树脂纳米陶瓷Lava Ultimate髓腔内固位冠修复老年脑卒中病人短冠磨牙的疗效观察

目的探讨树脂纳米陶瓷Lava Ultimate髓腔内固位冠修复老年脑卒中病人短冠磨牙的疗效。方法收集研究2018年3月至2021年10月北京市大兴区医院老年脑卒中短冠磨牙病人124例,根据修复方案分为两组,采用紫荆氧化锆全瓷冠修复治疗的61例病人为对照组,采用树脂纳米陶瓷Lava Ultimate髓腔内固位冠修复治疗的63例为观察组。采用改良美国公共卫生机构(United States public health service,USPHS)标准比较两组修复后6、12个月修复效果、微渗漏分级、并发症发生率、修复前、修复后12个月口腔健康影响程度量表中文版(OHIP-14)评分及修复后12个月李克特量表(Likert scale)评分。结果修复效果:修复后12个月观察组边缘密合度、颜色匹配度、修复体折裂、牙体完整性、继发龋合格率分别为93.65%(59/63)、93.65%(59/63)、96.83%(61/63)、96.83%(61/63)、95.24%(60/63),均高于对照组[80.33%(49/61)、81.97%(50/61)、83.61%(51/61)、81.97%(50/61)、83.61%(51/61)](P<0.05);微渗漏分级:两组修复后6、12个月微渗漏分级比较,差异无统计学意义(P>0.05);并发症:观察组并发症发生率3.17%(2/63)低于对照组14.75%(9/61)(P<0.05);口腔健康相关生活质量:修复后12个月观察组OHIP-14量表功能限制、生理疼痛、心理不适、生理障碍、心理障碍、社交障碍评分分别为(1.89±0.57)分、(2.03±0.62)分、(0.92±0.30)分、(0.53±0.18)分、(0.42±0.10)分、(0.63±0.25)分,均低于对照组[(2.55±0.74)分、(2.73±0.88)分、(1.29±0.27)分、(0.74±0.26)分、(0.31±0.13)分、(0.89±0.20)分](P<0.05);修复效果满意度:修复后12个月观察组修复效果自我评估、并发症满意度、生活质量满意度评分依次为(4.62±0.39)分、(4.25±0.44)分、(4.57±0.40)分,均高于对照组[(4.12±0.35)分、(3.86±0.35)分、(4.03±0.46)分](P<0.05)。结论树脂纳米陶瓷Lava Ultimate髓腔内固位冠修复应用于老年脑卒中病人短冠磨牙,修复效果良好,有助于降低并发症发生率,提高口腔健康相关生活质量,改善修复效果满意度。

牙科内固位针的临床应用

应用牙科内固位针共治疗１７例（２１个牙），经６～１８个月复查，效果优良者１１例（１３个牙），占６５％，失败者６例（８个牙），占３５％。患牙经治疗后，其稳固度及咀嚼效能均明显增加，使本要拔除的部分患牙得以保留。

三种插销式嵌体冠应用于短冠磨牙修复的临床效果对比研究

临床上对牙冠较短（＜4 mm）且缺损范围较大的磨牙行插销式嵌体冠修复［1］，插销式嵌体冠兼顾了嵌体与桩冠的优点，通过冠外固位，冠内固位及根管内固位获得共同固位力，很好地恢复了牙体的功能［2］。本文对纯钛，金合金，氧化锆三种材质的插销式嵌体冠，应用于短冠磨牙修复的临床效果进行对比研究。

根管螺纹钉修复磨牙牙冠大面积缺损临床观察

磨牙牙冠大面积缺损临床上十分常见，单纯充填修复不能获得良好的抗力形和固位形，影响咀嚼功能，降低了生活的质量。我科从1995∽12∽2002∽12，采用根管螺纹钉根管内固位，制作树脂核或银汞核修复磨牙牙冠大面积缺损，效果满意，现报告如下。

Response models of weakly consolidated soft rock roadway under different interior pressures considering dilatancy effect

