数字技术在创伤骨科的应用 临床数字骨科（一）

近年来,数字技术的飞速发展为骨科疾病的临床诊疗和基础研究提供新的手段,其与传统骨科互相融合、互相促进、互相影响,逐渐形成具有时代特征的现代数字骨科。目前应用于骨科的数字技术主要包括医学影像处理与三维建模技术、三维虚拟仿真与可视化技术、临床计算机辅助设计／计算机辅助制造（computerassisteddesign／computerassistedmanufacturing,CAD／CAM）技术、有限元技术、手术导航与机器人辅助技术、     

骨科创伤流行病学研究

随着工业、交通及建筑事业高速发展,随之而来的工业意外事故、交通事故、自然灾害的发生也随之增加,骨科创伤的患者也大量增加,尤以重症患者增长率为高。随着创伤后遗伤残的增加,不仅会造成潜在寿命损失,也已成为令人关注的重要公共卫生问题。同时社会也认识到了骨科创伤带来的巨大经济损失,如对单一的上肢损伤,1980年美国因上肢损伤所致的经济损失,超过100亿美元,其中30.8亿是医疗支出等直接费用;而收入减少、生产损失与补偿等间接费用则高达70.3亿,为直接损失的2倍。这些问题显示了骨科创伤流行病学研究的必要性,它对骨科创伤的预防和院前…     

北京大学人民医院创伤骨科

北京人民医院创伤骨科成立于1999年1月，为拥有50张病床的集病房、急诊、门诊及独立研究室为一体的完整学科，是国家教育部重点学科，北京大学博士学科点。学科现有教授1名，副教授3名，主治医师3名，在编医护人员共25名。在读博士研究生13名，硕士研究生4名。     

山东省立医院创伤骨科

山东省立医院创伤骨科成立于1992年，由周东生教授创办，是山东省成立最早的创伤骨科专业。科室现有医护人员23名，其中主任医师2名，副主任医师6名；博士生导师1名，硕士生导师2名。     

虚拟人体将为创伤骨科研究提供新技术

“虚拟人体”是一个较新的学术名词，这是当前科技前沿生命科学与信息科学相结合的研究新领域。虚拟人体研究是将人体结构和功能加以数字化，经过计算机技术处理，在电脑屏幕上出现可视的仿真人。虚拟人的全部研究发展包括四个阶段：“虚拟可视人”、“虚拟物理人”、“虚拟生理人”和“虚拟智能人”。当前研究进展情况已构建了“虚拟可视人”，正向后续阶段探索。有很多科学问题和应用开发问题尚有待解决，研究工作方兴未艾，任重道远。本就此项发展前景深远、当前尚未完善的新技术平台与创伤骨科研究工作的关系，进行了初步的分析探讨。     

全方位护理在创伤骨科患者中的应用

目的:探讨全方位护理在创伤骨科患者中的应用。方法:选取我院在2007～2011年收治的71例创伤骨科患者,其中,男性40例,年龄在17～54岁,女性31例,年龄19～61岁,所有患者均经临床诊断为骨科创伤。将71例患者随机分为两组,观察组37例,对照组34例,观察组患者在治疗过程中采用全方位护理,对照组患者仅采用常规护理,对两组患者的护理过程进行跟踪观察,并记录所得数据。结果:经过一系列的护理,两组患者的病情均有所改善,观察组37例患者中,显效21例,有效13例,无效3例,护理有效率为91.9%,对照组34例患者中,显效15例,有效11例,无效8例,护理有效率为76.5%。结论:在治疗骨科创伤疾病的过程中,给予患者全方位的护理可以有效改善患者的病情,提高患者的生活质量,因此,值得在临床推广应用。     

Validity of outcome measures used to assess one and six month outcomes in orthopaedic trauma patients

Introduction

To evaluate the validity of the 12-item Short Form Health Survey (SF-12), Sickness Impact Profile (SIP) and the Short Musculoskeletal Functional Assessment Questionnaire (SMFA) for use in an orthopaedic trauma population.

Materials and methods

A prospective validation trial was completed at a Level 1 adult trauma centre in Melbourne, Australia. One hundred and fifty four patients with orthopaedic trauma managed or followed-up by an orthopaedic unit were prospectively recruited. Patients with pathological fractures related to metastatic disease and/or an isolated orthopaedic injury, a documented history of mental illness or dementia or those for whom follow-up was likely to be difficult were excluded. The SF-12, SIP and SMFA were administered by a trained interviewer at one and six months. Each questionnaire was scored for the physical and mental components and then compared for content and construct validity at each time point.

