口腔种植外科相关颌骨解剖学研究进展

目前,种植义齿修复已经成为牙列缺损、缺失患者的最佳修复方式。通过对颌骨的精确测量,可获得种植手术所需相关解剖资料,为种植体的选择、设计及口腔种植手术的实施提供重要的参考。本文就口腔种植义齿相关的颌骨解剖测量进展作一综述。     

数字化外科技术在颌面部外伤修复重建中的应用与展望

近年来,数字化外科技术在颌面部外伤修复重建临床应用中得到不断发展和完善,极大地提高了手术的精确性和可靠性,节约了手术时间。本文主要从术前手术模拟、快速打印3D头模、术中导航、导板制作、个性化修复体及机器人的临床应用等六个方面来阐述数字化外科技术在颌面部骨折修复重建中的应用,总结了各个技术的原理、优缺点及应用现状,回顾了我们单位应用数字化技术提高颌面部外伤修复手术的精确度和可行性以及恢复了患者良好的面型及功能的临床应用经验。同时,本文对未来数字化外科在颌面部骨折修复重建中的应用提出了新的展望,我们认为,结合术前手术模拟、术中导航及术中机器人技术依据术中具体情况自动调整手术方案进行颌面部骨折修复重建的完全自动化智能机器人的实现将是最终的目标。     

口腔种植材料表面特性与生物膜形成研究进展

人类口腔环境为微生物提供了适宜生存的条件,多种微生物在牙齿表面形成了由基质包裹相互粘附的口腔生物膜,口腔生物膜是口腔微生物生存、代谢和致病的基础。随着1965年Brnemark种植体在临床上的成功应用,种植相关材料周围致病菌导致的种植体周围炎成为种植修复最常见的并发症之一,影响种植修复的远期效果。种植体周围炎引起了许多关注,并且口腔种植材料表面的特性和口腔生物膜的形成密切相关。本文就种植材料及天然牙齿表面的生物膜形成、种植材料表面特性对口腔生物膜及细菌粘附的影响因素、增强种植材料抗菌性能的方法以及未来的研究方向等作一综述。     

半导体激光在口腔临床医疗中的应用和研究进展

激光在口腔领域中的应用越来越多。半导体激光以其诸多的优点,在口腔领域的应用也越来越广泛,现就半导体激光在口腔内科、口腔正畸学、口腔修复学、口腔种植学以及颌面外科等领域的临床应用现状及目前的研究进展加以综述。     

计算机辅助设计与制作（CAD—CAM）在口腔科的应用

CAD—CAM在口腔临床上的应用,尤其在口腔修复科全瓷冠、套筒冠的修复以及口腔种植领域的应用,提高了修复体的制作效率和质量。该文就CAD—CAM在口腔修复中的应用新进展作一综述。     

口腔修复膜材料在牙种植中引导骨再生的效应

目的:对应用口腔修复膜材料在牙种植中引导骨再生的效应进行分析。方法:随机从2014年1月至2015年3月来我院进行牙种植再生的患者当中选出110例,将其随机分为两个小组,对其中一组患者使用口腔修复膜进行骨再生引导,作为研究组;对另外一组患者则使用钛膜进行骨再生引导,作为对比组。分别对两组患者骨再生成功率、再生骨厚度以及不良反应发生率进行分析。结果:研究中,研究组患者的骨再生成功率明显优于对比组,同时研究组患者的植骨和再生骨厚度明显高于对比组,不良反应发生率则要低于对比组。两组数据存在较大差异,具有统计学意义(P0.05)。结论:在对患者进行牙种植引导骨再生治疗过程中,采用口腔修复膜能够起到较好的疗效,并且再生骨质厚度较高,不良反应率较低。     

下颌种植覆盖义齿的生物力学研究进展

口腔生物力学是用生物力学的概念和方法,研究口腔医学中的有关基础性科学问题、解决口腔医学中的临床实际问题、发展口腔临床技术的一门学科。在口腔正畸学、修复学、种植学及口腔颌面外科学等领域存在着大量的生物力学问题,生物力学已成为口腔医学的基础科学之一。传统全口义齿修复常常会出现固位稳定差、咀嚼效率低、患者有疼痛感、适应时间长等情况,很大程度上不能满足患者的修复要求。种植覆盖义齿对于下颌牙槽嵴严重吸收的患者,效果尤为明显。种植覆盖义齿是义齿与种植体之间以不同的附着体作为连接,形成患者可以自行摘戴的种植体支持的覆盖义齿修复。下颌种植覆盖义齿因其能有效地提高下半口义齿的固位性和稳定性、显著提高了患者的咀嚼效率,目前已成为修复下颌牙槽骨严重吸收的无牙颌患者的有效修复方法。本文针对下颌种植覆盖义齿的生物力学研究进展作一综述。     

