《中华刨伤骨科杂志》创刊十周年纪念大会暨2009年学术年会征文通知

2009年9月，《中华创伤骨科杂志》将迎来创刊十周岁生日。从1999年9月创刊至今的10年间，《中华创伤骨科杂志》在中华医学会及杂志社领导、幕后无私奉献的编委和审稿专家及一路上对杂志给予无限关爱的读者与作者的关心支持下，已成为我国骨科领域的重要期刊之一，对我国创伤骨科事业的发展与建设起到了积极的导向、推动作用，是我国创伤骨科领域最重要的信息源与学术发布载体。     

首届亚洲创伤骨科高峰论坛通知

为推动我国创伤骨科的发展,增进相互了解,扩大与亚洲地区各国的学术交流与技术合作,《中华创伤骨科杂志》社、亚洲创伤骨科学会(A ADO)与中华骨科交流学会(台湾)将于2005年11月11至14日在广州联合举办“首届亚洲创伤骨科高峰论坛”。会议将对创伤骨科领域国际最新技术与进展,以     

计算机辅助骨科手术的应用和进展

计算机辅助手术(CAS)是近年来在外科手术领域发展最为迅速的一个领域。CAS在骨科手术中的具体应用被称为计算机辅助骨科手术(CAOS)。CAOS的含义是利用当今医学领域的先进成像设备如计算机断层扫描(CT)、磁共振成像(MRI)、正电子发射断层扫描(PET)、数字血管减影(DAS、超声成像(US)以及医用机器人(MR)所得到的多模图像数据，在计算机的帮助下，对医学图像信息进行处理并结合立体定位系统，对人体骨骼的解剖结构进行显示和定位，并由计算机规划手术路径，制定合理、定量的手术方案，进行术前手术模拟，在适当的图像监视和立体定位系统下，利用一定的导引系统，在骨科手术中使用计算机和医用机器人进行手术干预，为骨科医生提供强有力的工具和方法。CAOS在提高病灶定位精度，减少手术损伤，执行复杂外科操作，提高手术成功率方面有卓越的表现，配准和定位是CAOS的核心技术。CAOS已应用在脊柱外科、人工关节置换术、创伤骨科、骨肿瘤治疗中。     

重视外科导航技术在创伤骨科的应用与研究

作为外科导航技术在创伤骨科领域中的一员,这次有幸受《中华创伤骨科杂志》邀请进行“计算机辅助骨科导航技术”专刊的组稿。除背景资料的文献回顾外,本期将介绍内地与香港在该领域中的初步临床经验体会和成果,与读者分享。随着计算机及图像技术的迅猛发展,我们可借助计算机进行越来越多的外科手术。尤其在创伤骨科,医生可借助术前或术中所获得的影像进行骨折复位与固定。在临床实践中结合使用计算机和其它信息技术将无疑是未来的发展趋势。在本期专刊中我们将着重介绍外科导航技术在创伤骨科的适应证。经过几年的探索,我们已对下列骨科手术…     

创伤骨科回顾、现状与发展趋势

世界科技飞速发展,其中生命科学又是最为活跃的领域之一,取得了世人瞩目的成就。随着交通、建筑、工农业的快速发展及社会治安问题的突出,创伤率日益升高,创伤程度日趋复杂和危重,创伤骨科作为骨外科学领域的一个重要分支应运而生,目前已逐渐形成一门独立的学科。在《中国创伤骨科杂志》创刊之际,对创伤骨科的过去、现在和未来作一简单的回顾和展示,旨在对创伤骨科的发生、发展有一个整体的认识和宏观的构建,以期瞄准学科发展的国际前沿,不断汲取国外的创新观念,及时引进国外的先进技术,逐渐与国际接轨,以促进我国创伤骨科再越上一个新台阶。     

首届亚洲创伤骨科高峰论坛通知

为推动我国创伤骨科的发展，增进相互了解，扩大与亚洲地区各国的学术交流与技术合作，《中华创伤骨科杂志》社、亚洲创伤骨科学会（AADO）与中华骨科交流学会（台湾）于2005年11月11至14日在广州联合举办“首届亚洲创伤骨科高峰论坛”。会议将就创伤骨科领域国际最新技术与进展、主要以Video Symposium（多媒体动画）形式进行广泛的学术交流。届时将同时举行《中华创伤骨科杂志》第二届编委改选及编委会会议。     

