Objective: To analyze the current situation and development trend of domestic medical institutions in the fields of orthopedics,and to provide suggestions for the incubation and commercialization of scientific and technological achievements. Methods: According to the published patent data of the top ten hospitals on the Chinese Hospital Ranking List Orthopedic Specialty Ranking by Fudan University,we analyzed the current situation and development trend of intellectual property rights in aspects of the patent application, patent authorization, patent types, subdivision, and patent transformation. Results: The number of patent applications has grown rapidly since 2015.The patent applications and authorizations were mainly focused on aspects of orthopedic instruments, such as internal fixators, surgical saws and bone drills, and prostheses for bone bonding. The hotspots of orthopedic professional technology development were mainly concentrated in 8 directions, including prosthesis, positioning cutting instruments, and repositioning traction instruments. The combination of medical science and engineering was deepened through patent application and transformation. Conclusion: The distribution and transformation of intellectual property rights around medical institutions in the field of orthopedics have developed sharply with remarkable achievements in recent years. There is an obvious trend of joint research and development between medical institutions, industries, and enterprises, which has promoted the transformation and implementation of orthopedic-related scientific and technological achievements.

高山滑雪赛事的救援难度大,防疫工作要求高.本文通过总结2021年高山滑雪系列测试赛医疗保障过程中对新型冠状病毒肺炎(简称新冠肺炎)疫情防控的对策,分析新冠肺炎疫情给高山滑雪赛事医疗保障工作带来的困难,制定救援、转运的流程,探索医疗站的设置和防疫流程等工作.医疗保障部门应当在完善各项预案的前提下,对相关工作人员进行系统培训,并与属地疾病防治中心配合,保障过程中严格按照各项防疫规定,应对突发情况,做好防疫工作,保障赛事顺利进行.

目的:通过Meta分析系统评价皮质骨轨迹(cortical bone trajectory,CBT)螺钉与传统椎弓根螺钉(pedicle screw,PS)固定对短节段腰椎融合术患者临床疗效的影响,为脊柱外科医生选择相应的内固定方式提供理论参考.方法:检索PubMed、Scopus、Web of Science、EI和知网数据库自建库至2022年7月1日发表的对比CBT螺钉(CBT组)和PS(PS组)固定对腰椎椎间融合术疗效影响的文献,提取椎间融合率、手术并发症发生率、术后邻近节段退变(adjacent segment degeneration,ASD)发生率、术中失血量、手术时间、平均住院时间、背部疼痛视觉模拟评分(visual analog scale,VAS)、Oswestry 功能障碍指数(Oswestry disability index,ODI)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分等指标,采用RevMan 5.3进行Meta分析.随机对照试验采用Cochrane风险偏倚评估标准,队列分析采用Newcastle-Ottawa Scale(NOS)风险偏倚评估标准对纳入文献质量进行评估.结果:共纳入15篇文献,其中3篇为随机对照试验,12篇为队列研究,文献质量评估结果显示纳入文献质量较高.通过Meta分析得出,与PS固定相比,CBT组手术并发症发生率[RR=0.49,95％CI(0.34,0.70),P＜0.05]、术后 ASD 发生率[RR=0.33,95％CI(0.16,0.65),P＜0.05]更低;术中出血量[SMD=-0.81,95％CI(-0.98,-0.63),P＜0.05]更少;手术时间[SMD=-0.49,95％CI(-0.67,-0.30),P＜0.05]及平均住院时间[SMD=-0.60,95％CI(-0.81,-0.38),P＜0.05]更短;JOA 评分[SMD=0.23,95％CI(0.02,0.43),P＜0.05]更高;而两者在椎间融合率、背部疼痛VAS评分和ODI方面无统计学差异.结论:与应用PS固定相比,在短节段腰椎固定融合术中应用CBT螺钉固定的手术并发症发生率、术后ASD发生率较低,手术时间、住院时间较短,术中出血量较少,JOA评分较高.

