互聯(lián)網(wǎng)在骨科中的應用課件

互聯(lián)網(wǎng)在骨科中的應用互聯(lián)網(wǎng)在骨科中的應用1互聯(lián)網(wǎng)在骨科中的應用課件21992:第一次接觸調制解調器1997,6:第四軍醫(yī)大學網(wǎng)絡中心成立1997,8:首次國際使用互聯(lián)網(wǎng)1997,11:開始制作個人主頁1992:第一次接觸調制解調器31998年女性患者胸椎管狹窄黃韌帶骨化小針刀治療癱瘓1998年4中華骨科網(wǎng)中英文雙語骨科專業(yè)網(wǎng)站www.OrthoC中華骨科網(wǎng)www.OrthoC5互聯(lián)網(wǎng)在骨科中的應用課件6互聯(lián)網(wǎng)在骨科中的應用課件7互聯(lián)網(wǎng)在骨科中的應用課件8互聯(lián)網(wǎng)在骨科中的應用課件9互聯(lián)網(wǎng)在骨科中的應用課件10互聯(lián)網(wǎng)在骨科中的應用課件11互聯(lián)網(wǎng)在骨科中的應用課件12病例討論1:L1記住后凸畸形病例討論1:L1記住后凸畸形13互聯(lián)網(wǎng)在骨科中的應用課件14主訴和病史:30歲女性，脊柱后凸畸形20年并腰背痛向左小腿放散3月6歲時曾因L1-2脊柱結核行左前側入路病灶清除脊柱融合術隨著年齡的增加出現(xiàn)脊柱后凸畸形，進行性加重可以短距離行走，長距離行走出現(xiàn)間歇性跛行，大小便正常互聯(lián)網(wǎng)在骨科中的應用課件15體檢:左側胸腰部術痕嚴重脊柱后凸畸形無壓痛，無誘發(fā)性放散痛長距離行走間歇性跛行雙下肢肌力IV+.雙下肢及會陰部感覺運動正常膝反射:+++;跟腱反射:left/right=-/+;Barbinski'ssign:-;Ankle-clonus:left/right=+/-.體檢:16西京醫(yī)院骨科全體醫(yī)生北京積水潭醫(yī)院脊柱外科田偉主任Dr.RobertPashman,MDDirectorofScoliosis,andSpinalDeformityServices,Cedars-SinaiInstituteforSpinalDisordersinUnitedStatesYONENOBU,Kazuo,MDDepartmentofOrthopaedicSurgery,OsakaUniversity,PostgraduateMedicalSchool西京醫(yī)院骨科全體醫(yī)生17南京鼓樓醫(yī)院脊柱外科邱勇主任MADUlloaOrhopaedics&TraumaService,CHUSantiagodeCompostela,SpainDilipGopalakrishnanSpinesurgeryservice,DepartmentofOrthopaedics&Neurosurgery,MSRMC,Bangalore,INDIARichardT.Holt,MDSpineSurgery,PSC,Louisville

