缓慢的力量——Ilizarov技术在中国微言

1950年前苏联骨科医师Ilizarov发现了牵张成骨技术,应用模仿自然的缓慢牵伸力能治愈复杂创伤骨折、骨与软组织的缺损、感染和肢体的严重畸形。这种治疗模式既不同于传统骨科手术技术,也不同于现代的创伤骨科的骨折内固定接骨（AO）技术或截骨矫形技术,这些技术的特征之一就是迅速进行骨的固定和矫正畸形。以每天1mm为特征的Ilizarov技术,不仅解决了缺损和畸形中的骨的问题,而且解决了包括血管、神经、肌肉和皮肤在内的其他软组织的生长问题,对骨科一些创伤和畸形的效果无以伦比。由于诸多原因,在我国的传播不够广泛,还需要各方努力,来一起推动该技术的发展和应用。     

骨外固定——微创肢体重建的利器

骨外固定以其独特的环形、铰链和螺杆等的简单构型,用于复杂创伤及创伤后遗症,复杂的肢体畸形的治疗,可以获得其他方法不可比拟的效果,堪称肢体重建的一把利器.本文从以胫腓骨中段的短斜型闭合骨折为例,详细阐述了外固定器治疗骨折的优势.以复杂的足踝畸形病例为例,阐释了以Ilizarov技术为代表的骨外固定用于肢体畸形矫正并创造神奇效果的秘密.骨外固定顺应了肢体损伤、肢体畸形发生发展的客观规律,由外而内,提供一个适宜的重建方向,符合生物学要求,可以实现骨与软组织的自然修复与重建.     

骨外固定——微创肢体重建的利器

骨外固定以其独特的环形、铰链和螺杆等的简单构型,用于复杂创伤及创伤后遗症,复杂的肢体畸形的治疗,可以获得其他方法不可比拟的效果,堪称肢体重建的一把利器.本文从以胫腓骨中段的短斜型闭合骨折为例,详细阐述了外固定器治疗骨折的优势.以复杂的足踝畸形病例为例,阐释了以Ilizarov技术为代表的骨外固定用于肢体畸形矫正并创造神奇效果的秘密.骨外固定顺应了肢体损伤、肢体畸形发生发展的客观规律,由外而内,提供一个适宜的重建方向,符合生物学要求,可以实现骨与软组织的自然修复与重建.     

治疗感染性骨不连伴大段骨缺损的探讨与思考

感染性骨不连伴大段骨缺损是目前临床骨科较为常见、多发、治疗极为棘手的病种之一,治疗方法多种多样,但疗效却不理想,且缺乏统一的诊治与疗效判断标准,总结、分析几种临床上主要治疗方法的利弊,为该病探寻一条微创、安全、并发症少及疗效确切的可靠治疗方法.随着对Ilizarov技术的基础与临床研究的不断深入,该技术在治疗传统方法难以治愈的疾病如四肢关节严重畸形、感染性骨不连或伴有骨缺损、皮肤软组织缺损等方面显示出自身的优势,为治疗疑难骨科疾病开辟了一条新的有效途径.     

治疗感染性骨不连伴大段骨缺损的探讨与思考

感染性骨不连伴大段骨缺损是目前临床骨科较为常见、多发、治疗极为棘手的病种之一,治疗方法多种多样,但疗效却不理想,且缺乏统一的诊治与疗效判断标准,总结、分析几种临床上主要治疗方法的利弊,为该病探寻一条微创、安全、并发症少及疗效确切的可靠治疗方法.随着对Ilizarov技术的基础与临床研究的不断深入,该技术在治疗传统方法难以治愈的疾病如四肢关节严重畸形、感染性骨不连或伴有骨缺损、皮肤软组织缺损等方面显示出自身的优势,为治疗疑难骨科疾病开辟了一条新的有效途径.     

骨搬移重建微循环的哲学启示

自前苏联Ilizarov医生发现慢性牵拉后组织再生的“张力 应力法则”至今,骨外固定系统已逐渐完善并形成了一种全新的骨科治疗体系.骨搬移技术对物质发展的根本规律、生物学的基础研究、自然重建理念的形成、多种外科疾病的诊治思路和诊疗方法皆产生了重要影响.本文从医学与哲学的角度,论述了骨搬移技术的发展、对牵拉区域微循环的重建及其中包含的哲学思想,为骨搬移技术治疗骨科及血管外科系统疾病提供了医学与哲学上的思路和方法.     

骨搬移重建微循环的哲学启示

自前苏联Ilizarov医生发现慢性牵拉后组织再生的“张力 应力法则”至今,骨外固定系统已逐渐完善并形成了一种全新的骨科治疗体系.骨搬移技术对物质发展的根本规律、生物学的基础研究、自然重建理念的形成、多种外科疾病的诊治思路和诊疗方法皆产生了重要影响.本文从医学与哲学的角度,论述了骨搬移技术的发展、对牵拉区域微循环的重建及其中包含的哲学思想,为骨搬移技术治疗骨科及血管外科系统疾病提供了医学与哲学上的思路和方法.     

探讨Ilizarov技术和中国骨伤科治则之关系

中国骨伤科治则是以传统骨伤理论为基础,结合现代骨科技术形成的治疗骨病的原则,是中西结合医学的精华,是中国哲学文化与现代科技的智慧结合;Ilizarov技术的优势是微创,核心是张力-应力法则,原理是骨外固定技术引导下的牵拉性组织再生、修复、重建。二者的形成背景、指导思想、技术方法均大相径庭,但是二者的精髓却有惊人的相似之处。本文就二者的关联性做简要分析,为更好实践中医骨伤技术提供新方法,也为Ilizarov技术注入新鲜元素,完善该技术的本土转化。     

以柔克刚,以慢胜快:Ilizarov技术的发展与实践

人皆以外固定为简单、初级。实非如此。其涉及到的原理、操作、布局和内固定一样严谨和深奥,需要多年的学习曲线。Ilizarov技术是外固定皇冠上的明珠。发展到今天,可治疗一系列的骨科和非骨科的疾病。源起俄罗斯,其向东西半球流传的七十年间,风格渐异。走向东方的过程中变得轻巧活泼、刚柔相济、快慢结合,和中国哲学思想不谋而合。迄今为止,国内依然缺乏对Ilizarov外固定有着深刻理解和娴熟技术的医生。新时代下该技术需要更精准、客观、深入的传播。纲举则目张,理解其哲学思想,可直指人心、一览群山。     

导言：外固定与肢体重建——符合生态医学的新学科

29岁的内蒙古青年,15年前车祸伤致小腿肌肉广泛坏死,遗留整个小腿皮包骨头,重度马蹄内翻足,用足背负重行走,去过多个大医院检查都建议膝关节下截肢,在秦泗河的矫形骨科用细钢针穿骨安装骨外固定器（Ilizarov环式外固定器）,术后通过缓慢牵伸,足内翻畸形完全矫正,可以用足底全负重弃拐行走,避免了截肢。在秦泗河矫形外科用这项技术治疗的5000多例患者中,已经挽救了30多例濒临截肢的下肢残缺畸形,使许多无望、悲观的患者重新迈上了新生活。     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.