Surrounding rocks of weakly consolidated soft rock roadway show obvious strain softening and dilatancy effects after excavation. A damage coefficient concerning modulus attenuation was defined. Response models of stress and displacement of surrounding rock of soft rock roadway and analytical expressions to calculate plastic zones under different interior pressures and non-uniform original rock stresses were derived based on damage theories and a triple linear elastic-plastic strain softening model. Influence laws of dilatancy gradient on damage development, distributions of stresses and displacement in plastic region were analyzed. Interior pressure conditions to develop plastic region under different origin rock stresses were established and their influences on plastic region distribution were also discussed. The results show that the order of maximum principle stress is exchanged between ~0 and trr with the increase of interior pressure P0, which causes distributions of plastic zone and stress shift. Dilatancy effect which has great influences on the damage propagation and displacements in plastic region has little effect on the size of plastic region and stress responses. The conclusions provide a theoretical basis for a reasonable evaluation of stability and effective supporting of weakly consolidated soft rock roadway.

A severely displaced metaphyseal fracture of the proximal humerus with dislocation of the shoulder in a child

Fracture of the proximal humerus meta- physis with coexistent dislocation of the shoulder in chil- dren is a rare injury. The injury often occurs as a conse- quence of high velocity trauma. Most fractures of the proxi- mal humerus commonly associated with the epiphysis in children can be treated with closed reduction. We presented a case of 5-year-old girl who sustained this type of fracture-dislocation of the shoulder. Open reduction and internal fixation with multiple smooth K-wires was performed. At two years follow-up, the patient was pain free and regained full range of motion.

Transoral atlantoaxial reduction plate fixation for irreducible atlantoaxial dislocation

Objective： To design a clinically applicable transoraipharyngeai atlantoaxiai reduction plate （TARP）, introduce the operation procedure, and evaluate its preliminary clinical effects. Methods： A novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed. This system was applied clinically on five patients with irreducible atlantoaxiai dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxiai reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxiai joints and TARP was used to immobilize subsequently the atlas and axis. Results： Clinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperationai effect was satisfactory. Conclusions： The design of TARP is novel. The operational procedure is simple and easy to use. Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxiai dislocation and may have excellent prospects for further clinical applications.

Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.

Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

Fractures of the proximal humerus are uncommon in young patients.Although bilateral fracture of proximal humerus itself is rare,association with epilepsy and electrocution is frequent.Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature.We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient,which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

Treatment of posterior wall fractures of acetabulum

Objective： To explore the treatment methods and outcome of posterior wall fractures of the acetabulum. Methods： The data of 31 patients （25 males and 6 females, aged 19-59 years, mean： 40.5 years） with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study. The types of fractures, number of fragments, combined dislocations, and sciatic nerve function were documented before admission. All the fractures were treated with open reduction and internal fixation. Based on the fracture type and site, either screws alone or reconstructive plates were used. The patients were immobilized for an average of 12 weeks before partial weight bearing was permitted. After follow-up for 12-70 months （43.6 months on average）, modified Merle d＇Aubigne score was adopted to evaluate the outcomes of the operations. Results： The percentages of the excellent, good, fair and poor results were 48.4%, 41.9%, 6.5%, and 3.3%, respectively, with a good to excellent rate of 90.2%. Idiopathic sciatic nerve injury occurred in only one case. Conclusions： The sciatic nerve should be routinely exposed and protected during the surgery. The type of fixation should be based on the fracture type and site. Prolonged immobilization may be helpful in improving the final outcomes.

Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking cal- caneal plate

Objective：Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods：In this series,28 patients （26 unilateral and 2 bilateral） with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler＇s angle and Gissane＇s angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society （AOFAS） scale.Results：At average follow-up of 14.5 months,average AOFAS score was 86.3 （range 66 to 97）,with 86% having excellent to good results and 2 （7.7%） and 1 （3.7%） having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler＇s angle,mean Gissane＇s angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion：Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome,i.e.restoring anatomically reconstruction of height,width,Bohler＇s and Gissiane＇s angles of the calcaneum,and allowing early mobilization.