阻生牙拔除术的临床进展

阻生牙是指由于各种阻力导致不能正常萌出的牙齿的统称,通常阻生牙牙体大部甚至全部埋伏于骨内。阻生牙可导致各种并发症的发生,因此临床上一般主张预防性拔除阻生牙。阻生牙拔除手术因其难度高、风险大、术后反应重一直是口腔牙槽外科关注的重点。近年来随着手术器械、手术观念等方面的进步,阻生牙拔除术取得了一些临床进展。新型CT扫描设备CBCT可以为手术设计提供精确定位;借助各类微创器械,微创拔牙技术减小了手术创伤,降低了手术风险;新型麻醉方式和新型局麻药物可以极大减轻疼痛反应;心理干预也将成为阻生牙拔除患者围手术期管理的重要步骤。本文对近年来阻生牙拔除术在定位方式、微创技术、团队协作、疼痛控制和心理干预等方面的临床进展做一综述。     

高速气涡轮切割手机联合专用加长裂钻对拔除下颌阻生第三磨牙的效果分析

目的:探讨牙科高速气涡轮切割手机配合阻生牙专用加长裂钻拔牙对口腔外科门诊需要拔除下颌阻生第三磨牙患者的影响。方法:选取我院收治的59例需要拔除下颌阻生第三磨牙患者,按照随机数字表法将所有患者随机分为试验组和对照组两组。其中试验组患者采用牙科高速气涡轮切割手机辅助阻生牙专用加长裂钻进行拔牙,而对照组患者则采取传统的劈骨分牙法,通过两组患者的术后复诊对患者的下唇麻木、断根等发生率以及张口受限、疼痛、肿胀等情况进行评价。结果:根据我院对两组患者的术中情况及术后并发症情况进行统计分析,结果显示试验组患者的手术时间为(25.68±6.83)min,明显低于对照组患者[(35.23±14.23)min,t=3.962,P=0.000]。试验组患者中仅有1例术后出现断根情况,无其他并发症出现;而对照组患者术后则有3例断根情况和1例下唇麻木患者(后逐渐缓解)、1例下颌关节疼痛以及1例舌侧骨板骨折患者。根据我院对两组患者术后1d的临床资料进行统计分析,结果显示试验组患者术后1d面部肿胀程度明显比对照组患者轻(P0.05);试验组患者的疼痛情况明显优于对照组患者(P0.05);试验组患者的张口受限程度明显比对照组患者轻(P0.05)。结论:牙科高速气涡轮切割手机配合阻生牙专用加长裂钻拔牙对口腔外科门诊需要拔除下颌阻生第三磨牙患者具有较好的临床治疗效果,值得在临床上加以广泛推广和运用。     

口腔锥形束CT联合微创拔牙技术对埋伏阻生牙患者牙槽完整度及张口受限度的影响

摘要 目的：探讨口腔锥形束CT联合微创拔牙技术对埋伏阻生牙患者牙槽完整度及张口受限度的影响。方法：选取我院2017年1月到2023年2月收治的50例埋伏阻生牙患者作为研究对象,应用随机数字表法将其分为观察组与对照组,每组25例。对照组应用传统拔牙技术进行治疗,观察组采取口腔锥形束CT联合微创拔牙技术治疗,对比两组患者术后疼痛、面部肿胀、牙槽完整度,术后即刻和术后3 d的炎症因子水平,术后张口受限程度以及菌斑指数（PLI）,龈沟出血指数（SBI）、龈沟探诊深度（SPD）、牙龈指数（GI）等牙周健康指标水平。结果：观察组患者视觉模拟量表（VAS）评分、面部肿胀程度以及牙槽完整度评分明显低于对照组（P＜0.05）;术后即刻两组患者白细胞介素-6（IL-6）、白细胞介素-1（IL-1）、肿瘤坏死因子-α（TNF-α）相关炎症因子水平对比无明显差异（P＞0.05）,术后3 d两组患者IL-6、IL-1、TNF-α相关炎症因子水平均降低,且观察组低于对照组（P＜0.05）;观察组患者开口度正常的比例明显高于对照组,中度、重度张口受限度比例明显低于对照组（P＜0.05）;治疗前两组患者GI、SPD、SBI、PLI水平对无明显差异（P＞0.05）,治疗后两组患者GI、SPD、SBI、PLI水平均降低,观察组低于对照组（P＜0.05）。结论：口腔锥形束CT联合微创拔牙技术针对埋伏阻生牙进行治疗与传统拔牙相比能够改善患者术后疼痛、面部肿胀程度,减轻术后张口受限程度,减轻炎症反应水平,提升牙周健康程度,值得临床应用推广。     