口腔种植修复与常规修复对牙列缺失患者生活质量及龈沟液细胞因子水平的影响

目的:研究口腔种植修复与常规修复对牙列缺失患者生活质量及龈沟液细胞因子水平的影响。方法:选择从2015年7月到2016年7月在我院接受治疗的牙列缺失患者108例作为研究对象。根据随机数字表法将患者分为对照组(n=54)和观察组(n=54),对照组实施常规修复,观察组给予口腔种植修复,随访3个月后,对比两组患者疗效、生活质量、治疗前及治疗3个月后龈沟液的细胞因子水平变化以及并发症情况。结果:观察组的总有效率较对照组明显升高(98.15%vs87.04%)(P0.05)。治疗后3个月两组的生理功能、情感功能以及社会功能评分均分别较治疗前升高,且观察组高于对照组(P0.05)。治疗后3个月两组患者的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)以及肿瘤坏死因子-α(TNF-α)水平均分别高于治疗前,而观察组低于对照组(P0.05)。观察组患者并发症的总发生率较对照组明显降低(7.41%vs22.22%)(P0.05)。结论:牙列缺失患者经口腔种植修复方式治疗的效果更好,对于龈沟液细胞因子水平上升具有明显的抑制作用,减少并发症,值得关注及推广。     

静态与动态计算机辅助种植手术在口腔种植中的应用进展

牙齿缺失是常见的口腔疾病,可导致患者咀嚼功能降低,面部形态改变。种植牙成为了修复缺失牙的最佳选择。计算机辅助技术在口腔领域的应用,为临床医生提供更多修复缺失牙的手术方法。静态计算机辅助种植手术与动态计算机辅助种植手术修复缺失牙是计算机辅助种植手术的两种主要手术方式。这两种种植手术解决了患者咀嚼功能和面部美观问题,但其在临床应用中仍有一定的局限性。本文通过论述静态计算机辅助种植手术与动态计算机辅助种植手术的概念及分类,通过论述其使用过程中的优点、缺点,对比两种手术方式植入的种植体精确度以评估其在临床中的应用,探讨如何在临床应用中减少种植体的偏差,为临床医生在种植病例的手术方法选择提供参考。     

放射直视影像在口腔固定修复中的临床应用评价

目的：探讨放射直视影像（radiovisiography,RVG）在口腔固定修复中的应用价值。方法：对拟行口腔固定修复中的全冠及桩核冠修复的患牙术前进行RVG投照,对RVG图像进行分析,分别测量牙冠各部位的厚度以及牙根的长度、角度、根管各部位的直径,从而对活髓牙牙体预备中并发症的预测和预防以及桩间隙制备时器械的选择和桩的设计。结果：67颗活髓牙中7例前牙需要术前进行根管治疗,1例术中发生针尖大小的穿髓点,予dycal垫底后保留活髓。因为术前及早的预测穿髓事件的发生,病人均满意及理解。拟行桩核冠修复的21颗患牙无一例发生根管侧穿,观察3月未发现有一例根折。结论：RVG能快速,经济,直观的给临床口腔修复医师提供牙体全面的信息,有利于并发症的预防及治疗方案的选择。     

Teleconsultation with the mobile camera-phone in digital soft-tissue injury: a feasibility study

The purpose of this study was to examine the feasibility of teleconsultation using a mobile camera-phone to evaluate the severity of digital soft-tissue injury and to triage the injury with regard to management recommendations. With a built-in 110,000-pixel digital camera, pictures of the injured digit(s) or radiograph were taken by surgical residents in the emergency room and transmitted to another camera-phone to be viewed by the remote consultant surgeon. A brief medical and trauma history of each patient was relayed also by mobile phone. The consultant surgeon then reviewed all of these patients in the emergency room shortly after the initial telemedicine referral. Separate triaging for each digital injury into three groups was recorded during remote teleconsultation and according to actual treatment by the attending surgeon as follows: group I, the injury could be managed with conservative treatment, such as secondary intention wound healing, or primary closure with or without bone shortening; group II, skin grafting or local flap coverage was required for management of the injury; and group III, microsurgery such as replantation or free flap coverage was necessary to deal with the injury. Later, triaging was also performed individually by three junior plastic residents according to image review and patient referral information. Teleconsultation through a mobile camera-phone was performed for 45 patients with injuries of 81 digits from January to May of 2003. Of these 81 digital injuries, there were 12 cases (15 percent) where disagreement of triaging occurred between the teleconsultation and the actual treatment by the attending surgeon. In image reviewing, there was 79 percent sensitivity and 71 percent specificity in remote diagnosis of the skin defect and 76 percent sensitivity and 75 percent specificity in remote identification of the bone exposure regarding the concordance of opinions of all three surgeons; there was significant discordance in triaging in 20 cases (25 percent), and the difference in triaging was partly attributed to the inability to show instances of tiny exposed digital bone or tendon in some cases under the low-resolution digital image and the situation of a bloody oozing wound. In some cases, the difficulty in evaluating the probability of primary closure of severely avulsed skin edges or the probability of executing replantation for finger amputation also contributed to different triaging outcomes. Two neglected diagnoses of transected digital nerves were found and influenced triaging, highlighting the importance of on-site physical examination during teleconsultation. The telemedicine system using a mobile camera-phone based on the global system for mobile communication is feasible and valuable for early diagnosis and triaging of digital soft-tissue injury in emergency cases, with on-line verbal communication and review of the transmitted captured image. This system has the advantages of ease of use, low cost, high portability, and mobility. With advances in hardware for digital imaging and transmission technology and the development of the third-generation advanced mobile phone system in the foreseeable future, this system has potential for future applications in telemedicine and telecare.     

