手术治疗髁状突骨折的进展

下颌骨骨折是常见的面部损伤,而髁状突是下颌骨骨折的好发部位之一。髁状突是颞下颌关节重要的组成部分,故其治疗效果的优劣直接影响到颌、功能及面部外形,并有发展成颞下颌关节强直的潜在危险[1]。自Desant（1805年）最早发表了有关髁状突骨折治疗的观点,各种治疗方法不断出现,但基本可分为保守和手术治疗两大类。保守治疗后常出现咬合关系欠佳、关节疼痛、关节运动受限、假关节和关节强直,颌间固定,是以往保守治疗的主要方法而颌间固定具有以下缺点：①闭口固定时间过久,进食困难患者体重明显减轻。②口腔卫生较差。③下颌功能减…     

下颌骨髁突解剖参数的相关性分析及临床意义

目的通过测量下颌骨髁突的解剖学参数,为国人下颌骨髁突假体设计提供参数。方法用国产游标卡尺测量正常成年人下颌骨髁突的相关参数共8项指标。结果左右侧下颌骨髁突各项解剖参数相比,差异均无显著性意义(P>0.05)。内侧最凸点与外侧最凸点距离,前缘测量点与后缘测量点直线距离,关节面最高点与下颌骨髁突内侧缘明显缩窄处垂直距离,下颌骨髁突关节面最高点与外侧最凸点直线距离与左右下颌角外侧最凸点间距离,均成正相关关系。结论通过测量左右下颌角外侧最凸点间距离的数值可推算出国人下颌骨髁突假体个性化设计所需的参数。     

甲状旁腺激素促进下颌骨髁突骨折游离复位模型兔的骨愈合

背景:髁突骨折时若骨块严重移位需手术复位及内固定,若附着于髁突前内侧的翼外肌剥脱使骨块游离,术后可能发生髁突骨折块延迟愈合,因此如何促进髁突骨折游离复位后愈合是口腔颌面外科临床医师关注的临床难题。目的:探讨间歇性皮下注射甲状旁腺激素对兔髁突骨折游离复位后骨愈合的影响及作用机制。方法:将48只新西兰大耳兔随机分为实验组及对照组,每组24只,建立下颌骨髁突骨折游离复位内固定模型,实验组及对照组造模术后隔日分别经皮下注射甲状旁腺激素20μg/kg或生理盐水1 mL。术后第1,2,3,4周时麻醉处死动物,取术区骨标本观察愈合情况,利用免疫组织化学染色及实时荧光定量PCR检测骨折区域骨保护素和核因子κB受体活化因子配体的表达水平。结果与结论:(1)实验组骨折区域成骨细胞较多、新生骨痂较快且密度较高;(2)术后前4周内实验组破骨细胞数量较对照组少(P <0.05);(3)骨保护素的免疫组化平均吸光度值及mRNA表达量结果显示,4周内实验组均高于对照组(P <0.05);(4)核因子κB受体活化因子配体的免疫组化平均吸光度值及mRNA表达量结果显示,4周内实验组均低于对照组(P <...     

切开复位治疗髁状突骨折的疗效分析

目的 分析切开复位治疗髁状突骨折的疗效，探索更能提高髁状突骨折治疗效果的临床治疗方法。方法 对38例46侧髁状突骨折行切开复位微型钛板内固定术，术后行临床和影像学观察。结果 术后一年临床评价优良率为79％，无张口受限，关节疼痛厦弹响，无面瘫症状。影像学评价优良率为65％，髁状突异常主要有骨折片移位，骨质吸收和成角畸形。结论 切开复位微型钛板内固定治疗髁状突骨折可取得满意临床疗效，合理选择手术适应证和规范的手术操作是避免手术并发症的关键。     

