Systems-based integrated course is a advanced and mainstream educational mode in western medical education, and also it is a hotspot of current medical education reform in China. In this article, we introduce our practice and the students' feedback of the orthopedic module of 8-year clinical medicine systems-based integrated course. During practice, we follow the integral curriculum design of Sichuan University, establish a team of teachers, integrate the curriculum of relevant disciplines, and improve teaching methods, ameliorate evaluation forms, etc. Through the implementation of this course, we recognize that this new course system aims to cultivate excellent clinical doctors, which focuses on the bilateral permeation and reconstruction among disciplines, especially between basic curriculums and clinical curriculums, changes traditional teaching methods, and strengthens the ability of practice and lifelong learning.
Objective To investigate the early diagnosis of lower l imb deep vein thrombosis (DVT) after major orthopedic surgeries. Methods From October 2005 to June 2009, color doppler sonography and hemorheology detection were carried out for 62 cases undergoing first total hip arthroplasty (THA), 14 cases undergoing total knee arthroplasty (TKA), and 86 cases undergoing hip fractures surgery (HFS) before operation and 1, 7, 14 days after operation. The plasma D-dimerlevels of the DVT were also examined for the THA patients before operation and 3 days after operation. Of all cases, therewere 89 males and 73 females, aged from 34 to 74 years (51.5 years on average). After operation, all the patients were treated with the regular low molecular weight heparin sodium against DVT. Results After operation, 17 cases (10.5%) developed DVT, including 8 THA cases, 1 TKA case, and 8 HFS cases. Preoperative color doppler sonography showed no abnormal echo, normal b blood flow signal, and normal periodical variation in vein blood flow without regurgitation. Postoperative examinations showed that the vascular occlusion of common femoral vein and popl iteal vein occurred in DVT patients. There were significant differences (P lt; 0.05) in whole blood viscosity between patients with DVT and without DVT after 1, 14 days and no significant difference (P gt; 0.05) before operation and 7 days after operation. There was no significant difference (P gt; 0.05) in plasma viscosity and erythrocyte aggregation index, between patients with DVT and without DVT pre- and postoperation. There was significant difference (P lt; 0.05) in erythrocyte deformation index between patients with DVT and without DVT 14 days after operation. The preoperative plasma D-dimer levels of patients with DVT and without DVT were (372.00 ± 148.62) ng/mL and (369.00 ± 141.03) ng/mL, respectively, showing no significant difference (P gt; 0.05); the 3 days postoperatively levels were (574.00 ± 217.29) ng/mL and (391.00 ± 120.16) ng/mL, respectively, showing significant difference (P lt; 0.05). Conclusion Color doppler sonography in combination of hemorheology and plasma D-dimer examination can be beneficial for the early diagnosis of DVT in major orthopedic surgeries.
Graphene and its derivatives have good physical and chemical properties and biological properties, which can promote stem cell proliferation and osteogenic differentiation, and it has antibacterial properties and drug release property. Therefore, it has broad application prospects in the field of orthopedic biomaterials. This paper mainly introduces the research progress of graphene nanocomposite materials applied in the aspects of bone tissue engineering scaffold, bone repair, bone graft materials, etc. in order to provide desirable information for the future application basis and clinical research.
【Abstract】 Objective To investigate the appl ication and significance of computer assisted orthopedicsurgery(CAOS) in orthopedic trauma surgery. Methods In orthopedic trauma surgery, the appl ication status of CAOS was?analysed and the related problems were summarized. Results At present, CAOS is seldom used to reduce fractures but frequently used to insert internal fixation devices and reconstruct the cruciate l igament in orthopedic trauma surgery. And the studies have shown its superiority. During CAOS appl ication, surgeons should pay attention to some problems such as the disadvantages, cl inical evaluation, the roles of the surgeons and correct micro-traumatic concept. Conclusion CAOS is very important and cannot be replaced in orthopedic trauma minimal invasion surgery and surgeons should pay attention to some important related problems to make it develop successfully in the study of CAOS.