Additive Manufacturing of Anatomical Models from Computed Tomography Scan Data

The purpose of the study presented here was to investigate the manufacturability of human anatomical models from Computed Tomography (CT) scan data via a 3D desktop printer which uses fused deposition modelling (FDM) technology. First, Digital Imaging and Communications in Medicine (DICOM) CT scan data were converted to 3D Standard Triangle Language (STL) format by using InVaselius digital imaging program. Once this STL file is obtained, a 3D physical version of the anatomical model can be fabricated by a desktop 3D FDM printer. As a case study, a patient’s skull CT scan data was considered, and a tangible version of the skull was manufactured by a 3D FDM desktop printer. During the 3D printing process, the skull was built using acrylonitrile-butadiene-styrene (ABS) co-polymer plastic. The printed model showed that the 3D FDM printing technology is able to fabricate anatomical models with high accuracy. As a result, the skull model can be used for preoperative surgical planning, medical training activities, implant design and simulation to show the potential of the FDM technology in medical field. It will also improve communication between medical stuff and patients. Current result indicates that a 3D desktop printer which uses FDM technology can be used to obtain accurate anatomical models.     

Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomised controlled trial

Objective To determine whether, from a health provider and patient perspective, surgical stabilisation of the spine is cost effective when compared with an intensive programme of rehabilitation in patients with chronic low back pain.Design Economic evaluation alongside a pragmatic randomised controlled trial.Setting Secondary care.Participants 349 patients randomised to surgery (n = 176) or to an intensive rehabilitation programme (n = 173) from 15 centres across the United Kingdom between June 1996 and February 2002.Main outcome measures Costs related to back pain and incurred by the NHS and patients up to 24 months after randomisation. Return to paid employment and total hours worked. Patient utility as estimated by using the EuroQol EQ-5D questionnaire at several time points and used to calculate quality adjusted life years (QALYs). Cost effectiveness was expressed as an incremental cost per QALY.Results At two years, 38 patients randomised to rehabilitation had received rehabilitation and surgery whereas just seven surgery patients had received both treatments. The mean total cost per patient was estimated to be £7830 (SD £5202) in the surgery group and £4526 (SD £4155) in the intensive rehabilitation arm, a significant difference of £3304 (95% confidence interval £2317 to £4291). Mean QALYs over the trial period were 1.004 (SD 0.405) in the surgery group and 0.936 (SD 0.431) in the intensive rehabilitation group, giving a non-significant difference of 0.068 (–0.020 to 0.156). The incremental cost effectiveness ratio was estimated to be £48 588 per QALY gained (–£279 883 to £372 406).Conclusion Two year follow-up data show that surgical stabilisation of the spine may not be a cost effective use of scarce healthcare resources. However, sensitivity analyses show that this could change—for example, if the proportion of rehabilitation patients requiring subsequent surgery continues to increase.     

Medical robotics

Information and communication technology (ICT) and mechatronics play a basic role in medical robotics and computer-aided therapy. In the last three decades, in fact, ICT technology has strongly entered the health-care field, bringing in new techniques to support therapy and rehabilitation. In this frame, medical robotics is an expansion of the service and professional robotics as well as other technologies, as surgical navigation has been introduced especially in minimally invasive surgery. Localization systems also provide treatments in radiotherapy and radiosurgery with high precision. Virtual or augmented reality plays a role for both surgical training and planning and for safe rehabilitation in the first stage of the recovery from neurological diseases. Also, in the chronic phase of motor diseases, robotics helps with special assistive devices and prostheses. Although, in the past, the actual need and advantage of navigation, localization, and robotics in surgery and therapy has been in doubt, today, the availability of better hardware (e.g., microrobots) and more sophisticated algorithms(e.g., machine learning and other cognitive approaches)has largely increased the field of applications of these technologies,making it more likely that, in the near future, their presence will be dramatically increased, taking advantage of the generational change of the end users and the increasing request of quality in health-care delivery and management.     

