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互联网在骨科中的应用

互联网在骨科中的应用. 马真胜 医学博士 http://www. OrthoChina.com 西京医院骨科. 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. www.OrthoChina.com. www.OrthoChina.org. www.ChinaOrtho.org. 中华骨科网 中英文双语骨科专业网站. 病例讨论 1: L1 记住后凸畸形.

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互联网在骨科中的应用

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  1. 互联网在骨科中的应用

  2. 马真胜 医学博士 http://www. OrthoChina.com 西京医院骨科

  3. 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

  4. 1998年 女性患者 胸椎管狭窄黄韧带骨化 小针刀治疗 瘫痪

  5. www.OrthoChina.com www.OrthoChina.org www.ChinaOrtho.org 中华骨科网 中英文双语骨科专业网站

  6. 病例讨论1: L1记住后凸畸形 • 通过网站和邮件讨论组: • www. OrthoChina.com • ChinaOrtho E-mail list: • ChinaOrtho@egroups.com • Orthopod E-mail list: • orthopod@mailbase.ac.uk • Spine E-mail list: • spine@mailbase.ac.uk

  7. 主诉和病史: • 30岁女性，脊柱后凸畸形20年并腰背痛向左小腿放散3月 • 6 岁时曾因L1-2脊柱结核行左前侧入路病灶清除脊柱融合术 • 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，大小便正常

  8. 体检: • 左侧胸腰部术痕 • 严重脊柱后凸畸形 • 无压痛，无诱发性放散痛 • 长距离行走间歇性跛行 • 双下肢肌力 IV+. 双下肢及会阴部感觉运动正常 • 膝反射: +++; 跟腱反射: left/right=-/+; Barbinski's sign: -; Ankle-clonus: left/right=+/-.

  9. 西京医院骨科全体医生 北京积水潭医院脊柱外科田伟主任 Dr. Robert Pashman, MD Director of Scoliosis, and Spinal Deformity Services, Cedars-Sinai Institute for Spinal Disorders in United States YONENOBU, Kazuo, MD Department of Orthopaedic Surgery, Osaka University, Postgraduate Medical School

  10. 南京鼓楼医院脊柱外科邱勇主任 MAD Ulloa • Orhopaedics&Trauma Service, CHU Santiago de Compostela, Spain Dilip Gopalakrishnan • Spine surgery service, Department of Orthopaedics & Neurosurgery, MSRMC, Bangalore, INDIA • Richard T. Holt, MD • Spine Surgery, PSC, Louisville

  11. 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

  12. 背部瘢痕挛缩，左侧为重 • 椎旁肌肉缺失 • 腰椎活动受限，右侧凸畸形 • 骨盆倾斜

  13. 当地医院意见: • 后路脊柱内固定矫形植骨融合 • 2000.2.16--2000.7.2网上讨论 http://www.orthochina.com • 首先切除瘢痕，修复皮肤缺损 • 前路矫形固定，前路植骨融合

  14. 皮肤扩张器植入术后 (2000-2-16).

  15. 瘢痕切除，扩张皮瓣转移覆盖 (2000-4-5).

  16. Date: Fri, 18 Feb 2000 18:14:04 ESTFrom: Pashman7777777@aol.comDear Sirs,About the 15 year old with scoliosis-this is an interesting case. The 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 my experience, lumbar curves are best done through an anterior spinal fusion, especially in flexible individuals.Thanks,Robert Pashman, MD Director Scoliosis and Spinal Deformity ServicesCedars-Sinai Institute for Spinal Disorders

  17. Date: 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 structural, 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 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 Fairbank, Orthopaedic surgeon, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK, Tel +44 1865 741155, Fax +44 1865 744455

  18. Date: Mon, 21 Feb 2000 18:45:51 +0000From: Paul Allcock To: mazhensh@fmmu.edu.cn Thanks alot for the report,It's a valuable lesson showing that we should always examine the patient, not just the x ray.Paul Allcock, FRCSDundeeScotland

  19. 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 of the scoliosis is at the same the side as the scars* the patient's 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 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 instrumentation is concerned, I prefre TSRH ( personal choice ).Thank you very much.Prof. Yong QIU, chief of spine deformity center, NanJing GuLou Hospital, NanJing University

  20. 互联网手术直播 2000-8-23 • 前路矫形内固定，椎体间植骨融合 • 中华骨科网、南京鼓楼医院与南京金陵热线合作全程直播手术过程: • http://www.OrthoChina.org • http://www.superjlonline.com

  21. 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

  22. 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 Orthopaedic Oncology Services, Adyar, Chennai, India

  23. 左侧肱骨干中1/3闭合性骨折 • 左侧股骨粗隆下闭合性骨折 • 右侧胫骨干中1/3闭合性骨折 • C. 正位像 • D. 侧位像

  24. 14个国家的36封电子邮件回复 • 大部分来自美国和英国 • 美国12人 • 英国8人 • 西班牙3人 • 马来西亚2人 • 尼泊尔2人 • 巴巴多斯岛, 比利时, 加拿大, 哥伦比亚, 埃及, 法国, 印度,荷兰,土耳其各一人.

  25. 参与者 • 英国的医生均为年轻医生, • 美国医生绝大部分为高年资医生(12位中9位的任Consultant的时间在10年以上) • 回答的用语： “根据我的经验(In my experience)”占有绝对的优势.此次调查中 • 36名反馈中, 就此同一临床病例, 有多达30种不同的治疗方案. • 医学是建立在临床经验之上的, 而不是单纯的事实上(In My Experience v/s Evidence Based Medicine.). • 环境和医生的经验在治疗过程中的重要性.

  26. 互联网: 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

  27. 先天性多肢体畸形

  28. 互联网 X

  29. Thank you for your attention!

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