上一篇介绍了爱尔兰著名骨科专家Colles教授的故事,本篇继续介绍和他亦师亦友的另一位爱尔兰骨科专家Rob-ert William Smith 的故事.Colles、Smith、Bennett 和 Barton在伦琴发现X线前在腕关节骨折领域做出了震惊世界的贡献,足以称之为那个时代的腕关节四杰.这四位专家虽然各有千秋,但他们敏锐的观察力至今仍是我们学习的榜样.

Barton与Colles、Smith、Bennett并称19世纪腕关节四杰,他们在伦琴发现X射线之前,以敏锐的观察力,透过现象看本质,发现腕关节骨折的规律,成为西医骨科200年历史上的经典.Barton和Bennett的人生经历有很多相似之处,其中最典型的就是他们的贵族气质.Barton于1794年4月出生在费城一个显赫的家族中,他的父亲是著名的律师和学者William Barton[1],和查尔斯一起设计了美国护照并沿用至今.他的叔叔Benjamin Smith Barton则是北美著名古生物学家和考古学家.在移民北美200年内的诸多名门望族中,Barton家族无疑是最为出众的家族之一,在政治、经济和科学方面都留下了一串串闪闪发光的名字.

Edward Hallaran Bennett(1837-1907)出生在爱尔兰Cork城的一个律师之家,他是家中第五子,也是最小的儿子.他的爷爷 James Bennett 和外公 William Saunders Hal-laran都是当时著名的医生,他们家族在法国的后裔中有巴黎赫赫有名的解剖学教授James Richard Bennett.在这样良好的家境之下,Bennett从小接受良好的教育,在当地著名私立中学Hamblin and Porter's Grammar毕业后顺利考入都柏林大学三一学院,在Robert William Smith教授的指导下开展病理和解剖学研究.

上一篇笔者介绍了手外科之父Sterling Bunnel于1926年开飞机行会诊手术时飞机失事造成股骨颈骨折,前往哈佛大学麻省总医院骨科,找时任骨科主任Smith Petersen行三翼钉手术的故事,本篇就介绍Smith Peterson教授.他是哈佛大学麻省总医院骨科第六任骨科大主任,是北京积水潭医院首任院长孟继懋先生的老师,是哈佛医学院骨科学系近200年来缔造友好医患关系的榜样,更是股骨颈骨折、髋关节置换和脊柱后凸畸形截骨矫形领域方面的先驱.

Sterling Bunnell于1882年7月18日出生于旧金山[1],当时的美国西部和东海岸的纽约、波士顿等发达地区相比,还是一片荒芜,这给Bunnell提供了近距离观察大自然的机会.他幼儿时期就喜欢观察飞禽走兽,解剖小动物,具有极强的动手能力.长大之后考入了加州大学伯克利分校,该校为了从东部吸引人才,出台了一系列优惠政策,如可以给诺贝尔奖获得者提供车位,但到了 2021年,Jennifer A .Doudna获得诺贝尔化学奖之后,该校居然为没有车位分配而发愁.此时的伯克利分校已是西部顶尖名校,诺贝尔奖获得数目和哈佛、斯坦福、麻省理工等并驾齐驱.

上一篇介绍了人工髋关节之父John Charnley的传奇人生,其给世人留下了"学识渊博,谦谦君子"的印象.本篇则介绍西医骨科200年中颇具争议的人物,他就是AO内固定协会第一任主席Maurice E Müller.AO组织在20世纪50年代以骨折内固定理念风靡全球,掀起了西医骨科200年从保守治疗走向手术治疗波澜壮阔的历史画卷.由Müller的学生Joseph Schatzker撰写的《AO大师之路——Müller传》以极其华丽的语言,高度赞扬了 Müller的一生,但与此形成对比的,史学界对于Müller的评价一直存在争议,从商业传奇、行业精英到道德矮子,众说纷纭.

由我国著名矫形外科专家、国家康复医院矫形外科主任秦泗河教授主编的英文版下肢畸形矫正与功能重建-简称下肢重建外科《Lower Limb Deformities》已由极富盛名的施普林格(Springer)出版社出版.近日仔细翻阅,受益匪浅. 该书主要有以下几个突出特点: (1)注重软组织平衡:"重骨轻软"为骨科通病,骨骼畸形的矫正有具体角度可以把握,而软组织动力学重建则始终脱离不开术者的经验和判断.在涉及软组织平衡的问题上,也需术中反复权衡和尝试,力求完美.就上肢而言,手外科有不少肌腱转位和动力重建的方法,可弥补不足.而下肢则很少,足踝外科内有一些肌腱转位技术,但不全面.至于髋膝方面,则更少.在此书中,突出强调了软组织静态平衡和动力平衡的重要性,这是基于秦教授治疗上万例脊髓灰质炎后遗症的丰富经验,以及几十年如一日反复实践和思考的结果,是他从千百种术式中不断总结优化出的简便有效的术式.

