新型冠状病毒肺炎疫情期间创伤骨折的诊治原则

2019年12月底,新型冠状病毒肺炎(COVID-19)从湖北省武汉市向全国各地及境外蔓延[1]。2020年1月20日,中华人民共和国国家卫生健康委员会将COVID-19列入《中华人民共和国传染病防治法》规定的乙类传染病,并按甲类传染病进行防控[2]。COVID-19传染病极强,具"人传人"特点,发病隐匿、传播速度快、扩散范围广,无症状者亦可传染,给防控工作带来巨大挑战。虽然在疫情期间,创伤骨科以低能量骨折为主,但在物资转运、协调疏导等工作时仍不可避免有高能量创伤骨折发生,以四肢、骨盆和脊柱骨折最为多见,严重者危及生命;因此,优化诊疗方案、及时施治较平时更为严格,也更加重要。在COVID-19和创伤骨科急症处理的双重考验下,《中华创伤骨科杂志》本期刊登了多篇"新型冠状病毒肺炎与骨科"的相关文章,总结了疫情期间创伤骨科的诊疗规范,并报道了几例严重骨折、尤其是1例确诊COVID-19的腰椎爆裂骨折的手术救治,收到非常好的效果。本文针对疫情防控期间开展的创伤骨科诊疗和护理工作进行点评和总结,以期达到抛砖引玉的效果。     

创伤骨科在新型冠状病毒肺炎疫情期间应急流程管理及防控策略专家共识

由于新型冠状病毒肺炎(COVID-19)潜伏期长,早期症状无特异性,以往针对严重急性呼吸综合征冠状病毒(SARS-CoV)的筛查和防护手段已经不能满足COVID-19疫情控制的需求,必须对COVID-19进行全新的认识并采取特殊的处理流程。由于骨科创伤、出血及疼痛等急性症状的掩盖,COVID-19疫情容易被忽略,使得创伤骨科门急诊亦存在一定的风险和隐患。为了规范创伤骨科门急诊患者的收治,加强创伤骨科医护人员的防护,本文对COVID-19感染的特点及防治原则、疫情期间创伤骨科门急诊的管理、创伤骨科病房和手术室的防控策略、医护人员COVID-19感染防控知识培训进行阐述,为创伤骨科患者的救治以及医护人员的防护提供依据。     

新型冠状病毒肺炎疫情期间急诊创伤骨科患者特点和处理策略

目的探讨新型冠状病毒肺炎(COVID-19)疫情期间急诊创伤患者的损伤特点和处理策略。方法回顾性分析2020年1月20日至2月26日期间南方医科大学南方医院骨科收治的22例创伤急症住院患者资料。男18例,女4例;年龄4~66岁,平均年龄35岁。致伤原因:交通伤11例,锐器切割伤(含菜刀切伤)6例,重物压砸伤1例,机器碾压伤1例,跌倒摔伤2例,机器绞伤1例;损伤类型:高能量损伤13例,低能量损伤9例;损伤部位:上肢7例,下肢15例。医护人员诊疗过程中对于无新型冠状病毒(2019-nCoV)核酸筛查结果的1例患者采用二级防护,其余21例患者采用一级防护。记录患者和医务人员感染2019-nCoV的情况,总结疫情期间创伤急症的处理措施和经验。结果在诊治22例创伤急症患者期间,无一例医务人员和患者确诊COVID-19。紧急入院未做筛查的1例患者按疑似COVID-19病例对待,采用二级防护,术后排除COVID-19。结论COVID-19疫情期间,处理创伤急症的一线医务人员接诊过程均面临较高感染风险。创伤骨科急诊患者主要是交通伤和机器伤,老年患者主要由锐器切割及跌倒引起。通过完善院前筛查、选择合适的麻醉及手术方式、做好围手术期医护人员的防护及合理的术后病房管理和患者心理疏导,可降低院内COVID-19感染发生率。     