营养风险筛查与干预对食管癌术后康复效果的影响

目的：探讨与研究食管癌患者术前应用营养风险筛查与干预对患者术后康复效果的影响及临床应用价值。方法：选择在青岛市市立医院接受手术治疗的食管癌患者共174例纳入研究并分为观察组和对照组两组,对照组给予常规围手术期护理,观察组在常规围手术期护理基础上进行营养风险筛查和干预;比较两组术后2w营养状况、排气排便时间、胸腔引流管拔除时间、住院时间、术后并发症发生情况。结果：观察组患者术后营养状况明显优于对照组,差异显著（P＜0.05）;观察组术后排气排便时间、胸腔引流管拔除时间、住院时间、术后并发症发生率等均优于对照组,以上差别均具有统计意义（P＜0.05）。结论：将营养风险筛查与干预应用于食管癌患者围手术期护理中,可显著改善患者术后营养状况,促进康复,值得临床应用推广。     

术中神经电生理监测在颅底外科中的应用进展

临床颅底外科手术中充满各种风险,特别是有对神经系统结构造成损伤的潜在风险。有些损伤无法通过直接观察来判断,因此术中电生理监测(intraoperative neuroelectrophysiological monitoring,IONM)是神经外科手术医生术中实时监测和评估神经功能的重要手段。国外上世纪80年代就将其应用于颅底肿瘤手术中,但直至目前我国相关应用仍未普及。术中神经电生理监测是运用各种电生理技术,实时监测术中处于有损伤风险的神经系统功能的完整性,并提示手术医生及时终止风险性操作,有针对性的采取有效干预措施消除或减小神经损伤、改善患者预后的一门技术。近年来,颅底外科进展迅速,并向多学科协作和减少创伤的方向发展,术中神经电生理监测已经迅速发展为降低颅底手术中神经损伤发生率的重要辅助手段。     

微创技术在腰椎固定、融合术中的临床应用

近几年来,随着脊柱基础研究的发展以及各种新理论、新方法、新技术相继出现,微创技术在,临床中治疗各种腰椎疾患取得了很大进步.脊柱微创外科,具有创伤小、出血少、术后疼痛轻、恢复快等优点,受到腰椎疾病患者的欢迎.目前用于腰椎椎间融合的微创手术方法有前路腰椎椎体间融合术、后路腰椎椎体间融合术、经椎间孔腰椎椎体间融合术、极外侧椎体间融合术、轴向椎体间融合术以及多种微创技术联合应用.不同微创技术各有其优缺点,具有不同手术适应征,在临床应用中需要根据腰椎疾患的具体特征,选用合适的腰椎微创手术,以达到最佳临床效果.本文从腰椎微创手术入路改进、手术器械的创新以及在临床应用的效果方面作一综述.     

