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.
【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 investigate the effectiveness of 5G remote robotic surgery in the treatment of pelvic fractures. Methods A retrospective analysis was conducted on the clinical data of 160 patients with pelvic fractures admitted between July 2023 and June 2024 who met the selection criteria. Among these patients, 80 underwent internal fixation surgery with the assistance of 5G remote robotic surgery (5G group), while 80 received local robotic surgical assistance (control group). Baseline characteristics, including gender, age, body mass index, disease duration, cause of injury, and fracture classification, were compared between the two groups, and no significant difference was found (P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, accuracy of screw placement, maximum residual displacement postoperatively, quality of fracture reduction, incidence of complications, Majeed pelvic function score and classification at last follow-up were recorded and compared between the two groups. Results In the 5G group, 180 screws were implanted during surgery, while 213 screws were implanted in the control group. The 5G group demonstrated significantly reduced intraoperative blood loss and shorter incision length compared to the control group (P<0.05). No significant difference was observed between the two groups in terms of operation time or hospital stay (P>0.05). Radiographic evaluation revealed excellent and good reduction rates of 98.8% (79/80) in the 5G group and 97.5% (78/80) in the control group, while excellent and good screw placement accuracy rates were 98.3% (177/180) in the 5G group and 95.8% (204/213) in the control group. No significant difference was found between the two groups in maximum residual displacement, reduction quality, or screw placement accuracy (P>0.05). All patients were followed up 7-16 months (mean, 11.3 months), with no significant difference in follow-up duration between the groups (P>0.05). No perioperative or follow-up complication, such as wound infection, iatrogenic fractures, iatrogenic neurovascular injury, screw loosening or breakage, or nonunion, were observed in either group. The control group exhibited a worse degree of gait alteration compared to the 5G group (P<0.05), while no significant difference was found in incidences of squatting limitation or persistent pain (P>0.05). At last follow-up, no significant difference was observed between the groups in Majeed pelvic function scores or grading (P>0.05). Conclusion Compared with the local surgery group, 5G remote robotic surgery supported by remote expert technical guidance demonstrated smaller incision lengths, less intraoperative blood loss, and fewer postoperative complications, and was shown to be a precise, minimally invasive, safe, and reliable surgical method.
ObjectiveTo evaluate the effectiveness of TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury. Methods The clinical data of 76 patients with posterior pelvic ring injury between January 2016 and June 2021 were retrospectively analyzed. Among them, 45 cases were treated with minimally invasive percutaneous sacroiliac screw fixation assisted by TiRobot and O-arm navigation system (study group), 31 cases were treated with minimally invasive percutaneous sacroiliac screw fixation under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, the times of nail track adjustment, and intraoperative fluoroscopy times were recorded. The quality of fracture reduction was evaluated by Matta score. At last follow-up, Majeed score was used to evaluate the recovery of pelvic function. ResultsA total of 72 screws were implanted in the study group, with a median of 1 (1, 2) screws per patient. In the control group, 47 screws were implanted, with a median of 1 (1, 2) screws per patient. There was no significant difference in the number of screws between the two groups (Z=−0.392, P=0.695). The operation time, intraoperative blood loss, times of nail track adjustment, and intraoperative fluoroscopy times in the study group were significantly less than those in the control group (P<0.05). All patients were followed up 6-24 months (mean, 14 months). No serious complications was found after operation and during follow-up. Matta score was used to evaluate the quality of fracture reduction at 1 week after operation, and there was no significant difference between the two groups (Z=−1.135, P=0.256). At last follow-up, there was no significant difference of Majeed score between the two groups (Z=−1.279, P=0.201). ConclusionTiRobot-assisted surgery by O-arm navigation system is a reliable surgical method for the treatment of posterior pelvic ring injury, which can reduce the operation time and fluoroscopy times when compared with the traditional operation under the guidance of C-arm X-ray machine. The safety, accuracy, and efficiency of the operation were improved.
ObjectiveTo re-evaluate the systematic review and meta-analysis (SR/MAs) of the efficacy of robot-assisted pedicle screw placement. MethodsThe CNKI, VIP, WanFang Data, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases were electronically searched to collect SR/MAs of robot-assisted pedicle screw placement from inception to April 28, 2023. Two reviewers independently screened literature, extracted data and then assessed the quality of reports, methodological quality, risk of bias, and the strength of evidence quality by using PRISMA, AMSTAR-Ⅱ, ROBIS, and GRADE tool. ResultsA total of 20 SR/MAs were included. The results of the included studies showed that robot-assisted pedicle screw placement was more accurate and had a lower number of complications compared with freehand pedicle screw placement. The quality of reports, methodology, and evidence for pedicle screw placement efficiency in all SR/MAs were low or extremely low, with a high risk of bias. The main reasons included high heterogeneity of included studies, unclear research methods and selection criteria, and missing key reporting processes. ConclusionRobot-assisted pedicle screw placement may have better clinical efficiency than traditional freehand pedicle screw placement. But the quality of relational SR/MAs is low.