髁突颈横行截骨和骨折对大鼠下颌骨生长发育的影响

目的 建立年轻SD大鼠单侧髁突颈部截骨、骨折的动物模型,探讨应力改变对大鼠下颌骨及髁突生长发育的影响.方法 4周龄72只雄性SD大鼠按随机数字表法分3组,每组24只,分为截骨组、骨折组、对照组.建立大鼠单侧髁突颈部横行截骨,骨折的动物模型,观察术后1、3、5、9周髁突影像学、组织学及下颌骨解剖学的变化.检测与髁突生长发育关系密切的结缔组织生长因子（CTGF）及X型胶原（Col X）在髁突软骨中表达的变化.结果 截骨组手术侧术后1、3周髁突区膨大,髁突颈呈分离影像.骨折组手术侧术后1周髁突呈圆柱状,见骨折线.截骨组手术侧术后4个时间点下颌骨生长发育受到限制,髁突软骨的总厚度术后1周代偿性增厚为（1468.28±53.73） μm,大于骨折组手术侧;术后3、5周总厚度明显降低;术后9周与骨折组手术侧比较差异无统计学意义（P＞0.05）,但都小于对照组（P＜0.05）.截骨组手术侧CTGF在髁突软骨中的表达在术后1、3、5周分别为60.18±1.23、72.43±2.82、86.00±2.90均高于骨折组手术侧和对照组Col X表达在术后1周时为64.46±3.76,高于骨折组手术侧和对照组（均为P＜0.05）.结论 单侧髁突颈截骨,致应力改变明显,影响下颌骨及髁突生长发育,可导致手术侧、非手术侧下颌骨的不对称,并影响CTGF及Col X在髁突软骨的表达.     

下颌骨髁突支架的个体化设计与初步构建

Objective To explore the method of designing and manufacturing the mandibular condyle scaffold individually by rapid prototyping technologies and reverse engineering.Methods Cranial CT image data were processed in Mimics software for reconstruction of one side of ramus of mandible, and were inputted into Solidworks software to edit by the format of stl. A negative mold of the mandibular condyle scaffold was obtained. The mold was fabricated by resin materials utilizing rapid prototyping. Biomaterials were filled into the resin mold. When the materials were cured, we eliminated the resin mold and acquired a multi-pores three dimensional mandibular condyle scaffold model. The general morphology and microstructure of the scaffold model were observed by scanning electron microscopy (SEM). Results The mandibular condyle scaffold made of biomaterials was accordance with the one our computer designed. SEM observation revealed that the model was made of collagen in the cartilage-like layer and calcium phosphate cement/poly (lactic- co-glycolic acid) in the bone-like layer. Conclusion It is feasible to fabricate mandibular condyle scaffold individually by using reverse engineering and rapid prototyping technology.     

三维有限元分析下颌骨不同部位受力髁突的力学应变

背景：髁突骨折可以发生在直接及间接外力作用下,其危险性与撞击作用部位有着何种相关关系,目前报道较少。 目的：快速建立正常下颌骨的三维有限元模型,采用有限元方法分析下颌骨不同部位受力对髁突力学应变情况。 方法：以颌骨发育正常,无任何口腔疾患的青年志愿者1例进行多层螺旋CT扫描,利用医学逆向工程软件Mimics和大型有限元软件MSC.Patran建立下颌骨三维有限元模型并对下颌骨体部、颏部、下颌角部及髁突等部位进行数值撞击试验,对所建模型进行可行性验证。 结果与结论：①快速建立下颌骨三维有限元生物力学模型,重现了下颌骨的几何外形,能够得到下颌骨髁突的直观整体印象。建立的几何模型包括80 044节点和18 441单元。②于下颌骨颏部、一侧下颌体部、下颌角及髁突处分别加载100 N压力时,骨皮质中最大等效应力出现在髁突区域,髁突发生骨折的危险性最大。实验结果有助于从力学上对于髁状突骨折类型进行分析及对骨折的程度进行判断。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

坚固内固定治疗髁突中低位骨折

目的探讨手术切开复位坚固内固定治疗髁突中低位骨折的治疗效果。方法对15例中低位髁突骨折患者开放复位行小型钛板坚固内固定治疗,对比手术前后张口度、面神经损伤及咬合关系情况及术后颞颌关节功能状况,手术前后线曲面断层片及CT对比骨折复位与愈合状况。结果所有患者张口度均大于3cm,咬合关系良好,关节区疼痛和弹响2例,面神经暂时性损伤4例,影像学检查显示髁突外形良好。结论中低位髁突骨折明显移位者行坚固内固定可获得满意效果。     