认知心理干预对改善鼻内镜术后疼痛的影响

目的探讨认知心理干预对改善鼻内镜术后疼痛的影响,为临床护理工作提供理论依据。方法选取120例鼻内镜患者,随机分为对照组和干预组各60例。对照组采用围手术期常规护理,干预组在对照组基础上对患者进行认知心理干预,比较两组患者术后疼痛评分。结果对照组的疼痛评分明显高于干预组,差异有统计学意义(P0.05)。结论认知心理干预可改变患者的错误认知,降低术后并发症的发生率,提高患者的生活质量。     

胸外科手术术后神经病理性疼痛的发生情况及相关因素分析

目的:探讨胸外科手术术后神经病理性疼痛的发生情况及相关危险因素。方法:回顾性分析2015年至2016年就诊于我院行胸外科手术的患者的临床资料,包括患者的年龄、性别、吸烟史、BMI、术前是否使用催眠药物、术前诊断、手术侧别、手术方式、是否为微创、硬膜外自控镇痛泵使用情况、术中失血量、手术持续时间、引流管引流时间及是否发生神经病理性疼痛,对比分析是否发生神经病理性疼痛患者的临床资料,对有差异的临床资料进行多因素Logistic回归分析探讨发生神经病理性疼痛的危险因素。结果:共有123例患者纳入研究,33例(26.8%)患者的患者术后出现神经病理性疼痛,6例(4.9%)患者在术后一年仍有持续性神经性病理疼痛,术后出现神经病理性疼痛的平均时间为术后第7天,平均持续时间为75天,发生神经病理性疼痛的患者吸烟比例(81.8%)、术前使用催眠药比例(57.6%)、开胸手术比例(81.8%)、术中失血量(185 mL)、手术时间(196分钟)、术后引流时间(2.5天)均高于没有发生神经病理性疼痛的患者。多因素分析显示术前使用催眠药(OR=2.322,P<0.001)、手术时间延长(OR=3.703,P<0.001)和术后引流时间延长(OR=2.675,P=0.002)均是神经病理性疼痛发生的危险因素,电视辅助胸腔镜手术方式是保护性因素(OR=0.453,P=0.002)。结论:术前使用催眠药物、延长的手术时间及术后引流时间增加了神经病理性疼痛发生的风险,电视辅助胸腔镜技术可减少其发生率。     

碱性成纤维细胞生长因子对下颌阻生牙手术患者血清IL-6水平及牙槽骨密度的影响

目的:探讨碱性成纤维细胞生长因子对对下颌阻生牙手术患者血清IL-6水平及牙槽骨密度的影响。方法:收集我院就诊的104例行下颌阻生牙手术患者,随机分为实验组和对照组,每组52例。所有患者均行下颌阻生牙手术。对照组患者术后注射生理盐水,实验组患者术后注射碱性成纤维细胞生长因子。观察并比较两组患者血清白介素6(IL-6)、牙槽骨密度水平、临床治疗有效率以及不良反应发生情况。结果:与治疗前相比,两组患者治疗后的骨密度水平均升高,IL-6水平均下降,差异具有统计学意义(P0.05);与对照组相比,实验组患者的牙槽骨密度水平及临床治疗有效率均较高,IL-6水平较低,差异具有统计学意义(P0.05)。实验组患者未出现不良明显反应。结论:碱性成纤维细胞生长因子可显著提高下颌阻生牙术后患者的创口恢复,且有效预防感染的发生。     

单纯上牙槽后神经阻滞麻醉拔除上颌第三磨牙的临床观察

目的:观察单纯上牙槽后神经阻滞麻醉在上颌第三磨牙拔除中的镇痛效果,为临床应用单纯上牙槽后神经阻滞麻醉拔除上颌第三磨牙提供依据.方法:选择463例患者,共拔除500颗上颌第三磨牙,以500例上颌第三磨牙拔除术临床资料为研究对象,将其随机分为试验组(n=300)和对照组(n=200).试验组采用单纯上牙槽后神经阻滞麻醉拔除上颌第三磨牙,对照组加用腭前神经阻滞麻醉和腭侧浸润麻醉.进行视觉模拟量表(VAS)评分,分析并比较两组患者麻醉镇痛效果.结果:试验组与对照组疼痛感觉无显著差异(P0.05);对照组与试验组间VAS评分比较,差异无统计学意义(P0.05).结论:仅用单纯上牙槽后神经阻滞麻醉可满足临床上颌第三磨牙拔除的镇痛要求.     