目的:分析远程机器人辅助骨折复位内固定术治疗胸腰椎骨折的临床效果,为基于5G的远程机器人辅助骨科手术的应用与推广提供依据.方法:回顾性分析2021年4月—12月由北京积水潭医院脊柱外科医师远程操作外院手术机器人完成的骨折复位内固定术48例患者临床信息.统计患者骨折固定效果、并发症和远程通信成功率,评估远程机器人手术的临床应用效果.结果:48例远程机器人辅助胸腰椎骨折内固定术均顺利完成,平均手术时间为(93.23±33.37)min.共置入了288枚椎弓根螺钉,254枚(88.19％)螺钉为A级,26枚(9.03％)螺钉为B级,8枚(2.78％)螺钉为C级.螺钉位置的临床可接受率(A级+B级)为97.22％.术后的骨折椎体前缘高度比显著大于术前(P<0.001).远程通信成功率为100％,未出现围手术期并发症.结论:远程机器人辅助胸腰椎骨折内固定术可获得良好的骨折固定效果,基于5G的远程机器人辅助胸腰椎骨折内固定术是安全、有效的.

目的:构建基于熵的医院科技成果转化评估决策支持系统,提升科技成果转化成功率.方法:采用层次分析法(AHP)确定科技创新成果转化评估决策支持系统指标体系与权重,综合评估等级集合形成模糊评分表,对数据进行标化处理计算信息熵,综合评估科技创新成果转化结果.对医院骨科手术机器人科技成果转化进行实证分析,验证科技成果转化评估决策支持系统的科学性和实用性,并从政策层面、中介平台组建层面和具体操作层面给出如何提高科技成果转化成功率的建议.结果:基于熵的医院科技创新成果转化评估决策支持系统指标体系包括经济效益、技术先进性、市场风险、项目运营和环境与政策5个层面共15项指标,经对评估决策支持系统的计算分析,医院骨科手术机器人的专利成果转化评估各项数值与实际转化成效相比,均符合预期要求.结论:构建的基于熵的医院科技创新成果转化评估决策支持系统指标体系,能够为医院科技创新和成果转化决策提供支持.

目的 评价并对比机器人辅助开放手术与微创手术螺钉置入的精度和手术安全性.方法 回顾2015年11月至2019年12月北京积水潭医院脊柱外科接受机器人辅助胸腰椎骨折内固定手术的患者120例;男67例,女53例;年龄(49.7±13.6)岁;按照开放和微创入路分为两组,其中,开放手术71例,微创手术49例.使用术后CT影像,依照Gertzbein和Robbins评分进行椎弓根螺钉精确性评价.分析机器人辅助胸腰椎骨折内固定手术的临床和影像学指标以及手术时长、出血量、住院时间、关节突关节侵犯等指标.结果 120例患者骨折为(1.3±0.7)节段,置钉(6.2±2.4)枚.共置入744枚螺钉,其中703枚未突破椎弓根皮质(A级),32枚突破皮质小于2 mm(B级),9枚错误置入(C级).开放手术与微创手术在置钉精确性方面差异无统计学意义(χ2=0.976,P=0.323).穿破椎弓根皮质的41枚螺钉中,穿破外侧皮质33枚.开放组手术时间显著大于微创组(Z=-2.566,P=0.005);开放组出血量显著大于微创组(Z=-4.714,P=0.000);开放组术后住院时间大于微创组,差异有统计学意义(Z=-2.173,P=0.030).结论 机器人辅助的胸腰椎骨折内固定手术在开放和微创入路下均精确、安全.

In consideration of the current policies for scientific and technological achievement translation, the paper explored the model and strategy of such translation in medical institutions by analyzing typical cases of " orthopedic surgical robot" translation. Most common translation models in medical institutions are transfer or licensing. As hospitals lack the qualifications and conditions for product manufacturing and sales, " orthopedic surgical robot" was translated by means of a combined practice of both patent transfer and joint R&D with the enterprise under a strategic cooperation agreement. This practice not only manifested the contribution and interests of stakeholders in a rational way, but also guaranteed sustainable iterative R&D. Hospitals should launch cooperation with enterprises, universities or research organizations and form strategic alliances, and choose appropriate translation models based on their specifics, value and characteristics of the achievement flexibly.