永生化下颌骨髁突软骨细胞的微囊化研究

为了探讨微囊包裹软骨细胞在软骨组织工程中的适用性 ,根据气流切割原理采用海藻酸钠 -多聚赖氨酸 -海藻酸钠 ( APA)对永生化下颌骨髁突软骨细胞 ( Im mortalized mandibular condylar chondrocyte,IMCC)进行微囊包裹。用倒置显微镜观察、台盼蓝染色、细胞记数、HE染色、免疫组化等方法检测微囊的大小、细胞的生长及微囊内组织的软骨特性等情况。研究发现 ,IMCC可在微囊内存活 ,活细胞率 >80 % ,微囊直径平均 779μm。细胞数量随着培养时间的延长逐渐增多 ,约 2 0 d左右达到平台期 ,细胞在囊内呈簇样生长 ,高表达软骨特异的蛋白多糖和 型胶原。提示 IMCC可在微囊内形成类软骨组织样结构 ,微囊技术适用于包裹软骨细胞     

Influence of food consistency on growth and morphology of the mandibular condyle

The objective of this study was to determine if variation in the shape and mineralization of the mandibular condyle are the result of natural adaptation in response to different functional loading demands. Eight female Kuni Kuni piglets were randomly assigned to two groups of four, receiving either a soft or hard diet. Each animal was given three separate doses of vital stains intravenously at set time points during the study. At 8.5 months, animals were euthanized and temporomandibular joints (TMJs) were excised. Histological analysis was used to measure the amount of new bone deposition in the anterior, central, and posterior regions of the mandibular condyle. Backscatter electron (BSE) imaging was used as a semiquantitative estimate of bone mineralization in these two diet groups. Histology revealed that the degree of new bone deposition in the hard-diet group was significantly (n = 4, P < 0.001, paired t-test) higher than that of the soft-diet group. Also, the majority (87%) of animals fed a hard diet tended to show greater new bone deposition on the leftside in comparison to the right, indicating a chewing preference for the left side. In both groups, the degree of new bone deposition was significantly (P < 0.01) higher in the posterior area than in other regions. BSE imaging corroborated basic histology results, with significantly (P < 0.01) higher mineralization levels detected in the hard-diet group. These findings indicate that diet consistency has a small but significant effect on the rate of bone deposition in the mandibular condyle.     

A greater reduction in the distal femoral anterior condyle improves flexion after total knee arthroplasty in patients with osteoarthritis

BackgroundThe effect of an anterior condylar height (ACH) change after total knee arthroplasty (TKA) is not well-known. The effect of an ACH change was evaluated on postoperative knee flexion, New Knee Society Scores (2011KSS), and patellofemoral contact force.MethodsThe study included 101 knees that underwent TKA. The medial or lateral ACH was measured using pre-operative and postoperative computed tomography. Pearson correlation between the change in ACH and knee flexion was calculated. The determinant of the change in flexion was evaluated using multivariable linear regression. The association between ACH and 2011KSS was assessed. Using the cases with the three highest and three lowest pre-operative medial ACHs, computer simulation was performed to detect the changes in patellofemoral contact forces.ResultsA postoperative reduction in ACH correlated with increased flexion at one year (medial ACH, R = 0.58; lateral ACH, R = 0.48). On multivariable linear regression, reductions in medial ACH (β = 1.7, P < 0.001) and pre-operative flexion (β = ? 0.3, P < 0.001) were associated with increased flexion. A decrease in ACH was associated with improvements in advanced activities (medial, R² = 0.06; lateral, R² = 0.08) in 2011KSS. On computer simulation, all three cases with reduced and increased medial ACHs showed decreased and increased patellofemoral contact forces, respectively.ConclusionsA change in ACH was an independent predictor of knee flexion after TKA. Greater reduction in ACH was associated with improved flexion after TKA, whereas an increase in postoperative ACH may be a risk factor for flexion loss.     

面神经下颌缘支的走行层次及分段定位

目的 了解面神经下颌缘支的走行层次及分段定位,为防止面侧区颌面部下部手术中造成面神经下颌缘支损伤提供解剖学依据.方法 参照设定的坐标系,观测28具成人尸体(即56侧)面神经下颌缘支的走行层次和位置.结果 面神经下颌缘支主要穿行于腮腺和咬肌筋膜内,全长可分为降段、弓段和升段3段,与下颌后静脉及面动脉交叉处的坐标值分别是(-6.4±1.5)mm和(9.8 ±1.3)mm、(28.8±4.1)mm 和(11.6±1.6)mm.结论 采用分段定位的方法能更准确显示面神经下颌缘支的位置,以满足颌面部外科手术的需要.     