首届亚洲创伤骨科高峰论坛通知

为推动我国创伤骨科的发展，增进相互了解，扩大与亚洲地区各国的学术交流与技术合作，《中华创伤骨科杂志》社、亚洲创伤骨科学会（AADO）与中华骨科交流学会（台湾）于2005年11月11～14日在广州联合举办“首届亚洲创伤骨科高峰论坛”会议将就创伤骨科领域国际最新技术与进展、主要以Video Symposium（多媒体动画）形式进行广泛的学术交流，《中华创伤骨科杂志》即将进入中华医学会系列杂志，     

更正

为推动我国创伤骨科的发展，增进相互了解，扩大与亚洲地区各国的学术交流与技术合作，《中华创伤骨科杂志》社、亚洲创伤骨科学会（AADO）与中华骨科交流学会（台湾）于2005年11月11-14日在广州联合举办。。首届亚洲创伤骨科高峰论坛”。会议将就创伤骨科领域国际最新技术与进展、主要以Video Syruposium（多媒体动画）形式进行广泛的学术交流。《中华创伤骨科杂志》即将进入中华医学会系列杂志，届时将同时进行《中华创伤骨科杂志》第二届编委改进及编委会会议．     

中华医学会骨科学分会创伤骨科学组2008年工作回顾

创伤骨科是一个永久的话题,因为它包含了急救、骨折固定、晚期功能重建等一系列热点问题,因此创伤骨科学组也面临着极大的挑战!如何引导创伤骨科医生在此领域充分发挥他们的才能、创造性地工作学组的重要责任,因此,中华医学会骨科学分会创伤骨科学组2008年做了如下具体工作:     

本期导读

静脉血栓栓塞症(venous thromboembolism,VTE)是创伤骨科患者的常见并发症,也是导致患者围手术期死亡及医院内非预期死亡的主要原因之一。对创伤骨科患者施以有效的抗凝预防措施,可以降低VTE的发生风险,减轻患者痛苦,减少医疗费用。虽然目前国内已有2016版"中国骨科大手术静脉血栓栓塞症预防指南"、2018版"中国血栓性疾病防治指南"等循证证据,但是创伤患者有其独特的临床特点,中华医学会骨科学分会创伤骨科学组等4家组织及《中华创伤骨科杂志》编辑部着眼于创伤骨科患者VTE的预防,在上述指南和2012版"中国骨科创伤患者围手术期静脉血栓栓塞症预防的专家共识"基础上,邀请全国多位创伤骨科知名专家进行讨论研究,并于2020年11月召开了指南制定专家定稿会,最终形成"中国创伤骨科患者围手术期静脉血栓栓塞症预防指南(2021)"。     

下腔静脉滤网在骨科复杂创伤中的初步应用

目的探讨下腔静脉滤网在骨科复杂创伤伴有下肢深静脉急性血栓形成患者中的应用价值。方法对已发现的下肢深静脉血栓形成的骨科复杂创伤患者20例,术前置入下腔静脉滤网后再行手术治疗,术后随访评价患者静脉血栓的情况。结果20例发现下肢深静脉血栓的骨科复杂创伤患者接受了下腔静脉滤网植入术,术中顺利,未见严重并发症,骨科手术时,无一例患者发生肺栓塞,术后患者功能恢复满意。经随访,10例患者静脉血栓缩小,5例消失,5例未见明显变化。滤网周围均未见血栓形成。结论下腔静脉滤网能有效防止下肢深静脉栓塞引起的严重并发症,提高骨科手术的安全性。     

组织工程在创伤骨科领域的研究进展

组织工程作为生命科学研究领域的一门崭新学科,其研究范围涉及骨、软骨、肌腱、神经、血管等多种组织的再造与修复,与创伤骨科的研究与治疗范围有非常大的交叉本文仅就组织工程在创伤骨科领域的研究进展,从骨、软骨、肌腱、血管等创伤骨科治疗中涉及较多的组织构建方面作一简要概述。     

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.     

