互联网在骨科中的应用课件

互联网在骨科中的应用互联网在骨科中的应用1互联网在骨科中的应用课件21992: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1992:第一次接触调制解调器31998年女性患者胸椎管狭窄黄韧带骨化小针刀治疗瘫痪1998年4中华骨科网中英文双语骨科专业网站www.OrthoC中华骨科网www.OrthoC5互联网在骨科中的应用课件6互联网在骨科中的应用课件7互联网在骨科中的应用课件8互联网在骨科中的应用课件9互联网在骨科中的应用课件10互联网在骨科中的应用课件11互联网在骨科中的应用课件12病例讨论1:L1记住后凸畸形病例讨论1:L1记住后凸畸形13互联网在骨科中的应用课件14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，大小便正常互联网在骨科中的应用课件15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=+/-.体检:16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西京医院骨科全体医生17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

南京鼓楼医院脊柱外科邱勇主任18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,一月后愈病例报告:烫伤性脊柱侧弯15岁男性19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背部瘢痕挛缩，左侧为重20互联网在骨科中的应用课件21皮肤扩张器植入术后(2000-2-16).皮肤扩张器植入术后(2000-2-16).22瘢痕切除，扩张皮瓣转移覆盖(2000-4-5).瘢痕切除，扩张皮瓣转移覆盖(2000-4-5).23互联网在骨科中的应用课件24Date:Fri,18Feb200018:14:04EST

From:Pashman7777777@

DearSirs,

Aboutthe15yearoldwithscoliosis-thisisaninterestingcase.ThelumbarcurveisseverlyrotatedthoughandIwouldbesuprisedifaplasticsurgeryprocedurewillinfactstraightenthecurvebyitself.Moreover,inmyexperience,lumbarcurvesarebestdonethroughananteriorspinalfusion,especiallyinflexibleindividuals.

Thanks,

RobertPashman,MD

DirectorScoliosisandSpinalDeformityServices

Cedars-SinaiInstituteforSpinalDisordersDate:Fri,18Feb200018:14:025Date:Fri,18Feb200021:38:28+0000,From:JeremyFairbank

DearDrZhen-sheng

Yourcaseisveryinteresting,andIhavenotseenanythingquitelikeit.TheX-raysuggeststhecurvehasbecomestructural,andthatuntreatedithastoprogress,Heisonly14,andhehasquitealotofgrowthpotential.

Myviewisthatyoushouldintrumentandfusethescoliosisintheusualway,andthattheplasticsurgeonsshouldadviseyouonthebestwaytolengthenthescaratthesametime.Youshouldkeepaclosewatchonwhathappenstillhehasfinishedgrowing.Plasticsurgeondonothaveexperienceofscoliosis.Theydonotlikelengtheningscarsuntilgrowthhsfinished.Ifyouleaveittothem,theywillwatchthecurveprogresstoamuchworsesitiationfromwhatyouhavenow

JeremyFairbank

JeremyFairbank,Orthopaedicsurgeon,NuffieldOrthopaedicCentre,OxfordOX37LD,UK,Tel+441865741155,Fax+441865744455Date:Fri,18Feb200021:38:226Date:Mon,21Feb200018:45:51+0000

From:PaulAllcock

To:mazhensh@

Thanksalotforthereport,

It'savaluablelessonshowingthatweshouldalwaysexaminethepatient,notjustthexray.

PaulAllcock,FRCS

Dundee

ScotlandDate:Mon,21Feb200018:45:527Date:July2,20009:19:18AMEDT

DearProf.Ma,

Thankyouverymuchforsendingmeaclinicalscoliosiscaseforconsultation.Ihaveattentivelystudiedyourscoliosiscase,hereismypersonalopinions.Aboutitsetioloyg:itisascoliosiscausedbythebackscarsbecause

*theconvexityofthescoliosisisatthesamethesideasthescars

*thepatient'spelvisisobliqueandagainthepelvislevelsupatthesideoftheconvexityofthescoliosis

Aboutitstreatment:ifhisRissersignislessthan3,IsupposetheMilwaukeebrace,leavinghisspinegrowingalittlemoreandpushingthesurgerylater.ifhisRissersignismorethan3(includingR3,Ithinkthatthisisagoodindicationforanteriorsurgery(correctingandinstrumenting).TheinstrumentationareaisfromT11orT12toL3,dependingontheflexibiliyofthesecondarythoraciccurve(ifexisting).Asfarastheinstrumentationisconcerned,IprefreTSRH(personalchoice).

Thankyouverymuch.

