互联网在骨科中的应用24881.pptx

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1、互联网在骨科互联网在骨科中的应用中的应用1992:第一次接触调制解调器1997,6:第四军医大学网络中心成立1997,8:首次国际使用互联网1997,11:开始制作个人主页1998年女性患者胸椎管狭窄黄韧带骨化小针刀治疗瘫痪中华骨科网中华骨科网中英文双语骨科专业网站中英文双语骨科专业网站www.OrthoC病例讨论病例讨论1:L1记住后凸畸形记住后凸畸形主诉和病史:3030岁女性，脊柱后凸畸形岁女性，脊柱后凸畸形2020年并腰背痛向左小腿放年并腰背痛向左小腿放散散3 3月月 6 6 岁时曾因岁时曾因L1-2L1-2脊柱结核行左前侧入路病灶清除脊脊柱结核行左前侧入路病灶清除脊柱融合术柱融合术 随

2、着年龄的增加出现脊柱后凸畸形，进行性加重随着年龄的增加出现脊柱后凸畸形，进行性加重 可以短距离行走，长距离行走出现间歇性跛行，大可以短距离行走，长距离行走出现间歇性跛行，大小便正常小便正常体检:左侧胸腰部术痕左侧胸腰部术痕 严重脊柱后凸畸形严重脊柱后凸畸形 无压痛，无诱发性放散痛无压痛，无诱发性放散痛 长距离行走间歇性跛行长距离行走间歇性跛行 双下肢肌力双下肢肌力 IV+IV+.双下肢及会阴部感觉运动正常双下肢及会阴部感觉运动正常 膝反射膝反射:+;:+;跟腱反射跟腱反射:left/right=-/+;Barbinskis sign:-;:left/right=-/+;Barbinskis s

3、ign:-;Ankle-clonus:left/right=+/-.Ankle-clonus:left/right=+/-.西京医院骨科全体医生西京医院骨科全体医生北北京积水潭医院脊柱外科田伟主任京积水潭医院脊柱外科田伟主任Dr.Robert Pashman,MDDirector of Scoliosis,and Spinal Deformity Director of Scoliosis,and Spinal Deformity Services,Cedars-Sinai Institute for Spinal Services,Cedars-Sinai Institute for Spi

4、nal Disorders in United StatesDisorders in United StatesYONENOBU,Kazuo,MDDepartment of Orthopaedic Surgery,Osaka Department of Orthopaedic Surgery,Osaka University,Postgraduate Medical SchoolUniversity,Postgraduate Medical School南京鼓楼医院脊柱外科邱勇主任南京鼓楼医院脊柱外科邱勇主任南京鼓楼医院脊柱外科邱勇主任南京鼓楼医院脊柱外科邱勇主任MAD UlloaMAD Ul

5、loaOrhopaedics&Trauma Orhopaedics&Trauma Service,Service,CHU CHU Santiago Santiago de de Compostela,SpainCompostela,SpainDilip GopalakrishnanDilip GopalakrishnanSpine Spine surgery surgery service,service,Department Department of of Orthopaedics Orthopaedics&Neurosurgery,MSRMC,Bangalore,INDIA&Neuros

6、urgery,MSRMC,Bangalore,INDIARichard T.Holt,MDRichard T.Holt,MDSpine Surgery,PSC,LouisvilleSpine Surgery,PSC,Louisville病例报告:烫伤性脊柱侧弯15岁男性1月龄时被暖水袋烫伤背部并发化脓感染，肌肉坏死,一月后愈背部瘢痕挛缩，左侧为重背部瘢痕挛缩，左侧为重椎旁肌肉缺失椎旁肌肉缺失腰椎活动受限，右侧凸畸形腰椎活动受限，右侧凸畸形骨盆倾斜骨盆倾斜皮肤皮肤扩张扩张器植入器植入术术后后 (2000-2-16).(2000-2-16).瘢痕切除，瘢痕切除，扩张扩张皮瓣皮瓣转转移覆盖移覆盖 (

7、2000-4-5).(2000-4-5).Date:Fri,18 Feb 2000 18:14:04 ESTDate:Fri,18 Feb 2000 18:14:04 ESTFrom:PFrom:PDear Sirs,Dear Sirs,About the 15 year old with scoliosis-this is an interesting case.The About the 15 year old with scoliosis-this is an interesting case.The lumbar curve is severly rotated though and

8、I would be suprised if a plastic lumbar curve is severly rotated though and I would be suprised if a plastic surgery procedure will in fact straighten the curve by itself.Moreover,in surgery procedure will in fact straighten the curve by itself.Moreover,in my experience,lumbar curves are best done t

9、hrough an anterior spinal my experience,lumbar curves are best done through an anterior spinal fusion,especially in flexible individuals.fusion,especially in flexible individuals.Thanks,Thanks,Robert Pashman,MD Robert Pashman,MD Director Scoliosis and Spinal Deformity ServicesDirector Scoliosis and

10、Spinal Deformity ServicesCedars-Sinai Institute for Spinal DisordersCedars-Sinai Institute for Spinal DisordersDate:Fri,18 Feb 2000 21:38:28+0000,From:Jeremy Fairbank Dear Dr Zhen-shengYour case is very interesting,and I have not seen anything quite like it.The X-ray suggests the curve has become st

11、ructural,and that untreated it has to progress,He is only 14,and he has quite a lot of growth potential.My view is that you should intrument and fuse the scoliosis in the usual way,and that the plastic surgeons should advise you on the best way to lengthen the scar at the same time.You should keep a

