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简介：摘要目的比较无托槽隐形矫治器与常规唇侧固定矫治器在牙周炎正畸患者中的应用效果。方法抽取2018年3月至2020年5月洛阳市第五人民医院收治的牙周炎正畸患者98例，按随机数字表法分为研究组与对照组，每组49例。对照组采用常规唇侧固定矫治器进行治疗，研究组采用无托槽隐形矫治器进行治疗。比较两组矫治时间、矫治前后牙周状况[龈沟出血指数(SBI)、探诊深度(PD)、菌斑指数(PLI)]、上切牙区牙槽骨高度及骨密度变化情况。结果研究组倾斜牙扶正时间、扭转牙转正时间、矫治总时间均短于对照组，差异有统计学意义(P<0.05)。牙周状况方面，两组矫治后SBI、PD、PLI值均较矫治前升高，但研究组低于对照组，差异有统计学意义(P<0.05)。矫治后，两组上切牙区牙槽骨高度均较矫治前降低，但对照组与矫治前比较差异有统计学意义(P<0.05)，研究组与矫治前比较差异未见统计学意义(P>0.05)。矫治前，两组上切牙区牙槽骨高度比较，差异未见统计学意义(P>0.05)；矫治后，研究组上切牙区牙槽骨高度高于对照组，差异有统计学意义(P<0.05)。矫治后，两组腭侧牙槽嵴顶处、解剖根尖点冠方1 mm处骨密度均较矫治前降低，但研究组降低幅度低于对照组，差异有统计学意义(P<0.05)。结论与常规唇侧固定矫治器相比，无托槽隐形矫治器应用于牙周炎正畸患者中，可缩短矫正时间，维持骨高度，降低对骨密度的影响，并能维护口腔健康，改善牙周状况。

简介：摘要目的下颌前移矫治器（MADs）是治疗阻塞性睡眠呼吸暂停综合征（OSA）的常用方法之一。成人下颌骨前突通常伴有面部侧貌不协调，配戴仿生口腔矫治器（OA）是面部正畸治疗的有效方法，然而其对上颌窦的影响仍未见报道，本研究通过分析口腔矫治器治疗前后上颌窦相关测量数据，探讨配戴口腔矫治器对上颌窦气化的影响。方法研究纳入16例韩国中面部发育不良患者，所有患者均签署知情同意书，治疗前采用锥形束CT扫描进行头面部三维图像重建，每天配戴仿生口腔矫治器治疗12~16 h，每月测量颚骨宽度和上颌窦体积，治疗完成后拆除口腔矫治器再次行CT扫描。治疗前后数据均采用相关软件进行测量，采用t 检验进行分析。结果纳入患者年龄（25.0±8.7）岁，治疗时间（15.5±5.2）月。治疗后颚骨宽度（38.5±2.0）mm高于治疗前（35.3±3.0）mm，且差异有统计学意义（P<0.001）；治疗后左侧上颌窦体积（20.0±6.0）cm3高于治疗前（18.8±6.5）cm3，P<0.05；治疗后右侧上颌窦体积（19.7±5.8）cm3高于治疗前（18.5±5.7）cm3，P<0.05。结论配戴仿生口腔矫治器能够增加成人上颌窦体积，上颌窦体积增大对副鼻窦的功能以及睡眠相关指标的影响需要进一步的研究。

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简介：摘要目的评估双垫矫治器与生物调节器治疗安氏Ⅱ1类错的临床疗效，从而进一步探讨功能矫治器治疗Ⅱ类错的作用机制，为临床应用提供一定理论依据。方法采用回顾性研究，选择处于生长发育高峰期的安氏Ⅱ1类错患者42例，其中双垫矫治器组22例(男10例，女12例)，年龄(10.3±1.5)岁；生物调节器组20例(男10例，女10例)，年龄(10.9±1.2)岁。采用头影测量软件对治疗前后的头颅侧位定位片进行骨性和牙性分析，分别采用配对样本t检验和独立样本t检验对治疗前后各测量项目的差异及组间差异进行比较。结果两组患者的覆盖及面型均得到明显改善。治疗后两组患者的SNA变化量差异有统计学意义，生物调节器组减小1.65°±1.76°，双垫矫治器组减小0.23°±1.16°(P＝0.034)；两组颌凸角变化量差异有统计学意义，生物调节器组减小2.21°±2.16°，双垫矫治器组减小4.26°±2.74°(P＝0.027)；两组上牙槽座点距过S点做SN平面垂线间的距离变化量差异有统计学意义，生物调节器组增大(0.17±1.24)mm，双垫矫治器组增大(0.72±1.05)mm(P＝0.044)；两组上颌第一磨牙近中切点距过S点做SN平面垂线间的距离变化量差异有统计学意义，双垫矫治器组增大(1.07±1.84)mm，生物调节器组减小(1.55±1.95) mm(P＝0.024)。结论双垫矫治器和生物调节器对安氏Ⅱ1类错患者的矫治均有效，但生物调节器在矢状向上对上颌骨的抑制作用较双垫矫治器更明显，双垫矫治器更有利于二类关系的纠正以及患者侧貌的改善。