承接上期《Astley Paston Cooper教授》,这一篇我们介绍他的老师John Hunter (1728-1793)."hunter"单词本身就有猎人之意,John Hunter祖上的确以打猎为生,Hunter继承了猎人目光敏锐和手脚敏捷的优点.1728年2月13日晚,John Hunter出生于苏格兰Glasgow南部一个农场主之家.他13岁就开始弃学,帮助经营农场,长期的农场劳动使他练就了一双巧手.1748年,他的哥哥William Hunter医生在伦敦开设的解剖学校经营十分成功,因缺少人手,John Hunter便放下锄头,拿起解剖刀,到伦敦来效力.他在这家解剖学校里展示了一流的动手能力,他制作的解剖作品栩栩如生,充满了艺术的美感,因此在伦敦医学界开始小有名气.当时生产力相对落后,整个欧洲的医疗圈子属于学徒制,被当时几个大的医疗世家所掌控,属于贵族教育的范畴.Hunter借助于哥哥的解剖学校和人脉关系,开始接受医学教育,并得到了St.Bartholomew医院著名教授Percivall Pott的青睐[1].

上一篇我们讲述了著名骨科专家Harry Platt(1886-1986)的精彩故事,他名满天下,却有着清晰的自我认知,明白物理和化学知识不够精通、动手能力不足是自己的发展短板,因此在寻找传人的过程中,那些精通数理化、动手能力超级强的学霸就备受青睐.在这样的背景下,和他同样出生在Lancashire的John Charnley就成为了最佳入选,后来成长为享誉世界的人工髋关节之父[1-2].

Benjamin Collins Brodie 教授(1783-1862)的故事是Percivall Pott教授学派故事的延续,这个学派第二代的代表John Hunter和第三代的代表Astley Cooper教授的事迹均在骨科史萃中有阐述,Benjamin Collins Brodie则是第四代的杰出代表[1-3]. Brodie出生于一个富贵之家,祖上出过大法官级别的律师、大银行家和著名医生.他的父亲多才多艺,孩子们大学之前的教育都是自己在家里亲自传授,不是为了省下学费,而是担心学校老师不够博学多才,不够精通数理化.Brodie年轻时适逢拿破仑率领法兰西精锐部队横扫欧洲,他广散家财,组织义勇军,保卫家园,受到了英王乔治三世的赏识,英王没有想到这位年轻人多年之后会成为他儿子的私人医生.

Harry Platt教授(1886-1986)是现代骨科中第一位活到100岁的著名骨科专家;他是第一位公开承认自己不够手巧,更适合做内科医生的著名骨科专家;他是著名的骨科教育家和社会活动家;他是Robert Jones最杰出的四位学生之一;人工髋关节之父John Charnley是他最为优秀的学生.

西医骨科之父Hugh Owen Thomas祖上几代以正骨谋生,积累到他这一代才得以进入利物浦大学接受正规教育,这是西医200年初期医学教育的典型.最早能够接受正规教育的往往是贵族,Astley Paston Cooper正是其中的典型代表[1-4].1768年8月23日他出生于英格兰的诺福克,Cooper的父亲是牧师,母亲是著名诗人,叔叔是当时著名的外科医生.良好的家庭为他接受优质教育创造了条件,他在著名的圣托马斯医院实习,后来跟随实验外科学先驱Hunt-er,成为了当代外科的重要先驱.Cooper在普通外科方面造诣非常深厚,是疝外科的开拓性人物.以他名字命名的解剖结构和疾病非常多,有十几种仍然是现代医学职业考试的考点之一,比如乳房悬韧带(Cooper's Ligament).Cooper 1817年成功实施腹主动脉瘤手术,1820年成功为英王乔治四世切除颈部肿物,并成为他的私人医生.这些手术在缺少无菌术、麻醉术、抗生素和输血术的年代,是很了不起的成就,他被人们称为那个时代的"外科王子(The prince of surgery)"[4].