一、手术历史及发展 后外侧入路胸椎间盘切除术是治疗胸椎间盘突出症的经典术式. 最早采用椎板切除术治疗胸椎间盘突出症. 后路椎板切除术于20世纪30年代被提出,其手术方法简单,主要通过去除病变节段椎板为脊髓留出后方漂移空间,从而减轻脊髓受压迫的程度. 但该术式并未去除脊髓压迫的直接原因,由于脊髓被两侧的韧带固定,向后方漂移的范围小,术后效果往往不理想. 之后有学者对该术式进行了改良,试图在切除椎板后向一侧牵拉脊髓和神经根,从后方暴露突出椎间盘,再将其切除. 但这一改良的术式在术中必须通过牵拉脊髓才能切除椎间盘,而突出的椎间盘会导致病变节段椎管更加狭窄,这样的牵拉暴露常会导致脊髓受压症状加重.Arce和Dohrmann[1]回顾分析了行后路椎板切除术治疗的135例胸椎间盘突出症病例,发现58％的患者症状得到改善,10％的患者症状未改变,28％的患者症状加重. 因此,后路椎板切除术被认为具有高度的危险性,出现病变切除不彻底、术后效果欠佳等可能性较大,临床上很少将其作为主要的胸椎间盘切除术式. 但是该术式启发了人们积极探索治疗胸椎间盘突出症的新术式,达到在尽可能避免影响脊髓的情况下摘除突出的胸椎间盘的目的.

Objective To provide the normal value of atlas (C1) inner sagittal diameter in adults thus defining the diag?nostic value of developmental canal stenosis at C1 and to establish the Jishuitan (JST) morphological classification for C1 develop?mental canal stenosis in craniovertebral junction (CVJ) anomalies. Methods From December 2010 to November 2018, 101 pa?tients with various CVJ anomalies (50 males, 51 females; mean age 48.8±12.9 years, range 15-78 years; the anomaly group) and 857 patients with normal CVJ (461 males, 396 females; mean age 50.2±8.3 years, range 21-79 years; the normal group) were en?rolled in a retrospective study. In the anomaly group, 92 cases of atlantoaxial dislocation were furtherly divided into three sub?groups according to Wadia classification: atlantoaxial dislocation with os odontoideum (OO subgroup, n=33), atlantoaxial disloca?tion with occipitalization of the atlas (OA subgroup, n=24), atlantoaxial dislocation without both OO and OA (AAD subgroup, n=35); the rest of the anomaly group was combined with Chiari malformation (CM subgroup, n=9). The range of C1 inner sagittal diam?eter in each group was measured via CT scan images. The normality of C1 inner sagittal diameter of each group was tested via Shap?iro?Wilk method. T test was performed on C1 inner sagittal diameter of each group. The diagnostic value of C1 developmental canal stenosis was defined as the lower bound of 95% confidence interval ( CI) for the mean of the normal group. The C1 morphology of de?velopmental canal stenosis cases in anomaly group were analyzed via CT scan images thus establishing the JST morphological clas?sification for C1 developmental canal stenosis in CVJ anomalies. Results The mean C1 inner sagittal diameter was 29.05±1.60 mm (range, 24.05-33.50, 95% CI: 25.91-32.19). C1 developmental canal stenosis was defined as C1 inner diameter≤25.91 mm. The mean C1 inner sagittal diameter of the whole anomaly group was 26.84±2.04 mm (95% CI: 22.84-30.84), which differed signifi?cantly from that in the the normal group (t=10.504, P<0.01). A total of 33 cases meeting the criteria of C1 inner diameter≤25.91 mm were diagnosed as C1 developmental canal stenosis, including 14 cases of the OO subgroup, 4 cases of the OA subgroup, 15 cases of the AAD subgroup and none of the CM subgroup. Based on the C1 morphological characteristics of 33 cases, the JST clas?sification of C1 developmental canal stenosis in CVJ anomalies was established, which could be divided into type I-III. Type I: lit?tle atlas type, 84.9% (28/33), normal C1 posterior arch morphology without C1 occipitalization; Type II: atlas posterior arch incurv?ing type, 3.0% (1/33), C1 posterior arch incurves towards spinal canal, without C1 occipitalization; Type III atlas occipitalization type, 12.1% (4/33), furtherly divided into: type IIIa with normal C1 posterior arch morphology; type IIIb with incurving C1 posterior arch. Conclusion The normal value of C1 inner sagittal diameter in adults was from 24.05 to 33.50 mm. The criteria of C1 inner sagittal diameter≤25.91 mm can be used as the radiographic diagnostic value of C1 developmental canal stenosis. C1 developmen?tal canal stenosis in CVJ anomalies can be classified according to the JST classification system.