简介：摘要目的比较不同垫式活动矫治器治疗完全性唇腭裂的效果。方法抽取2017年6月至2020年6月郑州大学附属郑州中心医院收治的62例单侧完全性唇腭裂患儿作为研究对象，将牙弓主要缩窄于后部的患儿纳入螺旋组，采用螺旋扩弓器垫式活动矫治器；将牙弓前后部皆缩窄，且前部缩窄更明显患儿纳入扇形组，采用扇形扩弓器垫式活动矫治器。每组31例，均行扩弓治疗。比较两组治疗前后前牙覆盖、磨牙关系、下颌长、梨状孔最大横径、第一前磨牙区鼻腔下部最大横径、第一磨牙区鼻腔下部最大横径上齿槽座角(SNA)、下颌矢向位角(SNB)、SNA角与SNB角之差(ANB)、鼻气道体积、咽气道体积及咽气道最小横截面积。结果扇形组治疗后前牙覆盖低于治疗前及对照组治疗后，差异有统计学意义(P<0.05)；两组治疗后磨牙关系低于治疗前，下颌长高于治疗前，差异有统计学意义(P<0.05)。两组治疗后梨状孔最大横径、第一前磨牙区鼻腔下部最大横径、第一磨牙区鼻腔下部最大横径高于治疗前，差异有统计学意义(P<0.05)。两组治疗后SNA、ANB高于治疗前，SNB低于治疗前，差异有统计学意义(P<0.05)。两组治疗后鼻气道体积、咽气道体积、口咽气道最小横截面积高于治疗前，差异有统计学意义(P<0.05)。结论螺旋及扇形扩弓器垫式活动矫治器应用于完全性唇腭裂患儿，对各自适应证均能较好地扩弓，提高正畸治疗效果。

简介：摘要目的探讨改良型FRⅢ型矫治器治疗儿童安氏Ⅲ类错畸形的效果。方法回顾性分析2017年1月至2019年1月于南阳市中心医院接受传统FRⅢ型矫治器进行治疗(对照组，n＝59例)及接受改良型FRⅢ型矫治器进行治疗(研究组，59例)的安氏Ⅲ类错患儿的临床资料。对比两组患儿治疗12个月后的临床疗效，治疗前、治疗12个月后硬组织指标[ANB角、SNA角、SNB角、下颌平面角(MP-FH)、上颌位置、上颌长、下颌长、面下部高、上中切牙角(U1-NA角)、下中切牙角(L1-NB角)] 、咀嚼功能(OD值)。结果治疗12个月，研究组总有效率为91.53%，高于对照组(77.97%，P<0.05)。治疗12个月后，两组ANB角、SNA角、SNB角、下颌平面角(MP-FH)、U1-NA角较治疗前增加(P<0.05)，且两组比较差异有统计学意义(P<0.05)；两组患儿上颌位置、面下部高比较，差异未见统计学意义(P>0.05)；研究组患儿上颌长较治疗前增加(P<0.05)，而L1-NB角未见明显变化(P>0.05)，对照组上颌长较治疗前比较，差异未见统计学意义(P>0.05)，而L1-NB角减小(P<0.05)，两组上颌长、L1-NB角比较，差异有统计学意义(P<0.05)。治疗12个月后，两组患者OD值均上升(P<0.05)，且研究组OD值高于对照组(P<0.05)。结论相较于传统FRⅢ型矫治器，改良型矫治器更适用于治疗安氏Ⅲ类错患儿，不仅能提升治疗效果、有效改善患儿面型，还能提升患儿咀嚼效能。

简介：摘要无托槽隐形矫治有美观性好，舒适度高，便于口腔卫生的维护及减少复诊次数的优势。隐形矫治器戴用后很多的患者也出现了不适症状，包括疼痛与配戴不适、矫治器形变、断裂或附件脱落，也带来菌斑的黏附、材料的性能改变、牙周的稳定等口腔微环境的变化，这些问题均降低了患者的舒适度，影响矫治的效率。