综合康复锻炼对改善低位直肠癌患者术后前切除综合征的效果

目的:探讨综合康复功能锻炼对改善低位直肠癌术后患者前切除综合征(anterior resection syndrome,ARS)的护理效果.方法:选择低位直肠癌术后并发ARS的98例患者,按住院号的顺序随机分为对照组和综合组,其中对照组49例患者采取常规盆底相关肌肉力量锻炼方案;综合组49例患者采取盆底肌锻炼与神经康复锻炼,分别比较两组患者干预前及干预后1,3,6个月时两组患者的前切除综合征评分(low anterior resection syndrome score,LARSS)及生存质量情况.结果:两组在干预前和干预后1个月时LARSS评分,差异无统计学意义(P＞0.05),综合组在干预后3个月和6个月时LARSS评分明显低于对照组,差异有统计学意义(P＜0.05);两组在时间效应、组间效应及时间组间效应值,差异均具有统计学意义(P＜0.05);两组在干预前及1个月时生活质量各维度评分,差异无统计学意义(P＞0.05);在干预后3个月和6个月时除环境功能外综合组患者的生活质量其他维度评分均高于对照组,差异有统计学意义(P＜0.05);除环境功能组间效应外,两组患者在生活质量所有指标的时间效应、组间效应及时间-组间效应,差异有统计学意义(P＜0.05).结论:通过开展盆底肌力锻炼联合神经康复锻炼较单纯盆底肌力锻炼更能够快速改善低位直肠癌术后ARS症状,对改善患者生存质量更为显著,在临床值得进一步推广.     

功能训练对根治性膀胱全切后原位乙状结肠代膀胱患者的效果

目的:对根治性的膀胱全切除原位乙状结肠代膀胱患者采取系统性膀胱功能训练的临床效果和尿流动力学进行分析.方法:分析中国医科大学盛京医院2014年5月至2016年5月收治的根治性膀胱全切除原位乙状结肠代膀胱80例患者的资料,根据临床训练方法分成两组,将采取普通膀胱功能训练40例患者设为对照组,将采取系统性膀胱功能训练的40例患者设为观察组,比较两组的临床效果和尿流动力学特征.结果:观察组术后9个月残尿量、膀胱容量和最大尿流率等尿流动力学指标均优于对照组,且术后膀胱输尿管吻合口狭窄、夜间尿失禁、输尿管返流等总并发症发生率(2.50％)低于对照组(25.00％),差异均有统计学意义(P<0.05);观察组总体健康评分(83.40±14.30)高于对照组(65.33±13.10),差异有统计学意义(P<0.05).结论:对根治性的膀胱全切除原位乙状结肠代膀胱患者采取系统性膀胱功能训练能够改善尿流动力学指标,减少术后并发症且提高生活质量.     

不同微创入路在跟骨关节内骨折治疗中应用

目的探讨纵行切口和跗骨窦微创入路在跟骨关节内骨折治疗中的临床疗效。方法回顾性分析2008年3月至2012年3月我院收治的67例纵行切口或跗骨窦微创入路术治疗并跟踪随访的跟骨关节内骨折患者的临床资料,按照手术类型分为2组:纵行切口微创入路组(ZW组)36例(37足),行纵行复位小切口入路治疗方案;跗骨窦微创入路组(FW组)31例(33足),行跗骨窦间隙入路治疗方案。根据X线片对比2组患者手术前后的Bohler角、Gissane角、并发症、愈合时间、跟骨内骨折术后AOFAS踝关节与足后评分。结果 ZW组愈合时间、Bohler角、Gissane角等指标均优于FW组,但组间比较无显著性差异(P0.05);ZW组切口感染并发症明显少于FW组,组间比较差异具有统计学意义(P0.05);评分结果显示ZW组得分为82.49分,FW组得分为86.53分,组间比较无统计学意义(P0.05)。结论 2种治疗手段虽无明显差异,但经纵行小切口复位微创入路治软组织损伤程度、术后愈合时间、手术并发症等临床效果更为满意。     