自15世纪火枪出现,金属螺丝钉才开始问世.经过文艺复兴和工业革命的洗礼,造型各异的螺丝钉广泛出现,但木匠和骨科医生用的螺丝钉都是同一规格.直到20世纪40年代,一个伟大人物的出现,让木工螺丝钉和人体螺丝钉完全区别开来,他就是Robert Danis(1880-1962).

Reginald Watson Jones是20世纪四五十年代骨折保守治疗的标志性人物,他的学生遍布世界各地[1-4].我国骨科奠基人之一,北京积水潭医院首任院长孟继懋教授就曾赴英国跟他学习.Robert Jone是他的师父,也是他的伯乐(二者并无亲戚关系),Reginald Watson Jones在回忆录中称"Rob-ert Jones是外科天选之子(designed to be a surgeon),是自己的守护神(patron saint)".

在大部分西方国家骨科学者心目中,Hugh Owen Thomas是"西医骨科之父",他的侄子Robert Jones则是公认的"现代骨科之父"[1-2]. Robert Jones于1857年出生于一个建筑工人之家,他的父亲并不甘心做建筑本分工作,痴迷于写小说等在当时看来有些不务正业的工作,最终导致家庭破裂,Robert Jones便到利物浦投靠了姑父Hugh Owen Thomas.姑父膝下无子女,对其格外重视,为他设计好了学医之路.Robert Jones沿着正规医学教育的路线逐步长大,获得行医执照后到姑父的诊所当见习医生和学徒.他有幸站在了巨人的肩膀上,将姑父家族五代正骨经验和Hugh Owen Thomas的科学理念有机融合,继承并发扬光大.薪尽火传,Hugh Owen Thomas去世后,Robert Jones顺利接班,此时前来慕名学习交流的骨科医生已不局限于英国和欧洲,而是来自全世界,其中有开创梅奥诊所的梅奥兄弟William和Charles Mayo,他们于1906年拜访Robert Jones后,给予了极高评价,返回明尼苏达后开创了梅奥骨科.现在,梅奥骨科早已驰名世界,他们在记录科室历史时总是强调这一段师承,以表明自己是师出名门,罗马正宗[3],这也说明Robert Jones是一位卓越的医学教育家.

Hugh Owen Thomas (1834-1891)是公认的西医骨科之父[1],开创了骨科的保守治疗时代.他的侄子Robert Jones曾担任英国骨科医师协会主席,在第一次世界大战期间,领导随军骨科医生为国效力;Robert Jones的学生Wat-son Jones承前启后,成为第二次世界大战期间英国随军骨科医生领袖,他的名著《Watson-Jones Fractures & Joint Inju-ries》成为骨折保守治疗时代的经典[2-5].我国骨科奠基人之一,北京积水潭医院首任院长孟继懋教授曾在20世纪30年代跟随Watson Jones学习.从某种意义而言,Hugh Owen Thomas师徒所开创的骨科保守治疗时代及其遗留下来的治疗理念,在当今仍有借鉴意义,这也是我们回忆这位西医骨科之父的初衷[1-5].

Pilon fractures are always results of the high-energy trauma. They are often accompanied with serious soft tissue injury, and tension blisters happened in most cases. For comminuted fractures and poor soft tissue, how to select the incision is challenging. This study aimed to explore the outcomes of the treatment of ten 43-B/C pilon fractures using an anteromedial fibula approach. Ten closed pilon fractures combined with fibula fractures were treated in our hospital from January 2015 to July 2016. Six cases were AO/OTA type 43-B and 4 cases were 43-C, including 9 males and 1 female with a mean age of 36.3 years (range: 20-60 years). When the skin wrinkled, all patients were treated by the senior authors with open reduction and internal fixation using an anteromedial fibula approach. Postoperatively, patients were followed up at 1 month, 3 months, 6 months, 12 months, and 18 months, respectively. The incision healing, the American Orthopedic Foot and Ankle Society scores and fracture healing were recorded to get a comprehensive evaluation of the effect for the incision. All patients were followed from 9 to 18 months (average: 14.1 months). Anatomic reduction was achieved in 7 cases and satisfactory in 3 cases by the Burwell-Charnley radiological criteria evaluation. All patients had complete retention of the dorsal extensor tendon sheath. The most incisions had a good healing without necrosis at 2 weeks after surgery except 1 case. The factures were healed at a range of 12 to 18 weeks (average: 13.7 +/- 1.2 weeks). The American Orthopedic Foot and Ankle Society scores were excellent in 7 cases and good in 3 cases at 1 year after surgery (average: 85.6 +/- 4.2 points). The satisfactory outcomes were achieved in most patients. The anteromedial fibula approach used for pilon fractures can lead to an effective exposure and allow fixation of tibia and fibula fractures with minimal soft tissue injury. It is a safe, simple, and effective approach that allows for satisfactory functional rehabilitation of the ankle joint.