Objective To explore the application of robot-assisted pedicle screw fixation combined with total endoscopic decompression and interbody fusion in single segment lumbar decompression and fusion. Methods A total of 27 cases undergoing single segment lumbar decompression and fusion between August 2020 and May 2021 in the People’s Hospital of Deyang City were retrospectively collected. They were divided into group A and B according to their surgery method. The patients in group A underwent robot-assisted pedicle screw fixation combined with total endoscopic decompression and interbody fusion surgery, while the ones in group B underwent traditional posterior decompression and fusion. The operation time, amount of bleeding, Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI) score before operation and one month and three months after operation, and success rate of screw placement were compared. Results There were 12 patients in group A, 5 males and 7 females, aged (59.83±6.79) years, and 15 patients in group B, 6 males and 9 females, aged (53.73±14.87) years. The amount of intraoperative bleeding [(195.00±45.23) vs. (240.00±47.06) mL] and postoperative hospital stay [(5.92±1.56) vs. (8.33±3.62) d] in group A were less than those in group B (P<0.05), while the operation time [(185.80±52.13) vs. (160.70±21.37) min] and the success rate of screw placement [100.0% (48/48) vs. 96.7% (58/60)] had no statistical difference between the two groups (P>0.05). The VAS score and ODI score of the two groups decreased significantly over time (P<0.05), but there was no significant difference in VAS score between the two groups at the same time point before operation, one month after operation, or three months after operation (P>0.05). The ODI score of group A was better than that of group B one month after operation (P=0.010), but there was no significant difference between the two groups before operation or three months after operation (P>0.05). Conclusion Compared with traditional open surgery, the application of robot-assisted total endoscopic lumbar decompression and fusion technology in single segment lumbar fusion has good early clinical outcome, high success rate of screw placement, and small trauma, which is beneficial to early functional recovery and has the significance of further exploring its application prospect.
ObjectiveTo investigate the effectiveness of TiRobot-assisted percutaneous sacroiliac cannulated screw fixation in the treatment of posterior pelvic ring injuries with sacral variations, and to evaluate its feasibility and safety. Methods The clinical data of 7 patients with Tile type C pelvic fractures and sacral variations treated with TiRobot-assisted percutaneous sacroiliac cannulated screw fixation between January 2020 and June 2021 were retrospectively analyzed. There were 5 males and 2 females with an average age of 36 years (range, 17-56 years). The causes of injury were traffic accident in 4 cases and falling from height in 3 cases. According to Tile classification of pelvic fractures, there were 1 case of type C1.1, 1 case of type C1.2, and 5 cases of type C1.3; according to Denis classification of sacral fractures, there were 3 cases of zone Ⅰ and 4 cases of zone Ⅱ; sacral deformities included 3 cases of lumbar sacralization, 2 cases of sacral lumbarization, and 2 cases of accessory auricular surface of the sacrum. The time from injury to operation ranged from 2 to 7 days, with an average of 4.6 days. The implantation time of each screw, the fluoroscopy times of each guide pin, the quality of fracture reduction (according to Matta score), the excellent and good rate of screw position, the healing time of fracture, and the incidence of complications were recorded, and the effectiveness was evaluated by Majeed score. Results A total of 13 screws were implanted during the operation, the implantation time of each screw was 10-23 minutes, with an average of 18.2 minutes; the position of the guide pin was good, and no guide pin was adjusted, the fluoroscopy times of each guide pin were 3-7 times, with a median of 4 times. Postoperative imaging data at 3 days showed that the position of sacroiliac screw implantation was evaluated as excellent. No complication such as incision infection or vascular nerve injury occurred, and no adverse events related to robotic devices occurred. At 3 days after operation, according to Matta score, the quality of fracture reduction was excellent in 6 cases and good in 1 case, and the excellent and good rate was 100%. All the 7 patients were followed up 6-15 months, with an average of 12.4 months. Bone union was achieved in all patients, and the healing time ranged from 18 to 24 weeks, with an average of 21.2 weeks. Majeed score at last follow-up was 81-95, with an average of 91.5; 5 cases were excellent, 2 cases were good, and the excellent and good rate was 100%. ConclusionTiRobot-assisted percutaneous sacroiliac cannulated screw fixation for posterior pelvic ring injury with sacral variation is accurate, safe, minimally invasive, and intelligent, and the effectiveness is satisfactory.