Objective To evaluate the feasibility and significance of problem-based learning (PBL) in orthopedic internship. Methods A total of 315 students in grade 2002 were involved in PBL during their internship in the Department of Orthopedics at the First Affiliated Hospital of China Medical University, Shenyang, China. Teaching effectiveness was evaluated with a questionnaire and an ability examination. The results of PBL teaching during different semesters were compared, and the feasibil ity and significance of PBL were analyzed. Results Students who participated in PBL were in a dominant position and were more active in the learning process. The PBL pattern could improve students’ ability to identify, analyze and solve problems, and also contribute to fostering and enhancing their clinical thinking. This could help them solve the problems that emerged from the theory curriculum.Conclusions The PBL pattern used in the orthopedics internship has advantages and practical significance, which are applicable in modern medical teaching practice.
Objective To explore the timing of indwelling urinary catheter removal in male patients undergoing orthopedic surgery under general anesthesia by a prospective randomized controlled study. Methods Male patients who underwent orthopedic surgery under general anesthesia in the First People’s Hospital of Shuangliu District between September 2019 and January 2021 were selected prospectively. The patients were randomly assigned to group A (pull out the catheter before anesthesia) and group B (pull out the catheter within 24 hours after anesthesia) at a ratio of 1∶1 by sortition. The age, operation duration, operation site, heart rate when pulling out the catheter, first urination, urinary tract infection, patient comfort score, nursing satisfaction score and patient satisfaction related indicators of the two groups were recorded and analyzed. Results A total of 120 patients were included in the study. All patients successfully completed the trial without dropping out or quitting. There was no significant difference between the two groups in terms of age, operation duration and operation site (P>0.05). No urinary tract infection occurred in both groups. There was no significant difference in the first urination between the two groups (P>0.05). The heart rate of patients in group A when pulling out the catheter was slower than that of group B [(74.62 ± 11.38) vs. (84.52 ± 8.98) times/min], and the satisfaction of patients in group A (group A: 46 cases were satisfied, 11 cases were relatively satisfied, 3 cases were dissatisfied; group B: 17 cases were satisfied, 25 cases were relatively satisfied, 18 cases were dissatisfied), comfort score (17.82±2.73 vs. 16.68±2.13), and nursing satisfaction score (19.62±1.59 vs. 16.32±2.05) were better than those in group B (P<0.05). Conclusions For male patients who need catheterization before orthopedic surgery under general anesthesia, pulling out the catheter before waking up after anesthesia can effectively reduce the physiological stress reaction of patients, reduce discomfort, improve patient satisfaction, and reduce the workload of nurses after surgery, which is conducive to early rehabilitation exercise of patients.
Primary malignant bone tumors are extremely rare. Osteosarcoma, chondrosarcoma, Ewing’s sarcoma, and myeloma are the most common malignancy in bone. Osteosarcoma and Ewing’s sarcoma are common in children and adolescents, and the tumors are high lethality due to the high rate of pulmonary metastasis. While chondrosarcoma, myeloma, and chordoma are more common in middle aged and elderly people. Japanese Orthopaedic Association (JOA) published the secondary clinical practice guideline on the management of primary malignant bone tumors. We put an emphasis on explanation some important issue of this guideline for help Chinese musculoskeletal tumor professionals in clinical practice.
ObjectiveTo study the proper time of first postoperative eating in patients after orthopedic surgery with spinal anesthesia. MethodsA total of 160 patients who underwent orthopedic surgery from April 2012 to November 2014 were divided into trial group and control group.The symptoms of hunger, thirst, throat discomfort, vomiting and bloating were evaluated at hour 4 and 8 after surgery.The first oral feeding time and the incidence of constipation were analyzed and compared between the two groups. ResultsThe incidence of hunger and thirst in the trial group was significantly lower than that in the control group at hour 4 after surgery (P < 0.05).There was no significant difference in the incidence of throat discomfort, vomiting and bloating between the trial group and the control group at hour 4 and 8 after surgery (P > 0.05).Compared with the control group, the first time of oral feeding was significantly earlier (P < 0.05) and the incidence of constipation was significantly lower (P < 0.05) in the trial group. ConclusionWithout adverse reactions, early postoperative eating can alleviate the hunger and thirst sensation of patients after orthopedic surgery with spinal anesthesia, and reduce the incidence of constipation.