目的 探讨改良X线诊断骨质疏松性椎体压缩骨折的效能.方法 回顾分析2013年1月至2015年6月于北京积水潭医院脊柱外科确诊的406例骨质疏松性椎体压缩骨折患者的病历资料.以骨折椎体作为病例组,以未骨折椎体作为对照组.首先测量侧位X线片上椎体的形变程度,计算传统诊断方法的诊断效能;随后测量正位X线片上椎体的形变程度,绘制椎体形变程度与骨折之间的ROC曲线,提出改良X线诊断方法,计算其诊断效能,并与传统诊断方法比较.结果 406例骨折患者以胸腰段椎体骨折为主(83.00％).传统诊断方法的灵敏度为56.65％(胸腰段56.68％),特异度为96.39％(胸腰段93.87％),约登指数为0.5304(胸腰段0.5054).改良X线诊断方法的灵敏度为71.67％(胸腰段81.90％),特异度为79.06％(胸腰段75.17％),约登指数为0.5074(胸腰段0.5707).改良X线诊断方法的灵敏度高于传统诊断方法(P<0.001).结论 改良X线诊断方法能有效提高诊断的灵敏度,能够更好地帮助临床医生对骨质疏松性椎体压缩骨折进行初步诊断,特别是提高了对胸腰段椎体压缩骨折的诊断效能.

患者男,24岁,轻体力工人.主诉为右下肢疼痛麻木4个月余,疼痛范围由右侧臀部经大腿后外侧、小腿后外侧放射至足背及足底,咳嗽或打喷嚏时症状明显加重.既往无明确外伤史.于外院就诊,行腰椎MRI检查未见明显腰椎间盘突出和神经根受压(图1),诊断为不明原因的坐骨神经痛.给予非甾体抗炎药对症支持治疗和卧床休息等保守治疗.在治疗过程中,下肢疼痛症状逐渐加重,因疼痛无法行走,出现屈膝屈髋强迫体位.

目的 评估利用术前CT进行术前设计,再结合术中透视引导的穿刺通道技术在老年骨质疏松性椎体压缩性骨折(OVCF)手术中的有效性和安全性.方法 2017年7月至2018年6月连续选择年龄>60岁的OVCF病人,对符合纳入标准的病人行椎体成形术(PVP)或椎体后凸成形术(PKP),术前在伤椎的轴位CT图像上确定经皮入针的横向距离和角度,并通过测量确定骨面入点和椎弓根内壁的位置关系;术中透视确定经皮入针的纵向距离和角度,穿刺至骨面时,结合术前CT的测量结果 在正位片上确定骨面入点的位置.以该技术的穿刺成功率作为主要评价指标,并比较病人术前和术后视觉疼痛评分(VAS)及术中并发症.结果 研究共纳入43例病人,男10例,女33例,平均年龄(73.4±10.1)岁.共对50个节段进行PVP或PKP操作,节段范围为T5～L5,其中T12～L5节段所占比例为86％.穿刺成功率为96％(48/50),2个节段穿刺骨钻尖端没能到达对侧椎体,分别发生在L5和T5水平,骨水泥的弥散偏向一侧.术后仅有2例为通过椎体静脉窦渗漏至椎管,病人术后没有出现神经功能障碍.术前和术后VAS评分比较,差异有统计学意义(P<0.01).结论 利用术前CT进行术前设计,再结合术中透视引导建立穿刺通道的技术在OVCF手术治疗中是安全和有效的.