ObjectiveTo evaluate the effectiveness of orthopedic robot with modified tracer fixation (short for modified orthopedic robot) assisted percutaneous kyphoplasty (PKP) in treatment of single-segment osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 155 patients with single-segment OVCF who were admitted between December 2017 and January 2021 and met the selection criteria was retrospectively analyzed. According to the operation methods, the patients were divided into robot group (87 cases, PKP assisted by modified orthopedic robot) and C-arm group (68 cases, PKP assisted by C-arm X-ray fluoroscopy). There was no significant difference in gender, age, body mass index, T value of bone mineral density, therapeutic segment, grade of vertebral compression fracture, and preoperative visual analogue scale (VAS) score, midline vertebral height, and Cobb angle between the two groups (P>0.05). The effectiveness evaluation indexes of the two groups were collected and compared. The clinical evaluation indexes included the establishment time of working channel, dose of intraoperative fluoroscopy, the amount of injected cement, VAS score before and after operation, and the occurrence of complications. The imaging evaluation indexes included the degree of puncture deviation, the degree of bone cement diffusion, the leakage of bone cement, the midline vertebral height and the Cobb angle before and after operation. Results The establishment time of working channel in robot group was significantly shorter than that in C-arm group, and the dose of intraoperative fluoroscopy was significantly larger than that in C-arm group (P<0.001). There was no significant difference in the amount of injected cement between the two groups (t=1.149, P=0.252). The patients in two groups were followed up 10-14 months (mean, 12 months). Except that the intraoperative VAS score of the robot group was significantly better than that of the C-arm group (P<0.05), there was no significant difference between the two groups at other time points (P>0.05). No severe complication such as infection, spinal cord or nerve injury, and pulmonary embolism occurred in the two groups. Five cases (5.7%) in robot group and 7 cases (10.2%) in C-arm group had adjacent segment fracture, and the difference in incidence of adjacent segment fracture between the two groups was not significant (χ2=1.105, P=0.293). Compared with C-arm group, the deviation of puncture and the diffusion of bone cement at 1 day after operation, the midline vertebral height and Cobb angle at 1 month after operation and last follow-up were significantly better in robot group (P<0.05). Eight cases (9.1%) in the robot group and 16 cases (23.5%) in the C-arm group had cement leakage, and the incidence of cement leakage in the robot group was significantly lower than that in the C-arm group (χ2=5.993, P=0.014). There was no intraspinal leakage in the two groups. ConclusionCompared with traditional PKP assisted by C-arm X-ray fluoroscopy, modified orthopedic robot-assisted PKP in the treatment of single-segment OVCF can significantly reduce intraoperative pain, shorten the establishment time of working channel, and improve the satisfaction of patients with operation. It has great advantages in reducing the deviation of puncture and improving the diffusion of bone cement.
To introduce the current situation of platelet-rich plasma (PRP) and its appl ication in orthopedics field. Methods The latest l iterature was reviewed, concerning the preparations of PRP, physiological mechanism and the latest appl ications in orthopedics field. Results PRP represent a new biotechnology for the stimulation and acceleration of tissue heal ing and bone regeneration. To succeed, some of the challenges need to be addressed including standardization and definition of the different PRP preparations, the complete characterization of the platelet released factors and proteins. Furthermore, well-designed studies and cl inical trials are needed to evaluate the potential therapeutic impact ofPRP. Conclusion PRP provides a novel appl ication for orthopedics field.
目的 分析骨科醫療糾紛的原因及特點，為醫療糾紛的防范提供參考。 方法 收集2010年1月－2011年12月四川華西法醫學鑒定中心涉及四川省各級醫療機構的骨科醫療糾紛鑒定案例55例，進行回顧性分析。 結果 55例骨科醫療糾紛中2010年25例，2011年30例；醫源性醫療糾紛41例（74.5%），非醫源性醫療糾紛14例（25.5%）。醫源性醫療糾紛中醫療機構存在的問題主要以手術操作不當及失誤為主（15例，占27.3%），其次為醫患溝通不到位（8例，占14.5%）。 結論 骨科醫療糾紛防范的關鍵在于醫務人員認真履行其診療義務。
ObjectiveTo summarize the related research progress of antibacterial modification of orthopaedic implants surface in recent years. Methods The domestic and foreign related literature in recent years was extensively consulted, the research progress on antibacterial modification of orthopaedic implants surface was discussed from two aspects of characteristics of infection in orthopedic implants and surface anti-infection modification. Results The orthopaedic implants infections are mainly related to aspects of bacterial adhesion, decreased host immunity, and surface biofilm formation. At present, the main antimicrobial coating methods of orthopaedic implants are antibacterial adhesion coating, antibiotic coating, inorganic antimicrobial coating, composite antimicrobial coating, nitric oxide coating, immunomodulation, three-dimensional printing, polymer antimicrobial coating, and “smart” coating. Conclusion The above-mentioned antibacterial coating methods of orthopedic implants can not only inhibit bacterial adhesion, but also solve the problems of low immunity and biofilm formation. However, its mechanism of action and modification are still controversial and require further research.