南京鼓樓醫(yī)院脊柱外科邱勇主任18病例報告:燙傷性脊柱側彎15歲男性1月齡時被暖水袋燙傷背部并發(fā)化膿感染，肌肉壞死,一月后愈病例報告:燙傷性脊柱側彎15歲男性19背部瘢痕攣縮，左側為重椎旁肌肉缺失腰椎活動受限，右側凸畸形骨盆傾斜背部瘢痕攣縮，左側為重20互聯(lián)網(wǎng)在骨科中的應用課件21皮膚擴張器植入術后(2000-2-16).皮膚擴張器植入術后(2000-2-16).22瘢痕切除，擴張皮瓣轉移覆蓋(2000-4-5).瘢痕切除，擴張皮瓣轉移覆蓋(2000-4-5).23互聯(lián)網(wǎng)在骨科中的應用課件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互聯(lián)網(wǎng)手術直播2000-8-23互聯(lián)網(wǎng)手術直播2000-8-2329右髖關節(jié)腫瘤 30歲男性，右髖關節(jié)腫脹包塊形成6年臨床診斷:右髖關節(jié)惡性骨腫瘤穿刺活檢診斷不明確治療方案：骶髂關節(jié)離斷術患者拒絕截肢術右髖關節(jié)腫瘤 30歲男性，右髖關節(jié)腫脹包塊形成6年30互聯(lián)網(wǎng)在骨科中的應用課件31互聯(lián)網(wǎng)在骨科中的應用課件32Dr.MayilVahnanNataraja有保肢體的可能性亞太地區(qū)肌肉骨骼腫瘤學會主席ChiefoftheOrthopaedicOncologyServices,Adyar,Chennai,IndiaDr.MayilVahnanNataraja有保肢體的33左側肱骨干中1/3閉合性骨折左側股骨粗隆下閉合性骨折右側脛骨干中1/3閉合性骨折C.正位像D.側位像左側肱骨干中1/3閉合性骨折右側脛骨干中1/3閉合性骨折3414個國家的36封電子郵件回復大部分來自美國和英國美國12人英國8人西班牙3人馬來西亞2人尼泊爾2人巴巴多斯島,比利時,加拿大,哥倫比亞,埃及,法國,印度,荷蘭,土耳其各一人.14個國家的36封電子郵件回復35參與者英國的醫(yī)生均為年輕醫(yī)生,美國醫(yī)生絕大部分為高年資醫(yī)生(12位中9位的任Consultant的時間在10年以上)回答的用語：“根據(jù)我的經(jīng)驗(Inmyexperience)”占有絕對的優(yōu)勢.此次調查中36名反饋中,就此同一臨床病例,有多達30種不同的治療方案.醫(yī)學是建立在臨床經(jīng)驗之上的,而不是單純的事實上(InMyExperiencev/sEvidenceBasedMedicine.).環(huán)境和醫(yī)生的經(jīng)驗在治療過程中的重要性.參與者36互聯(lián)網(wǎng):一種新工具網(wǎng)站:工具專業(yè)化.TheOrthoChinaWeb:利用互聯(lián)網(wǎng)為骨科醫(yī)生及相關人員，特別是中國國內的骨科醫(yī)生服務互聯(lián)網(wǎng):一種新工具網(wǎng)站:工具專業(yè)化.37先天性多肢體畸形先天性多肢體畸形38互聯(lián)網(wǎng)X互聯(lián)網(wǎng)X39Thankyouforyourattention!Thankyouforyourattention!40互聯(lián)網(wǎng)在骨科中的應用互聯(lián)網(wǎng)在骨科中的應用41互聯(lián)網(wǎng)在骨科中的應用課件421992:第一次接觸調制解調器1997,6:第四軍醫(yī)大學網(wǎng)絡中心成立1997,8:首次國際使用互聯(lián)網(wǎng)1997,11:開始制作個人主頁1992:第一次接觸調制解調器431998年女性患者胸椎管狹窄黃韌帶骨化小針刀治療癱瘓1998年44中華骨科網(wǎng)中英文雙語骨科專業(yè)網(wǎng)站www.OrthoC中華骨科網(wǎng)www.OrthoC45互聯(lián)網(wǎng)在骨科中的應用課件46互聯(lián)網(wǎng)在骨科中的應用課件47互聯(lián)網(wǎng)在骨科中的應用課件48互聯(lián)網(wǎng)在骨科中的應用課件49互聯(lián)網(wǎng)在骨科中的應用課件50互聯(lián)網(wǎng)在骨科中的應用課件51互聯(lián)網(wǎng)在骨科中的應用課件52病例討論1:L1記住后凸畸形病例討論1:L1記住后凸畸形53互聯(lián)網(wǎng)在骨科中的應用課件54主訴和病史:30歲女性，脊柱后凸畸形20年并腰背痛向左小腿放散3月6歲時曾因L1-2脊柱結核行左前側入路病灶清除脊柱融合術隨著年齡的增加出現(xiàn)脊柱后凸畸形，進行性加重可以短距離行走，長距離行走出現(xiàn)間歇性跛行，大小便正?；ヂ?lián)網(wǎng)在骨科中的應用課件55體檢:左側胸腰部術痕嚴重脊柱后凸畸形無壓痛，無誘發(fā)性放散痛長距離行走間歇性跛行雙下肢肌力IV+.雙下肢及會陰部感覺運動正常膝反射:+++;跟腱反射:left/right=-/+;Barbinski'ssign:-;Ankle-clonus:left/right=+/-.體檢:56西京醫(yī)院骨科全體醫(yī)生北京積水潭醫(yī)院脊柱外科田偉主任Dr.RobertPashman,MDDirectorofScoliosis,andSpinalDeformityServices,Cedars-SinaiInstituteforSpinalDisordersinUnitedStatesYONENOBU,Kazuo,MDDepartmentofOrthopaedicSurgery,OsakaUniversity,PostgraduateMedicalSchool西京醫(yī)院骨科全體醫(yī)生57南京鼓樓醫(yī)院脊柱外科邱勇主任MADUlloaOrhopaedics&TraumaService,CHUSantiagodeCompostela,SpainDilipGopalakrishnanSpinesurgeryservice,DepartmentofOrthopaedics&Neurosurgery,MSRMC,Bangalore,INDIARichardT.Holt,MDSpineSurgery,PSC,Louisville

南京鼓樓醫(yī)院脊柱外科邱勇主任58病例報告:燙傷性脊柱側彎15歲男性1月齡時被暖水袋燙傷背部并發(fā)化膿感染，肌肉壞死,一月后愈病例報告:燙傷性脊柱側彎15歲男性59背部瘢痕攣縮，左側為重椎旁肌肉缺失腰椎活動受限，右側凸畸形骨盆傾斜背部瘢痕攣縮，左側為重60互聯(lián)網(wǎng)在骨科中的應用課件61皮膚擴張器植入術后(2000-2-16).皮膚擴張器植入術后(2000-2-16).62瘢痕切除，擴張皮瓣轉移覆蓋(2000-4-5).瘢痕切除，擴張皮瓣轉移覆蓋(2000-4-5).63互聯(lián)網(wǎng)在骨科中的應用課件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