新型冠状病毒肺炎疫情期间非重点疫区下肢骨折患者收治及围手术期管理的经验  

Admission and perioperative management of patients with lower extremity fracture in a mildly affected area in the epidemic of COVID-19

作　　者：许毅博 路遥[1] 马腾[1] 任程[1] 刘德印[1] 刘宏亮[1] 陶旺 段宁[1] 焦宁[1] 卢代刚[1] 王谦[1] 薛汉中[1] 林华 李忠[1] 张堃[1] Xu Yibo;Lu Yao;Ma Teng;Ren Cheng;Liu Deyin;Liu Hongliang;Tao Wang;Duan Ning;Jiao Ning;Lu Daigang;Wang Qian;Xue Hanzhong;Lin Hua;Li Zhong;Zhang Kun(Department of Orthopaedic Trauma,Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine,Xi'an 710054,China)

机构地区：[1]西安交通大学医学院附属红会医院创伤骨科,710054

出　　处：《中华创伤骨科杂志》2020年第5期411-415,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的总结新型冠状病毒肺炎(COVID-19)疫情期间非重点疫区下肢骨折患者收治及围手术期管理的经验。方法回顾性分析2020年1月23日至2月22日期间西安交通大学医学院附属红会医院创伤骨科下肢病区收治的88例(97处)下肢骨折患者资料。男43例,女45例;年龄为15~95岁,平均65.5岁。主要骨折部位:股骨颈骨折33例,股骨转子间骨折26例。主要手术方式:骨折切开复位内固定29例,股骨近端防旋髓内钉固定25例,髋关节置换术28例。记录患者受伤至入院时间、入院至手术时间、手术时间、骨折复位质量、住院时间、围手术期下肢深静脉血栓形成(DVT)情况等。患者入院进行COVID-19筛查,观察患者及医务人员感染COVID-19的情况。结果88例患者入院前筛查COVID-19感染均呈阴性。本组患者受伤至入院时间平均为4.5 d,入院至手术时间平均为3.7 d,住院时间平均为6.6 d。28例髋关节置换患者术后假体位置、角度良好,69例骨折固定患者术后骨折功能及解剖复位率为94.2%(65/69)。围手术期25例(28.4%)患者出现DVT。7例(8.0%)患者术后3 d内出现发热,考虑为吸收热。无一例患者和医务人员感染COVID-19。结论非重点疫区医疗机构创伤骨科医生在掌握COVID-19防控诊疗知识、骨折患者接诊原则的情况下,严格筛查流行病学史,把握手术适应证,规范操作,可降低院内COVID-19感染的发生率,在疫情期间依然可以为患者提供有效、安全的医疗服务。Objective To report our experience in the admission and perioperative management of 88 patients with lower extremity fracture in a mildly affected area in the epidemic of COVID-19.Methods A retrospective analysis was conducted of the 88 patients with 97 lower extremity fractures who had been admitted to Department of Orthopedic Trauma,Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine from 23rd January,2020 to 22nd February,2020.They were 43 males and 45 females,aged from 15 to 95 years(average,65.5 years).The patients underwent screening for COVID-19 infection before admission.Their fractures were located at the femoral neck in 33 cases and at the femoral trochanter in 26.Open reduction and internal fixation was performed for 29 cases,internal fixation with proximal femoral nail anti-rotation(PFNA)for 25 and hip replacement for 28.The time from injury to admission,time from admission to surgery,operation time,fracture reduction,hospital stay,and perioperative deep venous thrombosis(DVT)of lower limbs were recorded.COVID-19 infection was observed in the medical staff and patients as well.Results All the 88 patients were COVID-19 negative in the screening before admission.The time from injury to admission averaged 4.5 days,the time from admission to surgery 3.7 days and hospital stay 6.6 days.The prostheses were all well located in the 28 patients undergoing hip replacement.The rate of functional and anatomic reduction was 94.2%(65/69)in the 69 patients undergoing internal fixation.Peri-operatively,DVT occurred in 25 cases(28.4%).High temperature was observed in 7 patients within 3 days after operation,which was diagnosed as absorption fever.No medical staff or patients were infected by COVID-19.Conclusion In the epidemic of COVID-19,orthopedic surgeons in a medical institute in a mildly affected area can still provide effective and safe medical services for fracture patients and reduce nosocomial infection,as long as they comprehend the diagnosis and treatment guidelines for the epidemic

关 键 词：新型冠状病毒肺炎 下肢 骨折 围手术期 管理 

分 类 号：R687[医药卫生—骨科学] R56[医药卫生—外科学]