局部放置三七粉对下颌阻生齿拔出术患者的临床疗效

目的：探讨局部放置三七粉对下颌阻生齿拔出术患者的临床疗效。方法：选取我院收治的180例下颌阻生齿拔出术患者,根 据术后治疗方式不同,将患者分为对照组和实验组。对照组患者采用常规治疗方式,实验组患者在此基础上采用局部放置三七粉 治疗。观察并比较两组患者的临床疗效、疼痛情况以及术后并发症的发生情况等。结果：两组患者的并发症相比较,实验组并发症 发生的人数均明显低于对照组（P＜0.05）。两组患者的疼痛、焦虑、抑郁情况比较,实验组明显低于对照组,差异有统计学意义（P＜ 0.05）。结论：局部放置三七粉能够减轻下颌阻生齿拔出后患者的并发症,减轻疼痛,改善患者的心理状态,提高其疗效,值得临床 推广使用。     

Dental replacement resorption after bone grafting to the alveolar cleft

In a review of 100 consecutively performed bone grafts to the alveolar cleft, replacement resorption was found in 7 teeth adjacent to the cleft. Damage to the periodontal tissues during surgery is considered to be the main cause of this complication: granulation tissue from the bone graft may have some influence. Treatment of the affected teeth eventually includes extraction or surgical removal. To minimize the risk for this complication, we suggest that bone grafting should be done when the canine (or lateral incisor) is in an early stage of eruption and that orthodontic uprighting of the medial incisor should be done after surgery.     

Disarming canine teeth of nonhuman primates using the submucosal vital root retention technique.

Removing or reducing the size of canine teeth of baboons and macaques has become an accepted practice to minimize the potential for injury to laboratory animal care personnel. A submucosal vital root retention procedure was adapted from the technique of root banking human teeth. In this technique, the crown of a tooth is amputated below the level of the alveolar bone crest, and the exposed pulp covered by a mucoperiosteal gingival flap. Our aim was to disarm the canine teeth of baboons and macaques with a single surgical procedure that would preserve a vital tooth root buried in alveolar bone under normal mucosa. Our long-term objective was to develop a technique that would not require further clinical management during the life of the animal. This paper presents the surgical techniques used.     

Effect of altered occlusal function on transseptal ligament and new bone thicknesses in the periodontium of the rat

Alteration of tooth function is assumed to change stress/strain on the adjacent alveolar bone and its mucoperiosteum, producing changes in morphology similar to those described for other load-bearing bones. The present study suggested that crestal alveolar bone and its mucoperiosteum respond differently to stress/strain than load-bearing bones in other locations, possibly due to differences in the mechanism of bone loading by muscles and teeth. Occlusal hypofunction was initiated by extraction of agonist teeth; the contralateral teeth were placed in hyperfunction by the surgery. Untreated animals were also studied. 3H-proline was injected, animals were killed 1-5 weeks later, and the thicknesses of new bone and transseptal ligament were measured. After 5 weeks of altered function, total thickness (new bone + transseptal ligament) was similar in untreated and in hypofunctional and hyperfunctional situations; however, a new ratio between transseptal ligament and new bone thicknesses was established. Occlusal force was negatively correlated with new bone and positively correlated with transseptal ligament thickness; both thicknesses were statistically correlated in each functional situation (P less than 0.001). Hyperfunction resulted in increased transseptal ligament thickness, but decreased new bone thickness as compared to untreated controls (P less than 0.001). In contrast, hypofunction resulted in an increased new bone thickness, but a decreased transseptal ligament thickness (P less than 0.001). Tissue responses assure appropriate support for the teeth in each functional situation.     