外科导航技术在创伤骨科的应用

随着计算机及图像技术的迅猛发展,我们可借助计算机进行越来越多的外科手术。尤其在创伤骨科,医生可借助术前或术中所获得的影像进行骨折复位与固定。影像的来源可包括CT图像、术中实时透视图像或内窥镜影像。在临床实践中结合使用计算机和其它信息技术将无疑是未来的发展趋势。在这期的《中华创伤骨科杂志》专刊中我们将着重介绍外科导航技术在创伤骨科的应用。     

Computer assisted orthopaedic and trauma surgery. State of the art and future perspectives

In recent years computer technologies have become more and more integrated in surgical procedures. The potential advantages of computer assisted surgery (CAS) are: increase of accuracy of surgical interventions, less invasive operations, better planning and simulation and reduction of radiation exposure for both patient and surgeon. After introduction of CAS in neurosurgery, the clinical applications of this technique expanded also into trauma and orthopaedic surgery. The first application of this new technique in orthopaedic and trauma surgery was for placement of lumbar pedicle screws. After its introduction into spine surgery, CAS was applied in other fields of orthopaedic surgery like hip, knee and skeletal trauma surgery. In this article the technical background and the various clinical applications and future perspectives of computer assisted orthopaedic and trauma surgery are outlined.     

Orthopaedic trauma on the weekend: Longer surgical wait times,and increased after-hours surgery

IntroductionOrthopaedic trauma does not present in a linear fashion. Fluctuations in trauma volumes, after-hours surgery and surgical wait times impact orthopaedic surgeons and patients. There is little research focussing on how surgical trauma volumes change throughout the week. This study investigated the relationship between day of the week and surgical orthopaedic trauma volumes, after-hours surgery, and wait times for orthopaedic trauma patients.MethodsAll unscheduled surgical orthopaedic trauma cases presenting to one level I and three level IV urban adult trauma centers between 2008 and 2018 were retrospectively reviewed. Fluctuations in orthopaedic trauma volumes and amount of after-hours surgeries completed were investigated using Multivariable Poisson regression. Fluctuations in patient wait times were investigated using linear regression.ResultsWeekends were associated with increased surgical wait times (8.9%, p<0.001) despite decreased surgical trauma volumes (9.1%, p<0.001). Surgical orthopaedic trauma volumes were elevated on weekdays and decreased on weekends. More after-hours surgeries were performed from Thursday to Saturday with most performed on Friday night (26.6%, p<0.001). Surgical wait times increased midweek and remained high until Saturday.ConclusionWith a lack of dedicated trauma resources on the weekend, a significant increase in after-hours surgery and surgical wait times was identified following surgical volumes peaking on Thursday and Friday. We suggest adapting resource allocation to reflect surgical volumes. Dedicated weekend orthopaedic trauma resources or an adaptable schedule during increased orthopaedic trauma have the potential to ease this bottleneck, improve patient care, and decrease hospital costs.     