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简介：摘要目的探讨无托槽隐形矫治器联合微种植钉内收上前牙时，先远移尖牙与整体内收两种方式内收时上颌前后牙生物力学效应。方法采集患者上颌骨及上牙列的CBCT数据信息，使用Mimics、Geomagic Studio、HyperMesh等软件，采用逆向工程方法建立拔除上颌第一前磨牙使用无托槽隐形矫治器联合微种植钉整体内收上前牙的三维有限元模型，分析：①矫治器加力远移尖牙；②矫治器加力＋矫治器牵引钩处150 g牵引力远移尖牙；③矫治器加力＋尖牙舌钮处150 g牵引力远移尖牙；④矫治器加力整体内收上前牙；⑤矫治器加力＋矫治器牵引钩处150 g牵引力整体内收上前牙；⑥矫治器加力＋尖牙舌钮处150 g牵引力整体内收上前牙，六种工况下前后牙的牙周膜等效应力和初始位移。结果只远移尖牙时，尖牙所受牙周膜等效应力最大，分别为5.23E-02 MPa、5.65E-02 MPa、5.87E-02 MPa；上中切牙的唇侧位移量分别为－5.08E-03 mm、－9.67E-04 mm、－1.68E-03 mm，第一磨牙牙冠近移量分别为－1.53E-02 mm、－1.40E-02 mm、－1.51E-02 mm。整体内收上前牙时，中切牙所受牙周膜等效应力最大，分别为4.69E-02 MPa、6.26E-02 MPa、4.84E-02 MPa；中切牙的冠根位移差分别为1.44E-01 mm、1.35E-01 mm、1.29E-01 mm，第一磨牙牙冠近移量分别为－2.93E-02 mm、－2.61E-02 mm、－2.33E-02 mm。结论只远移尖牙时，切牙会为尖牙的远移提供支抗，在矫治器上牵引能够更有利于前后牙支抗的保护；整体内收上前牙时，在尖牙上牵引更有利于后牙支抗的保护和切牙的整体移动。

简介：摘要目的在三维有限元模型中，探讨舌侧矫治器预置不同转矩角度弓丝对上前牙牙周膜应力分布的影响。方法建立整体舌侧矫治三维有限元模型，模拟滑动法关闭拔牙间隙：弓丝预置0°、9°、13°、17°正转矩，分别在腭侧加力1.50 N以及颊侧加力1.00 N＋腭侧加力0.50 N条件下关闭间隙，分析上前牙牙周膜范·米塞斯(von Mises)应力分布情况。结果①弓丝预置9°、13°、17°正转矩时，随着预置正转矩角度加大，侧切牙、切牙牙周膜所受应力增大，并且牙周膜应力集中区位于牙颈部；尖牙未出现明显的应力集中区；②腭侧加力1.50N关闭间隙情况下，预置0°转矩时，牙周应力在尖牙牙颈部及根中，中切牙及侧切牙未见明显分布。随预置转矩角度增大时，牙周膜应力集中区从尖牙牙根颈部牙周膜扩展到牙根中部牙周膜；侧切牙、中切牙牙周膜所受应力也随预置正转矩角度增大逐渐增大，但始终集中在牙周膜颈部区域；③颊侧加力1.00 N＋腭侧加力0.50 N关闭间隙情况下，预置0°转矩时，上前牙牙周膜应力集中区分布在侧切牙及尖牙牙颈部。随预置正转矩角度增大，牙周膜应力集中区开始分布在侧切牙颊侧远中牙颈部，随后中切牙腭侧颈部偏近中区域及尖牙颈部近中牙周膜出现应力集中区。结论在个体化舌侧矫治器滑动法关闭间隙过程中，预置转矩弓丝对上前牙牙周膜应力分布有不同的影响；随着预置正转矩的增大，上前牙牙周膜所受应力水平及应力集中区域也随之扩大。颊腭侧同时加力关闭间隙，比单纯腭侧加力关闭间隙时上前牙牙周膜应力集中区域分布更加均匀，同时应力水平更小。

简介：AbstractThe pathophysiology of twin-to-twin transfusion syndrome (TTTS) is complex, and its understanding has evolved along with the evolution and revolution of fetal diagnostic and therapeutic techniques. Over the last few decades, several therapeutic interventions have been researched for improving the outcomes in TTTS. We present a summary of the current protocols for surveillance, diagnosis, and staging of TTTS in monochorionic pregnancies. We also describe in detail the technique for treatment of TTTS by endoscopic laser photocoagulation.