Results

Complete data were collected for 134 patients at one and six months. The one and six month component scores correlated strongly between the SF-12 physical, SIP physical (r = 0.513–0.669) and SMFA dysfunction (r = 0.529–0.778); the SF-12 mental, SIP mental (r = 0.643–0.719) and SMFA bother (r = 0.564–0.602) components. The strength of association was greater for the six month time point compared to the one month measure. The SF-12 demonstrated no ceiling or floor effects, and provided a lower time burden on participants and researchers when compared to the SIP and SMFA.

Conclusions

For large population-based surveillance research into orthopaedic injury the SF-12 provides a valid and versatile tool.     

Availability of orthopaedic trauma lists in the United Kingdom

National guidelines recommend that hospitals dealing with acute orthopaedic trauma should have daily, consultant led trauma lists, performed in dedicated trauma theatres. This study examined the availability and organisation of orthopaedic trauma lists in the United Kingdom using a postal survey. Of 228 responding hospitals, only 29% had daily trauma lists. In 17%, elective cases were cancelled to accommodate trauma whilst up to 20% of hospitals had a high proportion of their trauma lists not being consultant led. Twenty-one percent of responding hospitals did not have a dedicated trauma theatre. Our results suggest that most units have a long way to go in meeting national standards regarding the availability of orthopaedic trauma lists.     

1994～2003年深圳市骨科创伤住院病例调查分析

目的调查分析深圳骨科创伤流行病学的特点,为政府决策提供参考。方法按随机原则抽取1994～2003年深圳市各级各类医院中急性创伤住院病历35万份的20%,共抽取骨科创伤病历24606份。进行回顾性调查骨科创伤住院病例一般情况及创伤后的处理、恢复情况及伤害所致的经济损失情况等。结果深圳骨科创伤住院患者从1994年的126．46/10万增加到2003年的308．55/10万。男性占80%,年龄在10～40岁之间占77．58%；宝安区和龙岗区两个工业区占76．85%；在区级及以下医院就治的占71．86%：自费病例占67．89%,平均费用为6597．80元。结论深圳骨科创伤住院人数及发病率随经济增长而增加,患者逐年增多。以外来务工的年青男性为主,交通伤是第一位的原因,但救治力量有限,患者以自费为主。政府应以预防为主,加强教育,从经济、人口管理、卫生医疗上提高对骨科创伤的认识并积极采取措施。     

深入开展创伤骨科的临床研究

本期选登了今年中华医学会骨科分会创伤骨科学组年会的近20篇论文,集中展示了我国创伤骨科的现状。有关骨盆骨折的治疗涉及骨盆骨折大出血的处理和腰骶丛损伤问题。在全身支持治疗的同时,对骨盆骨折的固定和对出血血管的止血与修复是盆腔大出血治疗的重要措施。有关股骨近端骨折的内固定治疗,动力髋部螺钉适用于稳定型转子间骨折,对不稳定转子间骨折应选用髓内固定系统。股骨远端骨折目前固定方法较多,应强调术者的术前设计和内固定物的操作技术对预后的影响。跟骨骨折目前趋向使用平片与CT结合的分类评价,跟骨的复位固定应强调恢复跟骨的长度、高度、宽度和关节面的平整。今后,应加强创伤骨科临床研究方法规范、评价标准的统一,以提高我国创伤骨科的整体水平。     

Tourism and the Highlands: A cross-sectional study on trauma and orthopaedic service use by tourists in 2017

BackgroundNHS Highland covers a wide geographical region encompassing the Isle of Skye, and Ben Nevis. Tourism is a significant contributor to the local economy and in 2017 the Highlands welcomed 534,000 visitors. Health services across the region treat tourists in addition to the local population. We investigated how many tourists accessed the Trauma and Orthopaedic (T&O) Department at Raigmore Hospital, Inverness.MethodsWe conducted a cross-sectional study with data collected over one year (2017). The number of tourists referred to T&O including patient demographics, country of origin, type of injury and their clinical outcome were recorded. A freedom of information (FOI) request to NHS Highland was sought to investigate associated costs incurred by tourists.Results376 tourists accessed T&O services in 2017. Country of origin: 47 (12.5%) Scotland; 177 (47.1%) rest of UK; 74 (19.7%) EU; 45 (12.0%) non-EU. Highest referral month August (61), lowest referral month November (8). Injuries: 224 (59.6%) fracture; 62 (16.5%) soft tissue injury; 20 (5.3%) laceration. Commonest sites of injury were ankle, distal radius and finger. Outcomes: 28 (7.4%) Virtual clinic; 137 (36.4%) hospital admission; 193 (51.3%) advice to referring team and discharge; 13 (3.5%) direct discharge by T&O; 4 (1.1%) missing. No. of trauma cases booked: tourists 133 (9%), local population 1415 (91%).ConclusionsTourists account for fewer than ten percent of the T&O surgical workload over one year with common injuries being fractures affecting the extremities. Seasonal variation was observed with more referrals occurring in the summer months. Just under half of tourists originated from outside the UK and EU. Health boards should consider increasing resources over the summer months to deal with expected increases in tourist numbers and should be able to recover the cost of treatment from the patient or their travel insurance companies directly at point of care.     