目的 探讨三维导航引导下后外侧入路椎间盘摘除椎间融合术治疗胸椎间盘突出症的临床疗效及安全性.方法 选择胸椎间盘突出症患者19例,均接受术中即时三维导航引导下后外侧入路椎间盘摘除椎间融合术治疗.记录手术时间、术中出血量;术后12个月评价临床疗效,计算优良率和总有效率;记录患者术前、术后3个月及术后12个月疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数问卷表(ODI)评分、日本骨科协会(JOA)评分;记录患者术前及术后12个月Frankel分级情况;术后12个月行CT检查,观察椎间骨性融合情况,记录并发症发生情况.结果 19例患者手术时间(137.6 ±31.8)min,术中出血量(337.5 ±63.3)mL;疗效评价为优12例、良6例、改善1例、差0例,优良率为94.7%(18/19)、总有效率为100%(19/19).患者术后3个月及术后12个月VAS、ODI评分均较术前显著降低,JOA评分较术前显著提高,且术后12个月ODI评分变化更明显(P均 <0.05).1例Frankel B级患者改善到C级;4例C级患者中1例改善到D级,3例改善到E级;12例D级患者10例改善到E级, 2例Frankel分级无改善.患者术后12个月CT检查显示均获得良好的骨性融合,均未发生硬膜损伤、脑脊液漏、感染、脊髓损伤症状加重、内固定失效等并发症.结论 三维导航引导下后外侧入路椎间盘摘除椎间融合术治疗胸椎间盘突出症安全、有效.

目的 探讨术中即时三维导航辅助下后路半椎体切除术治疗完全分节型半椎体所致的先天性脊柱侧后凸畸形的临床治疗效果.方法 回顾性分析2006年3月至2012年2月北京积水潭医院脊柱外科接受术中即时三维导航辅助下一期后路半椎体切除术的13例先天性侧后凸畸形患者的临床资料.年龄7.5~39.0岁,平均19.1岁;其中,胸椎半椎体6例,腰椎7例.通过术前、术后2周及末次随访时站立位X线的影像资料来评价冠状面和矢状面的矫正效果.结果 随访2.5~8.0年,平均4.3年.节段性侧凸角由术前的49.1°矫正到术后2周时的13.4°,平均矫正率为73.8%,末次随访时为15.6°.总侧凸角由术前的51.7°矫正到术后2周时的15.2°,平均矫正率为71.6%,末次随访时为15.5°.后凸角由术前的37.2°矫正到术后2周时的9.8°,平均矫正率为75.1%,末次随访时为11.0°.术后及末次随访时患者躯干平衡良好,未发现神经、血管损伤及内固定失效等相关并发症.本研究共使用了96枚椎弓根螺钉,也未发现椎弓根螺钉穿破椎弓根内侧壁或外侧壁病例.结论 三维实时导航系统引导下的后路一期半椎体切除术可以安全、精确地切除半椎体,减少手术创伤及术后并发症,有效矫正脊柱畸形,临床效果显著.

Objective Osteoporosis is very common in postmenopausal women. The thoracolumbar junction is the most common site of vertebral compression fracture,a very frequent complication of osteoporosis that is related to bone mass as well as the biomechanical environment in the spine. The aim of this study was to analyze vertebral compression fracture risk in postmenopausal women according to thoracolumbar kyphosis. Methods Age,weight,height,disc height,bone mineral density,fracture site,and Cobb angle data and quantitative computed tomography(QCT)findings were compiled for 396 postmenopausal women with thoracolumbar fracture( study group),and 271 postmenopausal women with degenerative lumbar disease(control group). Proportions and characteristics were com-pared between the groups with the chi-squared tests and unpaired t-tests,respectively. Results In the study group,69 patients (19. 6% )had T11 fractures,153(43. 5% )had T12 fractures,174(49. 4% )had L1 fractures,and 70(19. 9% )had L2 fractures. Slight wedge deformity was found in osteoporotic thoracolumbar vertebrae. QCT findings and sagittal thoracolumbar Cobb angle(TLCobb)dif-fered between the groups(both P < 0. 01). No significant differences were found in body mass index(BMI),disc height,or coronal TL-Cobb. Fracture risk increased with thoracolumbar kyphosis,with an odds ratio(OR)of 7. 6[95% confidence interval(CI)2. 5-22. 8]af-ter adjustment for age,BMI,and qCT findings. Conclusion Thoracolumbar kyphosis increases the risk of vertebral compression frac-ture in postmenopausal women with osteoporosis.

骨质疏松是老年人群中最常见的代谢性骨病，据统计，20％的绝经后女性会发生不同程度的骨质疏松［1］。椎体压缩骨折是骨质疏松最常见的合并症之一，是影响老年人生活质量的重要因素。椎体压缩骨折好发于脊柱胸腰段，临床上表现为不同程度的腰背部疼痛，诊断主要依靠脊柱正侧位 X 线，观察骨折后椎体楔形变现象［2］。