12、 close watch on what happens till he has finished growing.Plastic surgeon do not have experience of scoliosis.They do not like lengthening scars until growth hs finished.If you leave it to them,they will watch the curve progress to a much worse sitiation from what you have nowJeremy FairbankJeremy F

13、airbank,Orthopaedic surgeon,Nuffield Orthopaedic Centre,Oxford OX3 7LD,UK,Tel+44 1865 741155,Fax+44 1865 744455 Date:Mon,21 Feb 2000 18:45:51+0000From:Paul Allcock To:Thanks alot for the report,Its a valuable lesson showing that we should always examine the patient,not just the x ray.Paul Allcock,FR

14、CSDundeeScotland Date:July 2,2000 9:19:18 AM EDT Dear Prof.Ma,Thank you very much for sending me a clinical scoliosis case for consultation.I have attentively studied your scoliosis case,here is my personal opinions.About its etioloyg:it is a scoliosis caused by the back scars because*the convexity

15、of the scoliosis is at the same the side as the scars*the patients pelvis is oblique and again the pelvis levels up at the side of the convexity of the scoliosisAbout its treatment:if his Risser sign is less than 3,I suppose the Milwaukee brace,leaving his spine growing a little more and pushing the

16、 surgery later.if his Risser sign is more than 3(including R 3,I think that this is a good indication for anterior surgery(correcting and instrumenting).The instrumentation area is from T11 or T12 to L3,depending on the flexibiliy of the secondary thoracic curve(if existing).As far as the instrument

17、ation is concerned,I prefre TSRH(personal choice).Thank you very much.Prof.Yong QIU,chief of spine deformity center,NanJing GuLou Hospital,NanJing University 互联网手术直播 2000-8-23右髋关节肿瘤30岁男性，右髋关节肿胀包块形成6年临床诊断:右髋关节恶性骨肿瘤 穿刺活检诊断不明确治疗方案：骶髂关节离断术患者拒绝截肢术Dr.Mayil Vahnan Nataraja有保肢体的可能性亚太地区肌肉骨骼肿瘤学会主席Chief of the

18、 Orthopaedic Oncology Services,Adyar,Chennai,IndiaA.左侧肱骨干中左侧肱骨干中1/3闭合性骨折闭合性骨折B.左侧股骨粗隆下闭合性骨折左侧股骨粗隆下闭合性骨折右侧胫骨干中右侧胫骨干中1/3闭合性骨折闭合性骨折C.正位像正位像D.侧位像侧位像l l1414个国家的个国家的个国家的个国家的3636封电子邮件回复封电子邮件回复封电子邮件回复封电子邮件回复l l大部分来自美国和英国大部分来自美国和英国大部分来自美国和英国大部分来自美国和英国 美国美国美国美国1212人人人人 英国英国英国英国8 8人人人人 西班牙西班牙西班牙西班牙3 3人人人人 马来西亚

19、马来西亚马来西亚马来西亚2 2人人人人 尼泊尔尼泊尔尼泊尔尼泊尔2 2人人人人 巴巴巴巴巴巴巴巴多多多多斯斯斯斯岛岛岛岛,比比比比利利利利时时时时,加加加加拿拿拿拿大大大大,哥哥哥哥伦伦伦伦比比比比亚亚亚亚,埃埃埃埃及及及及,法法法法国国国国,印度印度印度印度,荷兰荷兰荷兰荷兰,土耳其各一人土耳其各一人土耳其各一人土耳其各一人.l l参与者参与者参与者参与者 英国的医生均为年轻医生英国的医生均为年轻医生英国的医生均为年轻医生英国的医生均为年轻医生,美美美美国国国国医医医医生生生生绝绝绝绝大大大大部部部部分分分分为为为为高高高高年年年年资资资资医医医医生生生生(12(12位位位位中中中中9 9位

20、位位位的的的的任任任任ConsultantConsultant的的的的时间在时间在时间在时间在1010年以上年以上年以上年以上)回回回回答答答答的的的的用用用用语语语语：“根根根根据据据据我我我我的的的的经经经经验验验验(In(In my my experience)”experience)”占占占占有有有有绝绝绝绝对对对对的的的的优势优势优势优势.此次调查中此次调查中此次调查中此次调查中l l3636名名名名反反反反馈馈馈馈中中中中,就就就就此此此此同同同同一一一一临临临临床床床床病病病病例例例例,有有有有多多多多达达达达3030种种种种不不不不同同同同的的的的治治治治疗方案疗方案疗方案疗方

21、案.l l医医医医学学学学是是是是建建建建立立立立在在在在临临临临床床床床经经经经验验验验之之之之上上上上的的的的,而而而而不不不不是是是是单单单单纯纯纯纯的的的的事事事事实实实实上上上上(In My Experience v/s Evidence Based Medicine.).(In My Experience v/s Evidence Based Medicine.).l l环境和医生的经验在治疗过程中的重要性环境和医生的经验在治疗过程中的重要性环境和医生的经验在治疗过程中的重要性环境和医生的经验在治疗过程中的重要性.互联网互联网:一种新工具一种新工具网站:工具专业化.The OrthoChina Web:利用互联网为骨科医生及相关人员，特别是中国国内的骨科医生服务先天性多肢体畸形先天性多肢体畸形互联网互联网XThank you for your attention!