Study of bone remodeling in corticotomy-assisted orthodontic tooth movement in rats

The goal of this study was to determine the structure change of the alveolar bone and the expression of a group of bone remodeling-related factors. Sixty healthy male Wistar rats were randomly divided into three groups. Selective alveolar decortication (SAD), tooth movement (TM), and “combined therapy” (SAD+TM) was performed in group I, II, and III, respectively. On days 0, 7, 14, 21, and 42, a Micro-CT scan was performed on the maxillary alveolar bone and tooth. In addition, on days 0, 7, 14, 21, 28, and 42, some of the rats were killed by cervical dislocation and tissues were harvested. Analysis of scan data revealed a significant decrease in bone density of the alveolar bone at 14 days post-surgery, and increased at 42 days post-surgery to a level higher than that before the surgery. Microarray and bioinformatics analysis were performed to explore gene expression profile in three groups (SAD, TM, and SAD+TM), and a large number of differentially expressed genes were identified. In addition, real-time polymerase chain reaction was performed to determine the expression of bone remodeling-related factors. The expression of osteoblast-related cytokines, including osteopontin, bone sialoprotein, and osteocalcin, and osteoclast regulators macrophage-colony stimulating factor (M-CSF) and RANKL (activator of nuclear factor KB receptor ligand) were increased in group III, suggesting that there was increased bone synthesis and activation of bone absorption. Moreover, group III had a unique alveolar bone remodeling pattern: RANKL and osteoprotegerin-promoted alveolar remodeling. In conclusion, during the early stage of orthodontic tooth movement, corticotomy can accelerate the movement of teeth, modulate the state of bone metabolism, and activate osteogenesis and osteoclast, which support the theory of regional acceleratory phenomenon.     

引导性组织再生术细菌感染的动物实验研究

目的检测引导性组织再生术（guided tissue regeneration,GTR）生物膜上和术区牙槽骨表面细菌种属、数量,分析菌群构成特点及异同点,为开发GTR抗菌性生物膜提供实验依据。方法 Beagle犬下颌前磨牙根分叉区做骨缺损形成二壁骨袋,行GTR术,术后8周2次取出GTR膨化聚四氟乙烯膜（expanded polytetrafluoroethylene,ePTFE膜）,采集术区牙槽骨表面细菌标本。洗脱生物膜上和牙槽骨表面标本中细菌,进行培养,对每种培养基进行菌落计数,计算每种菌属构成比。结果 GTR术区牙槽骨表面和GTR生物膜上检测到的细菌包括：产黑色素菌、具核梭杆菌、放线菌、伴放线放线杆菌和变形链球菌,但是菌群特点并不相同,GTR术区牙槽骨区和生物膜上细菌构成比中,具核梭杆菌构成比均最大。结论应同时检测GTR术区牙槽骨区细菌种类,本研究中GTR术区牙槽骨表面和生物膜上细菌包括：革兰阳性菌、革兰阴性菌、厌氧菌和微需氧菌,提示抗菌性生物膜上的抗菌剂的选择应该为多种抗菌剂联合应用。     

Functional cues in the development of osseous tooth support in the pig, Sus scrofa

Alveolar bone supports teeth during chewing through a ligamentous interface with tooth roots. Although tooth loads are presumed to direct the development and adaptation of these tissues, strain distribution in the alveolar bone at different stages of tooth eruption and periodontal development is unknown. This study investigates the biomechanical effects of tooth loading on developing alveolar bone as a tooth erupts into occlusion. Mandibular segments from miniature pigs, Sus scrofa, containing M₁ either erupting or in functional occlusion, were loaded in compression. Simultaneous recordings were made from rosette strain gages affixed to the lingual alveolar bone and the M₂ crypt. Overall, specimens with erupting M₁s were more deformable than specimens with occluding M₁s (mean stiffness of 246 vs. 944 MPa, respectively, p=0.004). The major difference in alveolar strain between the two stages was in orientation. The vertically applied compressive loads were more directly reflected in the alveolar bone strains of erupting M₁s, than those of occluding M₁s, presumably because of the mediation of a more mature periodontal ligament (PDL) in the latter. The PDL interface between occluding teeth and alveolar bone is likely to stiffen the system, allowing transmission of occlusal loads. Alveolar strains may provide a stimulus for bone growth in the alveolar process and crest.