临床路径式早期康复训练对颅脑创伤术后患者误吸与吸入性肺炎的影响

目的：探究临床路径式早期康复训练对颅脑创伤术后患者误吸与吸入性肺炎的影响。方法：选取我院2015年3月至2016年3月收治的80例颅脑创伤患者作为研究对象,在确定患者或其家属如实掌握此次研究方案内容且签署知情同意书后随机分为对照组(常规护理)及研究组(临床路径式早期康复训练)各40例,比较两组患者临床护理效果。结果：研究组误吸发生率15%、吸入性肺炎发生率10%,而同期对照组误吸发生率30%、吸入性肺炎发生率20%,组间差异有统计学意义(P<0.05)。结论：临床路径式早期康复训练可显著降低颅脑创伤术后误吸与吸入性肺炎发生率,可作为优选护理方案推广使用。     

尺骨截骨位置不同对手术治疗儿童陈旧性孟氏骨折预后的影响

目的 探讨手术治疗儿童陈旧性孟氏骨折尺骨截骨点位置不同对疗效的影响。方法 回顾性队列研究。纳入2015年6月—2021年6月安徽省儿童医院骨科收治的68例儿童陈旧性孟氏骨折患者的临床资料,其中男42例、女26例,年龄3~12（6.6±2.4）岁。受伤至手术时间1~60个月,平均8.6个月。BadoⅠ型骨折60例,Ⅲ型8例。患儿均采用尺骨近端截骨矫形治疗,术中选择尺骨畸形最明显处截断尺骨,按照截骨点至尺骨近端间距占尺骨全长的比例不同分为3组,A组（占比≤25%）27例、B组（25%<占比<30%）20例、C组（占比≥30%）21例。观察指标：（1）对比3组患儿临床基线资料。（2）对比3组患儿手术时间,观察术后患肘肱桡关系恢复情况,尺骨截骨处愈合情况,以及并发症发生情况。（3）术后定期随访。取出内固定前,测量对比3组患儿肘关节旋前、旋后、伸肘、屈肘角度,采用Kim肘关节功能评分表评估并对比3组患儿肘关节功能;拆除内固定后,采用影像学Nakamura分级标准评估并对比3组患儿肘关节功能。结果 （1）3组患儿性别、年龄、患肢侧别、骨折分型、受伤至手术时间、术前患肢肘关节活动度等基线资料比较,差异均无统计学意义（P值均>0.05）。（2）3组患儿均顺利完成手术,A组手术时间为（100.6±31.7）min,B组为（133.0±24.2）min,C组为（94.9±28.6）min,差异无统计学意义（F=1.02,P=0.367）。术后第3天肘关节正侧位X线片示肱桡关系均恢复正常。A组有1例术后切口感染,予以抗感染治疗后愈合。68例患儿均获得随访,随访时间6~36个月,平均8.7个月。A组术后发生肱桡关节再脱位3例、半脱位3例,B组发生半脱位3例,C组发生半脱位2例、尺骨延迟愈合1例;3组间并发症发生情况比较,差异均无统计学意义（P值均>0.05）。3组患儿尺骨截骨处愈合时间比较,差异无统计学意义（F=0.01,P=0.989）。（3）3组患儿取出内固定前,肘关节旋前、旋后、伸肘、屈肘角度,以及Kim肘关节功能评定比较,差异均无统计学意义（P值均>0.05）。拆除内固定后,影像学Nakamura分级评定肘关节功能比较,3组间差异无统计学意义（Z=1.73,P=0.422）。结论 儿童陈旧性孟氏骨折采用尺骨近端截骨矫形治疗,术中选择尺骨畸形最明显处截断尺骨,尺骨截骨点位置的不同对患儿预后无明显影响。     

Comparison of conventional resistance training and the fly-wheel ergometer for training the quadriceps muscle group in patients with unilateral knee injury

A fly-wheel ergometer (FWE) offering resistance training of the knee extensors has been designed for space travel and found to be effective during bed rest. The possibility exists that this device is also effective in training the knee extensors after knee injury. The purpose of this study was to compare the FWE to standard knee extensor training equipment for their effects on individuals with a history of knee injury, a group who commonly suffer from weakness of the knee extensors that effects their function. Twenty-nine subjects completed the study, which included tests of knee self-assessment, knee extensor static and dynamic muscle strength, size and neural activation as well as single leg power output, standing balance and vertical jump performance. Both groups showed statistically significant (P < 0.05) improvements in these variables over the 3-month training period but no differences were noted between the groups. The FWE appears to be as effective as standard resistance training equipment for improving knee extensor muscle group size and performance after knee injury.