简介：AbstractThe rate of twin pregnancies has increased over the last decades, largely because of the ongoing development of assisted reproductive technology and increased maternal age at childbearing. Twins have a higher risk of adverse outcomes during pregnancy and the perinatal period. The prevalence of umbilical cord abnormalities is higher for twin pregnancies compared with singleton pregnancies. Some of these abnormalities are nonspecific to twinning and can also be found in singleton gestations (such as velamentous cord insertion, vasa previa, and single umbilical artery). Other abnormalities are associated with monochorionic twins, such as umbilical cord entanglement, and umbilical proximate cord insertion. Most of these abnormalities can be detected by ultrasound evaluation. The early and accurate ultrasound diagnosis of chorionicity, amnionicity, and placental and umbilical cord characteristics is crucial if we are to predict the risk of complications and to determine the best management for twin pregnancies. Histopathological examination of the placenta and umbilical cord after delivery can help to confirm prenatal diagnosis and to provide a better understanding of the physiopathology of their abnormalities. The aim of this review was to emphasize the role that the umbilical cord plays in twin complications and to describe the management of these high-risk pregnancies.

简介：AbstractMode of delivery in twin gestation has been a matter of debate for decades. In 2013, the only randomized controlled trial concerning mode of delivery in twin gestations was published, answering some of the most pressing questions in this matter. The Twin Birth Study randomized patients carrying dichorionic-diamniotic or monochorionic-diamniotic twins, with the first twin in cephalic presentation, between 32 and 39 weeks of gestation, to planned vaginal vs. planned cesarean delivery, and found no significant differences in perinatal or maternal outcomes. These clinical findings greatly benefit our clinical practice, but there lacks related study investigating how the practices have changed. In this review, we searched PubMed from 1980 through January 2021 using combinations of the following terms: twin, delivery, vaginal delivery, and cesarean section. We will try to address the known literature before and after the publication of the Twin Birth Study in western countries and compare that to what has been practiced in China.

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简介：AbstractTwin reversed arterial perfusion sequence, a severe and unique complication of monochorionic multiple pregnancy, is characterized by vascular anastomosis and abnormal or absent cardiac development in the twins. This article reviewed its pathogenesis, prenatal ultrasound diagnosis, and management. The pump twin’s chances for survival can be maximized by proper management. The optimal timing of the interventions remains a debate, although the latest studies encourage early intervention, i.e., in the first trimester. The most preferred approach is to interrupt the vascular supply to the acardius, such as through ultrasound-guided laser coagulation and radiofrequency ablation of the intrafetal vessels.

简介：AbstractObjective:To review the literature on long-term neurodevelopmental outcome after fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS).Methods:A literature search in PubMed, Embase, Emcare, Web of Science, Cochrane library, and Academic Search Premier was performed. Inclusion criteria were studies between 2009 and 2019 in TTTS-survivors treated with fetoscopic laser surgery and followed-up after the neonatal period with cognitive developmental tests and neurologic exams. Exclusion criteria were non-English articles and reviews, case reports, letters, and guidelines.Results:Nineteen articles were included. Long-term severe neurodevelopmental impairment (NDI) was reported by seven and ranged from 4.0% to 18.0% with a mean of 9.7% (95% confidence interval (CI): 7.8-11.5). The prevalence of cerebral palsy ranged from 1.6% to 18.2%, with a mean of 5.1% (95% CI: 4.1-6.2). The mean prevalence of minor impairment was 13.7% (95% CI: 11.4-16.0). However, only 78.9% (15/19) studies used a validated neurodevelopmental test. As studies lack uniform definitions of primary outcome, timing of follow-up, inclusion criteria, and methods, adequate comparison is hampered.Conclusion:The prevalence of severe NDI and cerebral palsy after fetoscopic laser surgery for TTTS in the last decade remains stable around 9.7% and 5.1%, respectively. International agreements on primary outcomes, methods, and follow-up are necessary to improve the knowledge of NDI in TTTS-survivors.

简介：AbstractTwin anemia polycythemia sequence (TAPS) is a chronic form of unbalanced feto-fetal transfusion through minuscule placental anastomoses in monochorionic twin pregnancies, leading to anemia in the donor twin and polycythemia in the recipient twin. TAPS can occur spontaneously in up to 5% of monochorionic twins or can arise in 2%-16% of cases after incomplete laser surgery for twin-twin transfusion syndrome. TAPS can develop across the entire second and third trimester. Antenatal diagnosis for TAPS is reached via Doppler measurement of the fetal middle cerebral artery peak systolic velocity, showing an increased velocity in the donor, combined with a decreased velocity in the recipient. Treatment options for TAPS include expectant management, preterm delivery, intrauterine blood transfusion with or without a partial exchange transfusion, fetoscopic laser surgery and selective feticide. The best treatment option is unclear and is currently being investigated in an international multicenter randomized trial (the TAPS trial). Spontaneous fetal demise occurs in 5%-11% of TAPS twins, more often in donors (8%-18%) than in recipients (2%-5%). Severe long-term neurodevelopmental impairment is seen in 9% of TAPS twins, with donors having an increased risk for cognitive impairment and hearing problems (15%).

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