Less is more--a new general practiced oriented form of knee navigation]

Modern navigation technology appears to be acquiring an established place in the fields of orthopedics and orthopedic surgery. This technology helps the surgeon to apply his manual skills with greater precision and thus more effectively, and its positive impact on the quality of surgical treatment has already been demonstrated. The SURGETICS navigation system described in this paper shows that the technology can be adapted to the requirements of daily surgical practice, without compromising its utility for the surgeon and, in the last resort, the patient. Provided that due consideration is given to clinical needs, this technology will surely become a standard tool, not only in European hospitals.     

Progress of Gastric Cancer Surgery in the era of Precision Medicine

With the development of genomics, the update of modern imaging technology and the advent of artificial intelligence and big data, the surgical treatment of gastric cancer has gradually stepped into precision medicine. Precision surgery treatment of gastric cancer is based on accurate molecular typing and staging using modern molecular diagnostic technology and imaging, and the formulation of precise and individualized surgical treatment plans, with the concept of minimally invasive and accelerated rehabilitation surgery running through it. For intermediate-stage gastric cancer, we have adopted a comprehensive treatment approach including traditional radiotherapy and chemotherapy, targeted therapy and immunotherapy. Utilize artificial intelligence and big data technology to improve the standardization and interconnectivity of specialty data and realize the transformation of evidence-based medicine. Promoting the standardization, standardization and individualization of gastric cancer surgical treatment, providing patients with precise diagnosis and treatment, and further improving patients'' prognosis are the opportunities and challenges in the development of gastric cancer surgery.     

腹腔镜胃癌根治术的研究进展

胃癌是全球发病率较高的恶性肿瘤之一,且发病率呈逐年上升的趋势。传统的治疗方法是开腹胃癌根治术,但该方法对患者机体造成的创伤较大,不利于患者术后恢复,在一定程度上影响了手术治疗的效果。随着医学技术的发展及"微创外科"理念的不断深入,腹腔镜手术以其创伤小、术中出血量少以及术后恢复快等特点被广泛应用于外科手术治疗中。近年来,3D腹腔镜技术的出现使手术视野更加清晰,术中操作更加简便,在一定程度上提高了手术的安全性,但临床对于进展期胃癌根治术的远期疗效一直存在争议。因此,本文对腹腔镜在胃癌根治术中的作用及意义作以综述,为胃癌的微创治疗提供理论参考。     

X线双能量数字化平行板探测器的研究和设计

用硅光电池研究设计一种性能最优良,对X射线也很灵敏的并经微电子技术大规模集成化制造,部分粘贴闪烁晶体、造出x线双能量数字平行板探测器,配上相应计算机,并直接与传统x线机组合的数字仪,可实行各种数字式的摄片和透视。     

臀肌筋膜挛缩症的外科手术治疗

臀肌筋膜挛缩症(Gluteal Muscle Contracture,GMC)是指由于各种原因引起的臀肌及其筋膜挛缩,导致髋关节功能受限,表现出特殊的症状、体征的临床综合征。GMC多发生于青少年和儿童患者,目前普遍认为一旦确诊GMC,应尽早手术治疗。随着临床技术的发展,GMC的手术方式也在不断创新、不断发展,其大致分为开放式手术和微创手术两大类,两者虽各具优缺点,但针对不同的患者都取得了不错的治疗效果。本文现对GMC的外科手术治疗的进展作一简要综述。     

Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial

Objectives To assess the clinical effectiveness of surgical stabilisation (spinal fusion) compared with intensive rehabilitation for patients with chronic low back pain.Design Multicentre randomised controlled trial.Setting 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom.Participants 349 participants aged 18-55 with chronic low back pain of at least one year''s duration who were considered candidates for spinal fusion.Intervention Lumbar spine fusion or an intensive rehabilitation programme based on principles of cognitive behaviour therapy.Main outcome measure The primary outcomes were the Oswestry disability index and the shuttle walking test measured at baseline and two years after randomisation. The SF-36 instrument was used as a secondary outcome measure.Results 176 participants were assigned to surgery and 173 to rehabilitation. 284 (81%) provided follow-up data at 24 months. The mean Oswestry disability index changed favourably from 46.5 (SD 14.6) to 34.0 (SD 21.1) in the surgery group and from 44.8 (SD14.8) to 36.1 (SD 20.6) in the rehabilitation group. The estimated mean difference between the groups was –4.1 (95% confidence interval –8.1 to –0.1, P = 0.045) in favour of surgery. No significant differences between the treatment groups were observed in the shuttle walking test or any of the other outcome measures.Conclusions Both groups reported reductions in disability during two years of follow-up, possibly unrelated to the interventions. The statistical difference between treatment groups in one of the two primary outcome measures was marginal and only just reached the predefined minimal clinical difference, and the potential risk and additional cost of surgery also need to be considered. No clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.