新型冠状病毒肺炎疫情下急诊创伤骨科诊疗行为的建议和策略

目的探讨新型冠状病毒肺炎(COVID-19)疫情下急诊创伤骨科诊疗行为的建议和策略。方法回顾性分析2020年1月21日至2月15日期间武汉大学人民医院骨外科收治的128例急诊创伤骨科患者资料,男71例,女57例;年龄为5~88岁,平均48.7岁。门诊处置107例;住院手术21例,其中急诊手术4例,择期手术17例。记录患者和医务人员感染COVID-19的情况,总结疫情暴发以来实施的一些措施和经验。结果107例接受门诊处置的患者中,3例确诊COVID-19,3例疑似COVID-19。4例接受急诊手术的患者中,1例疑似COVID-19;17例接受择期手术的患者中,1例确诊COVID-19,2例疑似COVID-19。医务人员感染COVID-19的情况:2名护士确诊COVID-19,但均为轻症患者;1名医生和1名护士均疑似COVID-19。医务人员感染COVID-19均发生在疫情防控措施执行之前,不排除社区感染的可能。结论各级医疗机构在做好COVID-19防控的同时,保证安全、有效的医疗行为正常运转尤为重要。在COVID-19疫情期间,参与急诊创伤骨科的一线医务人员的接诊过程均面临诸多挑战。通过健全急诊创伤分诊流程、住院患者分类管理、住院病房优化管理、围手术期标准预防、完善落实医护防护制度、患者及陪护宣教配合等措施,可降低院内COVID-19感染发生率,在疫情期间依然可以为急诊创伤骨科患者提供优质、安全的医疗服务。     

新型冠状病毒肺炎疫情下骨科疾病的诊疗原则

由冠状病毒(2019 novel coronavirus,2019-nCoV)引发的新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情仍在持续,由此造成的医护人员感染并不少见。如何才能做到既满足临床骨科疾病的诊疗需求,又防止疫情的大肆蔓延是骨科医生面临的巨大挑战。依据骨科患者的暴露史和病情进行分级防控极为重要,为减少医护人员和患者的暴露,保证医疗安全和降低防疫物资的消耗,将骨科患者分为三级(1、2、3级)六类(1A、1B、2A、2B、3A、3B)进行处理,为各级医院骨科开展临床诊治提供有效参考。     

新型冠状病毒肺炎期间骨盆髋臼骨折诊疗专家共识

自2019年12月以来,新型冠状病毒(2019-nCoV)感染的肺炎(COVID-19)疫情暴发并向全国蔓延。相较于严重急性呼吸综合征(SARS)冠状病毒,2019-nCoV致死率更低,但却具有更高的传染性和致病力。截至2020年2月22日24时,累计报告确诊病例76936例(武汉36174例)[1];截至2月11日,全国医务人员感染3019例[2],远远超过了"非典"疫情感染人数。骨盆、髋臼骨折是创伤救治中最为复杂的病情之一,其发生率约占全身骨折的3%[3]。骨盆、髋臼骨折常发生于高能量损伤,容易合并大出血、重要脏器损伤等严重情况,病死率一直居高不下[4]。病毒流行为疫区骨盆、髋臼骨折院前急救、急诊诊疗、手术策略、麻醉和围手术期管理等医务工作带来了巨大挑战。在疫情流行期间,为了降低骨盆、髋臼骨折救治过程中患者之间、患者与医务人员之间、医务人员相互之间交叉感染的风险,提高骨折预后水平,需要通过多学科协作,统筹传染病和骨盆、髋臼骨折的诊疗方案,制定严密的诊疗计划,降低疾病的致残率和致死率。为响应党中央号召,科学战"疫",坚决打赢这场疫情防控的人民战争、总体战、阻击战,根据《新型冠状病毒感染的肺炎诊疗方案(试行第六版)》,结合肺炎防治和创伤救治相关诊疗指南[5,6,7,8,9,10],特制定此诊疗专家共识,以规范COVID-19疫情期间骨盆、髋臼骨折的诊疗,提高治愈率,降低交叉感染的风险。     