Prof.YongQIU,chiefofspinedeformitycenter,NanJingGuLouHospital,NanJingUniversityDate:July2,20009:19:18AM28互联网手术直播2000-8-23互联网手术直播2000-8-2329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右髋关节肿瘤 30岁男性，右髋关节肿胀包块形成6年30互联网在骨科中的应用课件31互联网在骨科中的应用课件32Dr.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,IndiaDr.MayilVahnanNataraja有保肢体的33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.侧位像左侧肱骨干中1/3闭合性骨折右侧胫骨干中1/3闭合性骨折3414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.14个国家的36封电子邮件回复35参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.参与者36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互联网:一种新工具网站:工具专业化.37先天性多肢体畸形先天性多肢体畸形38互联网X互联网X39Thankyouforyourattention!Thankyouforyourattention!40互联网在骨科中的应用互联网在骨科中的应用41互联网在骨科中的应用课件421992: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1992:第一次接触调制解调器431998年女性患者胸椎管狭窄黄韧带骨化小针刀治疗瘫痪1998年44中华骨科网中英文双语骨科专业网站www.OrthoC中华骨科网www.OrthoC45互联网在骨科中的应用课件46互联网在骨科中的应用课件47互联网在骨科中的应用课件48互联网在骨科中的应用课件49互联网在骨科中的应用课件50互联网在骨科中的应用课件51互联网在骨科中的应用课件52病例讨论1:L1记住后凸畸形病例讨论1:L1记住后凸畸形53互联网在骨科中的应用课件54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，大小便正常互联网在骨科中的应用课件55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=+/-.体检:56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西京医院骨科全体医生57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

南京鼓楼医院脊柱外科邱勇主任58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,一月后愈病例报告:烫伤性脊柱侧弯15岁男性59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背部瘢痕挛缩，左侧为重60互联网在骨科中的应用课件61皮肤扩张器植入术后(2000-2-16).皮肤扩张器植入术后(2000-2-16).62瘢痕切除，扩张皮瓣转移覆盖(2000-4-5).瘢痕切除，扩张皮瓣转移覆盖(2000-4-5).63互联网在骨科中的应用课件64Date:Fri,18Feb200018:14:04EST

From:Pashman7777777@

DearSirs,

Aboutthe15yearoldwithscoliosis-thisisaninterestingcase.ThelumbarcurveisseverlyrotatedthoughandIwouldbesuprisedifaplasticsurgeryprocedurewillinfactstraightenthecurvebyitself.Moreover,inmyexperience,lumbarcurvesarebestdonethroughananteriorspinalfusion,especiallyinflexibleindividuals.

Thanks,

RobertPashman,MD

DirectorScoliosisandSpinalDeformityServices

Cedars-SinaiInstituteforSpinalDisordersDate:Fri,18Feb200018:14:065Date:Fri,18Feb200021:38:28+0000,From:JeremyFairbank

DearDrZhen-sheng

Yourcaseisveryinteresting,andIhavenotseenanythingquitelikeit.TheX-raysuggeststhecurvehasbecomestructural,andthatuntreatedithastoprogress,Heisonly14,andhehasquitealotofgrowthpotential.

Myviewisthatyoushouldintrumentandfusethescoliosisintheusualway,andthattheplasticsurgeonsshouldadviseyouonthebestwaytolengthenthescaratthesametime.Youshouldkeepaclosewatchonwhathappenstillhehasfinishedgrowing.Plasticsurgeondonothaveexperienceofscoliosis.Theydonotlikelengtheningscarsuntilgrowthhsfinished.Ifyouleaveittothem,theywillwatchthecurveprogresstoamuchworsesitiationfromwhatyouhavenow

JeremyFairbank

JeremyFairbank,Orthopaedicsurgeon,NuffieldOrthopaedicCentre,OxfordOX37LD,UK,Tel+441865741155,Fax+441865744455Date:Fri,18Feb200021:38:266Date:Mon,21Feb200018:45:51+0000

From:PaulAllcock

To:mazhensh@

Thanksalotforthereport,

It'savaluablelessonshowingthatweshouldalwaysexaminethepatient,notjustthexray.

PaulAllcock,FRCS

Dundee

ScotlandDate:Mon,21Feb200018:45:567Date:July2,20009:19:18AMEDT

DearProf.Ma,

Thankyouverymuchforsendingmeaclinicalscoliosiscaseforconsultation.Ihaveattentivelystudiedyourscoliosiscase,hereismypersonalopinions.Aboutitsetioloyg:itisascoliosiscausedbythebackscarsbecause

*theconvexityofthescoliosisisatthesamethesideasthescars

*thepatient'spelvisisobliqueandagainthepelvislevelsupatthesideoftheconvexityofthescoliosis

Aboutitstreatment:ifhisRissersignislessthan3,IsupposetheMilwaukeebrace,leavinghisspinegrowingalittlemoreandpushingthesurgerylater.ifhisRissersignismorethan3(includingR3,Ithinkthatthisisagoodindicationforanteriorsurgery(correctingandinstrumenting).TheinstrumentationareaisfromT11orT12toL3,dependingontheflexibiliyofthesecondarythoraciccurve(ifexisting).Asfarastheinstrumentationisconcerned,IprefreTSRH(personalchoice).

Thankyouverymuch.

Prof.YongQIU,chiefofspinedeformitycenter,NanJingGuLouHospital,NanJin