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。     

Characterisation of orthopaedic trauma admitted to adult level 1 trauma centres

BACKGROUND: Despite the vast number of traumatic injuries that are orthopaedic in nature, comprehensive epidemiological data that characterise orthopaedic trauma are limited. The aim of this study was to investigate the nature of orthopaedic trauma admitted to adult Level 1 Trauma Centres. METHODS: Data were obtained from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), which includes all patients with orthopaedic trauma admitted to the two adult Level 1 Trauma Centres in Victoria (Australia). Information was collected from the medical record and hospital databases on patients' demographics and injury event, diagnoses and management. RESULTS: Data were analysed on 784 patients recruited between August 2003 and March 2004. Patients were mainly young (<65 years) (70.7%), male (59.1%) and injured in a transport collision (51.3%). Fractures of the femur (23.7%) and spine (23.5%) were the most common injuries and were predominately managed with operative (87.6%) and conservative (78.8%) methods, respectively. Differences in most parameters were evident between younger (<65 years) and older (> or =65 years) patients. CONCLUSIONS: This study presents epidemiological data on patients with orthopaedic trauma who were admitted to adult Level 1 Trauma Centres. This information is critical for the future monitoring and evaluation of the outcomes of orthopaedic trauma.     

骨科创伤的早期救治

创伤已成为当今社会的一大公害,而骨科创伤占现代创伤总数的1/2～2/3。为降低其死亡率和伤残率,对骨科创伤的急救应以抢救生命为核心,保持患者的呼吸道通畅和维持有效循环血容量,积极抗休克治疗和进行各项生命体征的监护,恰如其分的伤情评估和分科救治。而对骨科创伤的早期治疗应把握好全身治疗与局部治疗的关系,在生命体征稳定的情况下,早期彻底清创,稳妥固定骨折,尽早修复软组织缺损,积极防治并发症,以利提高救治成功率。     

等速技术原理及其在骨科康复中的临床应用

等速运动是一项新的肌肉功能评价和肌力训练方法，作为骨科康复的一项技术，其在肌肉功能评价方面具有较好的准确性和可重复性。等速肌力训练时，运动速度预先在等速仪器上设定，运动中阻力与肌肉实际力量相匹配，是一种顺应性阻力，这使肌肉在整个活动范围内始终承受最大阻力，产生最大肌力。因此，等速肌力训练在骨科康复治疗中即有效又安全。     

Improved trauma patient outcomes after implementation of a dedicated trauma admitting service

Background

Regionalised trauma systems have been shown to improve the outcome of seriously injured patients. However, it is not clear which components of these systems have the most impact on patient outcomes. The study evaluates the association between implementation of a single, dedicated trauma admitting service at an urban trauma centre and subsequent patient outcomes.

Methods

This was a retrospective review of prospectively collected trauma registry data at the St George Public Hospital, a level I urban trauma centre in Sydney, Australia. Two concurrent 18-month periods, before and after implementation of a full-time trauma service, were compared for differences in patient mortality, complication rates, and ED, ICU and hospital lengths of stay.

Results

There were 962 patients admitted to the hospital in the 18 months immediately preceding the implementation of the trauma service (the PRE group) and 990 patients in the subsequent 18 months (the POST group). There were no significant differences between groups with respect to patient demographics or mechanism of injury, although a higher proportion of patients in the POST group had injury severity scores (ISS) above 15 (30.6% versus 24.8%, p = 0.02). There was an 8% reduction in death rate among the most severely injured patients (ISS > 15), in the POST group as compared to the PRE group (12.2% and 20.2% respectively, p = 0.007).

Conclusions

The implementation of a full-time trauma service in this hospital was associated with a reduction in death rate among the most severely injured patients, and a decrease in LOS in patients with an ISS < 15.