新型冠状病毒肺炎疫情期间泌尿外科非新冠肺炎急危重症的治疗建议

新型冠状病毒肺炎(novel coronavirus pneumonia,NCP),简称新冠肺炎,是一种由世界卫生组织(World Health Organization,WHO)命名为2019-nCoV的具有强烈传染性的新型冠状病毒感染引起的肺炎[1]。2019-nCoV除了攻击肺部外,还可引起包括心脏、肾脏等多个器官受损,WHO将该病毒引起的疾病统称为2019年冠状病毒疾病(corona virus disease-19,COVID-19)[2]。新冠肺炎从2019年12月在湖北省武汉市散在发生,逐步蔓延至全国多个省、自治区和直辖市。     

新型冠状病毒肺炎疫情下加速康复外科理念在老年髋部骨折急诊快通道中的应用效果

目的 探讨新型冠状病毒肺炎(COVID-19)疫情下加速康复外科(ERAS)理念在老年髋部骨折急诊快通道中的应用效果.方法 对COVID-19疫情期间东南大学附属南京中大医院创伤骨科于2020年3月至2021年3月与2021年4月至9月分别通过急诊常规救治流程(对照组)和依据ERAS理念实施优化的急诊快通道流程(快通道...     

新型冠状病毒肺炎疫情期间肝移植病房管理单中心经验

自2019年12月发生的新型冠状病毒肺炎(COVID-19)影响范围广、感染人数多,在对社会生活造成严重影响的同时,也给医院器官移植病房的管理带来了巨大挑战。肝移植受者术后免疫力低下,新型冠状病毒(2019-nCoV)易感性可能较普通人群更高。因此,肝移植病房的管理具有其特殊性。COVID-19疫情期间,青岛大学附属医院肝脏移植科医护人员通过学习国家卫生健康委员会发布的COVID-19防控和诊疗方案以及相关指南,加强医护人员自身防护,制订适应疫情形势的住院患者管理流程,完善患者及其家属COVID-19相关知识宣教,建立并优化肝移植病房管理方案。期望通过特殊时期肝移植病房的有效管理,在予肝移植受者科学治疗的同时,有效避免2019-nCoV感染。     

新型冠状病毒疫情期间骨科患者手术器械消毒灭菌与管理的流程与策略

2019年12月以来,新型冠状病毒肺炎(COVID-19)已在世界多地暴发。虽然疫情在我国得到控制,随着复工复产的逐步深入,部分COVID-19患者治愈后"复阳",特别是近1个月以来,境外输入病例逐渐增多,因此疫情防控形势仍然严峻,医疗机构在未来一段时间内仍面临巨大压力。基于2016版《医院消毒供应中心清洗消毒及灭菌技术操作规范》、2012版《医疗机构消毒技术规范》、《新型冠状病毒肺炎防控方案(第五版)》及《新型冠状病毒肺炎诊疗方案(试行第六版)》等相关标准,河北医科大学第三医院消毒供应中心制定本科室"新型冠状病毒(2019-nCoV)感染复用器械处理流程、2019-nCoV感染器械回收流程、2019-nCoV感染器械转运车处理流程"等应急预案。为疫情防控期间消毒供应中心(CSSD)各项防控管理措施提供参考。     

防控新型冠状病毒肺炎期间足踝外科临床诊疗工作专家共识

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19),是由SARS-CoV-2(severe acute respiratory syndrome coronavirus 2)病毒感染引起的急性呼吸道传染病,其特点为典型临床症状不明显、潜伏期长、隐蔽性和传染性强,患者早期常无特异症状,甚至无任何症状,但已具传染性。该病主要以飞沫与接触传播为主要途径,并存在粪口和气溶胶传播的可能。足踝外科门诊和住院诊疗过程需要详细问诊、严格查体,充分接触患者,故发生交叉感染的风险很大。为避免在诊治过程中出现患者之间、患者与医务人员之间、医务人员之间发生交叉感染,本文从足踝外科门急诊、术前、术中、术后防控等环节进行分析,同时结合全国多家抗疫一线医务工作者的救治经验及循证医学证据,通过专家讨论最终形成专家共识,为在COVID-19防控期间足踝外科临床工作防止交叉感染提供参考依据。     

