreased patient morbidity (swelling, scarring, and mental nerve and lower-lip muscle dysfunction), and improvement in functional rehabilitation.     

Influence of the Lower Jaw Position on the Running Pattern

Introduction

The effects of manipulated dental occlusion on body posture has been investigated quite often and discussed controversially in the literature. Far less attention has been paid to the influence of dental occlusion position on human movement. If human movement was analysed, it was mostly while walking and not while running. This study was therefore designed to identify the effect of lower jaw positions on running behaviour according to different dental occlusion positions.

Methods

Twenty healthy young recreational runners (mean age = 33.9±5.8 years) participated in this study. Kinematic data were collected using an eight-camera Vicon motion capture system (VICON Motion Systems, Oxford, UK). Subjects were consecutively prepared with four different dental occlusion conditions in random order and performed five running trials per test condition on a level walkway with their preferred running shoes. Vector based pattern recognition methods, in particular cluster analysis and support vector machines (SVM) were used for movement pattern identification.

Results

Subjects exhibited unique movement patterns leading to 18 clusters for the 20 subjects. No overall classification of the splint condition could be observed. Within individual subjects different running patterns could be identified for the four splint conditions. The splint conditions lead to a more symmetrical running pattern than the control condition.

Discussion

The influence of an occlusal splint on running pattern can be confirmed in this study. Wearing a splint increases the symmetry of the running pattern. A more symmetrical running pattern might help to reduce the risk of injuries or help in performance. The change of the movement pattern between the neutral condition and any of the three splint conditions was significant within subjects but not across subjects. Therefore the dental splint has a measureable influence on the running pattern of subjects, however subjects individuality has to be considered when choosing the optimal splint condition for a specific subject.     

Mandibular reconstruction with the titanium hollow screw reconstruction plate (THORP) system: evaluation of 62 cases

The titanium hollow screw reconstruction plate (THORP) system for reconstruction of lower jaw defects provides a functional stable fixation and is used as a long-term or permanent implant in tumor surgery and in traumatology. The rigid fixation of the head of the screw to the plate, avoiding unphysiologic loads to the bone underneath the plate, and the titanium plasma-coated perforated hollow screws, enabling the development of direct bone-titanium contact as well as the ingrowth of bone into the lumen and perforations, are the major advantages of this system compared to conventional systems. The different surgical methods, such as preservation of the condylar process with only two screws, intraoperative freely adjustable condylar prosthesis, lingual application of the plate, and primary bone transplantation, are described. The evaluation of 62 patients reconstructed with the THORP system between 1981 and 1986 revealed no plate loosening, even in irradiated bone, and showed satisfactory aesthetic and functional results.     

Cast titanium overlay denture for a geriatric patient with a reduced vertical dimension

An older patient reporting to the dental surgery for his/her dental treatment is becoming a common occurrence. Improved oral hygiene has meant that teeth are retained for a longer time, along with the potential problems of attrition, decreased vertical dimension, temporomandibular joint discomfort/strain, and poor aesthetics. The case in question is that of a 65-year-old male patient who had severe attrition in the lower arch, temporomandibular joint pain and reduced vertical dimension. The maxillary arch had previously been restored with a fixed partial prosthesis. For restoration of the lower teeth, a removable cast titanium overlay denture was fabricated incorporating an increased vertical dimension. Porcelain facings were placed to restore the aesthetics of the anterior teeth. The titanium was cast in a semi-automatic electric arc, pressure type casting machine. A titanium overlay denture with porcelain facing on the anterior teeth may provide a means of restoring a patient's concerns regarding aesthetics and function.     

Oral hygiene and the need for treatment of the dependent institutionalised elderly

Objective: To assessing the oral hygiene and treatment needs of a geriatric institution in southern France. Background: For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments. Materials and methods: From 2003 to 2004, a cross‐sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated. Results: The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment. Conclusion: The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly.