互联网在骨科中的应用

互联网在骨科中的应用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英文双语骨科专业网站www.OrthoC病例讨论1:L1记住后凸畸形形主诉和病史:30岁女性，脊柱柱后凸畸形20年并腰背痛向向左小腿放散散3月6岁时曾因L1-2脊柱结核行左左前侧入路病病灶清除脊柱柱融合术随着年龄的增增加出现脊柱柱后凸畸形，，进行性加重重可以短距离行行走，长距离离行走出现间间歇性跛行，，大小便正常常体检:左侧胸腰部术术痕严重脊柱后凸凸畸形无压痛，无诱诱发性放散痛痛长距离行走间间歇性跛行双下肢肌力IV+.双下肢及会阴阴部感觉运动动正常膝反射:+++;跟腱反射:left/right=-/+;Barbinski'ssign:-;Ankle-clonus:left/right=+/-.西京医院骨科科全体医生北京积水潭医院院脊柱外科田田伟主任Dr.RobertPashman,MDDirectorofScoliosis,andSpinalDeformityServices,Cedars-SinaiInstituteforSpinalDisordersinUnitedStatesYONENOBU,Kazuo,MDDepartmentofOrthopaedicSurgery,OsakaUniversity,PostgraduateMedicalSchool南京鼓楼医院院脊柱外科邱邱勇主任MADUlloaOrhopaedics&TraumaService,CHUSantiagodeCompostela,SpainDilipGopalakrishnanSpinesurgeryservice,DepartmentofOrthopaedics&Neurosurgery,MSRMC,Bangalore,INDIARichardT.Holt,MDSpineSurgery,PSC,Louisville病例报告:烫伤性脊柱侧侧弯15岁男性1月龄时时被暖暖水袋袋烫伤伤背部部并发化化脓感感染，，肌肉肉坏死死,一月后后愈背部瘢瘢痕挛挛缩，，左侧侧为重重椎旁肌肌肉缺缺失腰椎活活动受受限，，右侧侧凸畸畸形骨盆倾倾斜皮肤扩扩张器器植入入术后后(2000-2-16).瘢痕切切除，，扩张张皮瓣瓣转移移覆盖盖(2000-4-5).Date:Fri,18Feb200018:14:04ESTFrom:Pashman7777777@DearSirs,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+441865741155,Fax+441865744455Date:Mon,21Feb200018:45:51+0000

From:PaulAllcockTo:mazhensh@Thanksalotforthereport,It'savaluablelessonshowingthatweshouldalwaysexaminethepatient,notjustthexray.PaulAllcock,FRCS

Dundee

ScotlandDate: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互联网手术术直播2000-8-23右髋关节肿肿瘤30岁男性，右右髋关节肿肿胀包块形形成6年临床诊断:右髋关节恶恶性骨肿瘤瘤穿刺活检诊诊断不明确确治疗方案：：骶髂关节节离断术患者拒绝截截肢术Dr.MayilVahnanNataraja有保肢体的的可能性亚太地区肌肌肉骨骼肿肿瘤学会主主席ChiefoftheOrthopaedicOncologyServices,Adyar,Chennai,India左侧肱骨干干中1/3闭合性骨折折左侧股骨粗粗隆下闭合合性骨折右侧胫骨干干中1/3闭合性骨折折C.正位像D.侧位像14个国家的36封电子邮件件回复大部分来自自美国和英英国美国12人英国8人西班牙3人马来西亚2人尼泊尔2人巴巴多斯岛岛,比利时,加拿大,哥伦比亚,埃及,法国,印度,荷兰,土耳其各一一人.参与者英国的医生生均为年轻轻医生,美国医生绝绝大部分为为高年资医医生(12位中9位的任Consultant的时间在10年以上)回答的用语语：“根根据我的经经验(Inmyexperience)”占有绝对的的优势.此次调查中中36名反馈中,就此同一临临床病例,有多达30种不同的治治疗方案.医学是建立立在临床经经验之上的的,而不是单纯纯的事实上上(InMyExperience