新型冠状病毒肺炎疫情下胸外科面临的挑战与对策

2019年12月以来,湖北省武汉市陆续出现2019新型冠状病毒(2019-nCoV,SARS-CoV-2)感染病例,疫情持续蔓延,全国其他地区也相继发现了此类病例。新型冠状病毒肺炎疫情给胸外科临床实践带来了巨大挑战。门诊需要加强对磨玻璃影及肺内斑块影病例的鉴别诊断。疫情期间严格控制手术指征,推迟择期手术;拟行限期手术患者,需隔离2周且核酸检测阴性后,方可开展手术;在疫区拟行急诊手术患者,术前应注意排查是否合并新型冠状病毒感染,必要时行核酸检测;拟行急诊手术患者,必要时术前应开展核酸检测,术中按三级防护处理。严格开展手术消毒隔离措施。在术后患者中,积极排查合并新型冠状病毒感染患者。在新型冠状病毒感染患者抢救过程中,需要注意预防、治疗相关并发症,包括机械通气相关性气胸或纵隔气肿以及气管插管后损伤。     

Outcomes of orthopaedic trauma patients undergoing surgery during the peak period of COVID-19 infection at a UK major trauma centre

BackgroundTo review the clinical outcomes of all patients undergoing emergency orthopaedic trauma surgery at a UK major trauma centre during the first 6 weeks of the COVID-19 related lockdown.MethodsA retrospective review was performed of all patients who underwent emergency orthopaedic trauma surgery at a single urban major trauma centre over the first six-week period of national lockdown. Demographics, co-morbidities, injuries, injury severity scores, surgery, COVID-19 status, complications and mortalities were analysed.ResultsA total of 76 patients were included for review who underwent multiple procedures. Significant co-morbidity was present in 72%. The overall COVID-19 infection rate of the study population at any time was 22%. Sub-group analysis indicated 13% had active COVID-19 at the time of surgery. Only 4% of patients developed COVID-19 post surgery with no mortalities in this sub-group. The overall mortality rate was 4%. The overall complication rate was 14%. However mortality and complications rates were higher if the patients had active COVID-19 at surgery, if they were over 70 years and had sustained life-threatening injuries.ConclusionThe overall survival rate for patients undergoing emergency orthopaedic trauma surgery during the COVID-19 peak was 96%. The rate of any complication was more significant in those presenting with active COVID-19 infections who had sustained potentially life threatening injuries and were over 70 years of age. Conversely those without active COVID-19 infection and who lacked significant co-morbidities experienced a lower complication and mortality rate.     

血管紧张素转换酶2在人类高致病性冠状病毒肺炎中作用的研究进展

2019年底爆发的新型冠状病毒(SARS-CoV-2)是一种新发现的人类高致病性冠状病毒。据调查其和严重急性呼吸综合征冠状病毒(SARS-CoV)具有一定的相似性。血管紧张素转换酶2(ACE2)是SARS-CoV感染细胞的受体,并且可能也是SARS-CoV-2的功能受体。目前发现SARS-CoV可通过刺突蛋白与ACE2结合侵入细胞,同时ACE2在炎症性肺疾病的病程中也起到了重要作用。因此ACE2在SARS及新型冠状病毒肺炎(COVID-19)中的可能作用值得讨论。本文简要总结了ACE2在SARS中的作用,讨论了ACE2在COVID-19中可能的作用及感染其他器官的潜在风险,最后针对ACE2的功能探讨了SARS的治疗策略,以期为临床治疗COVID-19提供借鉴和启示。     

Guideline for diagnosis and treatment of spine trauma in the epidemic of COVID-19

Outbreak of COVID-19 is ongoing all over the world. Spine trauma is one of the most common types of trauma and will probably be encountered during the fight against COVID-19 and resumption of work and production. Patients with unstable spine fractures or continuous deterioration of neurological function require emergency surgery. The COVID-19 epidemic has brought tremendous challenges to the diagnosis and treatment of such patients. To coordinate the diagnosis and treatment of infectious disease prevention and spine trauma so as to formulate a rigorous diagnosis and treatment plan and to reduce the disability and mortality of the disease, multidisciplinary collaboration is needed. This expert consensus is formulated in order to (1) prevent and control the epidemic, (2) diagnose and treat patients with spine trauma reasonably, and (3) reduce the risk of cross-infection between patients and medical personnel during the treatment.     

