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•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.org中华骨科网中英文双语骨科专业网站www.ChinaOrtho.orgwww.OrthoChina.com病例讨论1:L1记住后凸畸形通过网站和邮件讨论组:www.OrthoChina.comChinaOrthoE-maillist:[e-mail]-maillist:[e-mail]-maillist:[e-mail]•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•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'ssign:-;Ankle-clonus:left/right=+/-.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.RobertPashman,MDDirectorofScoliosis,andSpinalDeformityServices,Cedars-SinaiInstituteforSpinalDisordersinUnitedStatesYONENOBU,Kazuo,MDDepartmentofOrthopaedicSurgery,OsakaUniversity,PostgraduateMedicalSchool南京鼓楼医院脊柱外科邱勇主任MADUlloaOrhopaedics&TraumaService,CHUSantiagodeCompostela,SpainDilipGopalakrishnanSpinesurgeryservice,DepartmentofOrthopaedics&Neurosurgery,MSRMC,Bangalore,INDIARichardT.Holt,MDSpineSurgery,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•椎旁肌肉缺失•腰椎活动受限，右侧凸畸形•骨盆倾斜•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–首先切除瘢痕，修复皮肤缺损–前路矫形固定，前路植骨融合•皮肤扩张器植入术后(2000-2-16).瘢痕切除，扩张皮瓣转移覆盖(2000-4-5).Date:Fri,18Feb200018:14:04ESTFrom:[e-mail],Aboutthe15yearoldwithscoliosis-thisisaninterestingcase.ThelumbarcurveisseverlyrotatedthoughandIwouldbesuprisedifaplasticsurgeryprocedurewillinfactstraightenthecurvebyitself.Moreover,inmyexperience,lumbarcurvesarebestdonethroughananteriorspinalfusion,especiallyinflexibleindividuals.Thanks,RobertPashman,MDDirectorScoliosisandSpinalDeformityServicesCedars-SinaiInstituteforSpinalDisordersDate:Fri,18Feb200021:38:28+0000,From:JeremyFairbankDearDrZhen-shengYourcaseisveryinteresting,andIhavenotseenanythingquitelikeit.TheX-raysuggeststhecurvehasbecomestructural,andthatuntreatedithastoprogress,Heisonly14,andhehasquitealotofgrowthpotential.Myviewisthatyoushouldintrumentandfusethescoliosisintheusualway,andthattheplasticsurgeonsshouldadviseyouonthebestwaytolengthenthescaratthesametime.Youshouldkeepaclosewatchonwhathappenstillhehasfinishedgrowing.Plasticsurgeondonothaveexperienceofscoliosis.Theydonotlikelengtheningscarsuntilgrowthhsfinished.Ifyouleaveittothem,theywillwatchthecurveprogresstoamuchworsesitiationfromwhatyouhavenowJeremyFairbankJeremyFairbank,Orthopaedicsurgeon,NuffieldOrthopaedicCentre,OxfordOX37LD,UK,Tel[phone],Fax[phone]Date:Mon,21Feb200018:45:51+0000From:PaulAllcockTo:[e-mail],It'savaluablelessonshowingthatweshouldalwaysexaminethepatient,notjustthexray.PaulAllcock,FRCSDundeeScotlandDate:July2,20009:19:18AMEDTDearProf.Ma,Thankyouverymuchforsendingmeaclinicalscoliosiscaseforconsultation.Ihaveattentivelystudiedyourscoliosiscase,hereismypersonalopinions.Aboutitsetioloyg:itisascoliosiscausedbythebackscarsbecause*theconvexityofthescoliosisisatthesamethesideasthescars*thepatient'spelvisisobliqueandagainthepelvislevelsupatthesideoftheconvexityofthescoliosisAboutitstreatment:ifhisRissersignislessthan3,IsupposetheMilwaukeebrace,leavinghisspinegrowingalittlemoreandpushingthesurgerylater.ifhisRissersignismorethan3(includingR3,Ithinkthatthisisagoodindicationforanteriorsurgery(correctingandinstrumenting).TheinstrumentationareaisfromT11orT12toL3,dependingontheflexibiliyofthesecondarythoraciccurve(ifexisting).Asfarastheinstrumentationisconcerned,IprefreTSRH(personalchoice).Thankyouverymuch.Prof.YongQIU,chiefofspinedeformitycenter,NanJingGuLouHospital,NanJingUniversity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:––•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.MayilVahnanNataraja•有保肢体的可能性•亚太地区肌肉骨骼肿瘤学会主席•ChiefoftheOrthopaedicOncologyServices,Adyar,Chennai,IndiaA.左侧肱骨干中1/3闭合性骨折B.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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.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(Inmyexperience)”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(InMyExperiencev/sEvidenceBasedMedicine.).环境和医生的经验在治疗过程中的重要性.互联网:一种新工具•网站:工具专业化.•TheOrthoChinaWeb:–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互联网XThankyouforyourattention!