Integration of Science into Orthopaedic Practice: Implications for Solving the Problem of Articular Cartilage Repair*

J. Buckwalter
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引用次数: 25

Abstract

President Peterson, thank you for the honor of presenting the Fourth International Cartilage Repair Symposium Presidential Guest Lecture. I appreciate the opportunity to address the fascinating subject of integrating science into orthopaedic practice, a subject that should be the primary concern of surgeons and scientists seeking to restore damaged and diseased articular cartilage. It took more than 2000 years for a few thoughtful practitioners of the art of orthopaedics to value and apply principles and observations derived from basic research 1. Yet, in the short time since this occurred, the understanding that optimal patient care depends on science as well as art has transformed orthopaedic practice from a disparate array of manipulations and operations, best characterized as well-intentioned savagery, to a range of treatments that, in many instances, can be considered civilized. Equally important, we live in a time when the integration of knowledge from new basic research into orthopaedic practice has the potential to solve the most daunting clinical problems, including the pain and loss of mobility caused by the limited capacity of human joints to repair themselves. Individuals with varying experience and qualifications have practiced orthopaedics for more than twenty-five centuries 1,2. It would be reasonable to expect that, over this period of time, orthopaedic treatments would have become generally safe and effective. Yet, only 250 years ago, John Hunter (1728-1793), the individual regarded as the father of scientific surgery 3, noted that "surgery, namely operations, is like an armed savage that attempts to get by force that which civilized men would get by stratagem." 2 Orthopaedic operations in Hunter's day were painful, bloody, brutal, and extremely dangerous: the typical results, for patients who survived the operations, were disappointing and disabling 1. It was a situation that led to Hunter's comment that …
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科学与骨科实践的整合:解决关节软骨修复问题的意义*
彼得森校长,感谢您荣幸地主持第四届国际软骨修复研讨会主席客座演讲。我很高兴有机会讨论将科学融入骨科实践的迷人主题,这应该是外科医生和科学家寻求修复受损和患病关节软骨的主要关注点。一些有思想的骨科从业者花了2000多年的时间才重视和应用基础研究中得出的原则和观察结果。然而,在这种情况发生后的很短时间内,人们认识到,最佳的病人护理既取决于科学,也取决于艺术,这一认识已经将骨科手术从一系列不同的操作和手术(最好的特征是善意的野蛮)转变为一系列在许多情况下可以被认为是文明的治疗。同样重要的是,我们生活在这样一个时代,新的基础研究知识与骨科实践相结合,有可能解决最令人生畏的临床问题,包括由人类关节自我修复能力有限引起的疼痛和活动能力丧失。具有不同经验和资格的个人已经从事骨科手术超过25个世纪了。我们有理由认为,在这段时间里,骨科治疗将变得普遍安全和有效。然而,仅仅在250年前,被视为科学外科学之父的约翰·亨特(John Hunter, 1728-1793)就指出:“外科学,即手术,就像一个武装的野蛮人,试图用武力得到文明人可以用计谋得到的东西。”在亨特的时代,整形手术是痛苦的、血腥的、残酷的,而且极其危险的。对于那些手术幸存下来的病人来说,典型的结果是令人失望的和致残的。正是这种情况导致了亨特的评论……
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