FROST: Factors Predicting Orthopaedic Trauma Volumes

IntroductionOrthopaedic surgeons often speculate weather and season impact the nature and volume of surgical trauma. Little evidence exists to support this. We aimed to identify the relationship between weather conditions, time of year, surgical orthopaedic trauma volumes, after-hours surgery, and surgical wait times.MethodsUnscheduled surgical orthopaedic cases were retrospectively reviewed at major adult hospitals in Calgary, Alberta, Canada, over an eleven-year period (2008–2018). Weather variables were gathered and a predictive model for ice was generated. Multivariable Poisson regression was used to determine the effect of weather and time of year on orthopaedic trauma volumes and after-hours surgery. Linear regression was used to investigate surgical wait times.Results41,421 unscheduled orthopaedic trauma surgeries were analyzed against daily weather patterns. 49% of all surgery performed was for hip (26.4%) or ankle fractures (22.6%). Same day snow (p=0.002) and ice for two days prior (p=0.031; p=0.003) were significantly associated with increased overall trauma volumes. Same day snow (p<0.001) and ice (p=0.002), as well as ice two days prior (p=0.001), predicted a significant increase in ankle fracture volumes. There was no correlation between weather patterns and hip fracture volumes. Independent of weather, time of year was highly predictive of large swings in orthopaedic trauma volumes and increased wait times. Generally, when patient volumes increased so did after-hours surgery.ConclusionWinter and summer months as well as ice and daily snow contributed to the most significant increases in overall orthopaedic trauma volumes. On a snowy day in February with ice present for three consecutive days, trauma volumes increased as much as 71%. Despite this, resources dedicated to orthopaedic trauma are consistent throughout the year, which highlights the need to allocate resources for orthopaedic trauma surgery based on seasonal demands. We suggest our predictive model be used to guide the amount of operating room time reserved for orthopaedic trauma to better reflect expected volumes. This contrasts the current system which relies on after-hours surgeries and increased patient wait-times to compensate for increased orthopaedic trauma volumes. Since orthopaedic trauma can be predicted by weather patterns, interventions should aim to decrease weather-related orthopaedic trauma and reduce the burden prolonged wait times have on our system.     

计算机辅助导航骨科手术及医用机器人技术在创伤骨科的应用

本文介绍了计算机辅助导航骨科手术(CAOS)及医用机器人技术在创伤骨科应用中的主要进展、当前在临床应用中存在的主要问题和相关对策,并对其未来的发展趋势进行了预测,同时简要介绍了北京积水潭医院创伤骨科在计算机辅助导航骨科手术及医用机器人技术方面的研究进展。当前骨科手术导航定位所应用的医学图象导引系统已经由使用单一的C型臂、CT等传统影像设备向应用三维C型臂、多模态图像处理系统等新型影像设备转变,基于多模态图像的导航系统将有可能成为导航手术的主流。医用机器人已经在自动化程度和人机交互模式方面,有了长足进展,摆脱了原有工业机器人的结构模式。医学图像后处理技术及其它相关信息技术极大地丰富了导航和机器人外科,只有在不断完善光学定位技术的同时,加大对其它定位方法的研究,才能够提高定位精度;要对相关设备进行开放式结构设计,使不同导航系统的注册软件能够互相兼容,手术器械能够通用,降低设备成本。骨科医生要正确认识计算机辅助导航骨科手术及医用机器人技术,在充分了解CAOS的技术特点、基本原理、操作程序的基础上,对要实施的手术具有深刻的理解,才能开展CAOS手术。目前,迫切需要建立CAOS技术标准、临床适应证和手术操作规范,进行CAOS产品之间的技术比较和评估,便于医生选择合适的CAOS产品。伴随快速发展的信息技术,数字化手术室、智能化微创导航手术系统、医用机器人辅助的远程医疗将有可能成为未来CAOS技术的主要组成部分。     

A meta-analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper-limb orthopaedic trauma surgery

The adjuvant effectiveness of nalbuphine in context of brachial plexus block (BPB) in patients undergoing upper-limb orthopaedic trauma surgery has remained uncertain. The purpose of this meta-analysis was to evaluate the analgesic benefit of mixing nalbuphine into local anaesthetics in BPB for wound pain from upper-limb trauma surgery. Primary outcome was the duration of analgesia. Seventeen trials (1104 patients) were analysed. Patients receiving nalbuphine have an increased weighted mean difference (WMD) 95% confidence interval of the duration of analgesia by 186.91 minutes (133.67 to 240.16) (P < 0.001). Compared to placebo, nalbuphine shorten the onset time of sensory and motor block by WMD of 2.59 (1.27 to 3.92) and 3.06 minutes (1.65 to 4.48) (P < 0.001), respectively. Meanwhile, nalbuphine prolonged the durations of sensory and motor block (P < 0.001). Qualitative and quantitative synthesis revealed no differences with regard to the outcomes related to side-effects. There is moderate-quality evidence that the addition of nalbuphine to local anaesthetics for BPB in patients undergoing upper-limb orthopaedic trauma surgery significantly prolongs the duration of analgesia, while preserving a similar safety-profile compared with local anaesthetics alone. However, these benefits should be further weighed against nalbuphine-related neurological safety in future studies.