Revisiting conservative orthopaedic management of fractures during COVID-19 pandemic

COVID-19 pandemic has brought the need to revisit the conservative management of orthopaedic injuries back into sharp focus. On the advent of COVID-19 pandemic, it has been acknowledged by the British Orthopaedic Association (BOA) emergency COVID-19 and the National Health Service England (NHSE) guidelines to manage urgent orthopaedic and trauma conditions pragmatically balancing optimum treatment of patients against clinical safety with resource utilization .The current Coronavirus outbreak has refocussed orthopaedic minds on managing many injuries conservatively, which would have otherwise been managed with operative fixations. We revisit the role of conservative orthopaedic management of fractures in the context of COVID-19 and current guidelines.     

Coronavirus Disease 2019 Pneumonia in Immunosuppressed Renal Transplant Recipients: A Summary of 10 Confirmed Cases in Wuhan,China

BackgroundPrevious studies on coronavirus disease 2019 (COVID-19) have focused on populations with normal immunity, but lack data on immunocompromised populations.ObjectiveTo evaluate the clinical features and outcomes of COVID-19 pneumonia in kidney transplant recipients.Design, setting, and participantsA total of 10 renal transplant recipients with laboratory-confirmed COVID-19 pneumonia were enrolled in this retrospective study. In addition, 10 of their family members diagnosed with COVID-19 pneumonia were included in the control group.InterventionImmunosuppressant reduction and low-dose methylprednisolone therapy.Outcome measurements and statistical analysisThe clinical outcomes (the severity of pneumonia, recovery rate, time of virus shedding, and length of illness) were compared with the control group by statistical analysis.Results and limitationsThe clinical symptomatic, laboratory, and radiological characteristics of COVID-19 pneumonia in the renal transplant recipients were similar to those of severe COVID-19 pneumonia in the general population. The severity of COVID-19 pneumonia was greater in the transplant recipients than in the control group (five severe/three critical cases vs one severe case). Five patients developed transient renal allograft damage. After a longer time of virus shedding (28.4 ± 9.3 vs 12.2 ± 4.6 d in the control group) and a longer course of illness (35.3 ± 8.3 vs 18.8 ± 10.5 d in the control group), nine of the 10 transplant patients recovered successfully after treatment. One patient developed acute renal graft failure and died of progressive respiratory failure.ConclusionsKidney transplant recipients had more severe COVID-19 pneumonia than the general population, but most of them recovered after a prolonged clinical course and virus shedding. Findings from this small group of cases may have important implications for the treatment of COVID-19 pneumonia in immunosuppressed populations.Patient summaryImmunosuppressed transplant recipients with coronavirus disease 2019 infection had more severe pneumonia, but most of them still achieved a good prognosis after appropriate treatment.     

儿童冠状病毒感染

冠状病毒为RNA病毒,广泛存在于人类和动物。人冠状病毒(HCoVs)是社区呼吸道感染常见病原;严重急性呼吸综合征冠状病毒(SARS-CoV)、中东呼吸综合征冠状病毒(MERSCoV)以及新型冠状病毒(2019-nCoV)引起了近20年内3次人际疫情。儿童对冠状病毒普遍易感;相对于成年人,因其相对不成熟的生理状况,儿童发生病毒感染时会有与年龄相关的临床特点。本文对儿童HCoVs社区获得性感染、儿童严重急性呼吸综合征(SARS)及儿童中东呼吸综合征(MERS)的特征进行总结;并依据目前我国已公开发表的新型冠状病毒感染疾病(COVID-19)的相关方案、专家建议及2019-nCoV儿童感染资料,对儿童COVID-19诊疗进行总结。