Low- and middle-income countries contribute to only a small percentage of publications in multiple medical fields. Editorial bias was reported to be an important reason for this. However, whether this trend exists in leading spine journals remains unclear. This study determined the composition of the editorial boards of leading spine journals and analyzed the international representation of editorial boards.The editorial board members of four leading subspecialty spine journals, including The Spine Journal, Journal of Neurosurgery: Spine, European Spine Journal, and Spine were identified from the journals' websites. The countries of editorial board members were identified and analyzed according to the continent and country income categories classified by the World Bank.A total of 608 editorial board members were identified from the four leading spine journals. The majority (91.4%) of editorial board members were from high-income countries, followed by upper-middle income countries (7.2%), and lower-middle income countries (1.3%). No editorial board members were from low-income countries. Regarding the continent of residence, 46.5% of the editorial board members were from North America, followed by Europe (38.5%), Asia (9.9%), South America (2.8%), Oceania (1.6%), and Africa (0.7%). The editorial board members came from 40 different countries, which were concentrated in North America, Western Europe, and East Asia. The largest number of editorial board members came from the United States (42.3%), followed by Germany (6.9%), the United Kingdom (6.7%), Switzerland (5.8%), and Italy (5.1%).A lack of international representation on editorial boards exists in leading spine journals. Editorial board members from high-income countries are substantially overrepresented, while editorial board members from low- and middle-income countries are severely underrepresented. The United States is the most represented country on the editorial boards of leading spine journals.

Objective To introduce the operation method of a rotational support plate through a traditional anterolateral approach for posterolateral tibial plateau fractures and analyze the postoperative outcome.Methods From May 2016 to September 2017,10 patients with posterolateral tibial plateau fractures who underwent surgery with the rotational support plate were retrospectively analyzed.There were 6 males and 4 females,aged from 23-66 years (average,46.2 years).The causes of the fractures included traffic accident in 4 cases,fall from height in 5 cases and falling injury in 1 case.According to AO-OTA classification,there were 1 case of 41-B2,8 cases of 41-B3 and 1 case of 41-C3.According to Schatzker classification,there were 6 cases of type Ⅱ,1 was of type Ⅲ,2 were of type Ⅴ,and 1 was of type Ⅵ.Four cases suffered multiple fractures.One patient suffered pelvic fracture,ipsilateral femoral shaft and medial malleolus fracture;One patient suffered ipsilateral tibiofibular fracture;1 patient suffered ipsilateral fibular head and medial femoral epicondyle fracture;One patient suffered ipsilateral fibular head fracture.Fracture healing time,complications,knee range of motion,Hospital for Special Surgery (HSS) knee score were recorded to evaluate postoperative outcomes.Results All 10 patients were followed up for 15.25 months (range,12-27 months).The bony union time ranged from 3.0-4.5 months (average,3.2 months).The range of motion of the knee joint was 105°-161.4° (average,139.9°).According to the HSS system,the score was 64-98 (average,88),including 8 of excellent and 2 of fair.No skin necrosis,incision infections,or fixation failure occurred during follow-up.Conclusion Fixation of posterolateral tibial plateau fracture was successfully achieved using the newly designed plate through a traditional anterolateral approach.It has many advantages such as reliable fixation,satisfying recovery,simplicity of operator,and small tissue damage.

A mismatch between the femoral bow and intramedullary nails causes a series of complications. Previous investigations have sought to determine the curvature of the femur using the radius of the femoral bow. However, the radius of the curvature is affected by femur length. To eliminate the influence of femur length, we instead used an angle to indicate femoral curvatures. Forty patients with intertrochanteric fractures who underwent a surgical procedure at our institution were enrolled in this study. We conducted a lateral X-ray of the contralateral femur before operation. We drew a triangle in the X-ray images using Digimizer software. The tangent values of the acute angle were used to indicate femoral curvature. The tangent values were then compared with the dimensions of currently used nails. The average tangent value of the femurs was 0.0835 +/- 0.0147, as measured from the inner cortex and 0.0798 +/- 0.0150, as measured from the outer cortex. The tangent values were related to sex, with males having straighter femurs than females, and there was no obvious correlation between tangent values and age or femur length. Tangent value is a reliable method with a high intersurveyor consistency; femur curvatures were significantly greater than the curvatures of currently used nails.