State of Pelvic and Acetabular Surgery in the Developing World: A Global Survey of Orthopaedic Surgeons at Surgical Implant Generation Network (SIGN) Hospitals
State of Pelvic and Acetabular Surgery in the Developing World: A Global Survey of Orthopaedic Surgeons at Surgical Implant Generation Network (SIGN) Hospitals
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DOI：
10.1097/bot.0000000000000826
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发表时间：
2017-07-01
影响因子：
2.3
通讯作者：
Mir, Hassan R.
中科院分区：
文献类型：
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作者：
Whiting, Paul S.;Anderson, Duane R.;Mir, Hassan R.
目标：记录发展中国家骨盆和髋臼手术的现状，并确定这些复杂损伤治疗中需要改进的关键领域。设计：一项包含 50 个问题的在线调查。背景：国际、多中心。患者/参与者：外科植入物生成网络 (SIGN) 医院的 181 名骨科医生，这些医院代表低收入和中等收入国家治疗高能量损伤的机构的横截面干预措施：50 个问题调查的管理和分析。主要结果指标：外科医生培训和经验；医院资源；骨盆/髋臼骨折治疗的体积和模式；术后康复方案和资源；骨盆/髋臼骨折患者的经济责任。结果：75 个机构返回完整调查，占全球 SIGN 钉数量的 61.8%。尽管 96% 的受访者接受过骨科手术培训，但 53.3% 的受访者没有接受过骨盆或髋臼手术的正式培训。所有响应站点都可以紧急进入手术室，但只有 60% 的站点配备计算机断层扫描仪，只有 21% 的站点可以进行骨盆栓塞血管造影。超过一半的部位可以使用空心螺钉 (53.3%) 和骨盆重建板 (56%)，而 68% 的部位没有骨盆复位钳和牵开器。 21.3% 的站点无法进行术中透视检查。响应医院每年平均发现 38.8 例骨盆环损伤，其中 24% 的医院均采用非手术治疗。各机构平均每年治疗 22.5 例髋臼骨折，其中 34.7% 的机构均采用非手术治疗。在某些地点，患者需要行驶长达 1000 公里或 20 小时才能接受骨盆/髋臼治疗。尽管 78.7% 的机构提供住院物理或职业治疗服务，但只有 17% 的机构报告获得了家庭物理治疗，只有 9% 的机构报告出院后有护理或康复设施。在超过 80% 的医院中，患者及其家属至少承担部分手术费、种植费、住院费和门诊费。超过 40% 的医疗机构对住院费用提供政府援助，但只有 28% 的医疗机构对门诊服务提供补贴。 结论：我们报告了低收入和中等收入国家骨盆和髋臼手术的现状。我们的研究结果表明，发展中国家在外科医生培训、医院资源、器械和植入物的可用性以及获得适当的骨盆和髋臼手术术后康复服务方面存在巨大需求。需要制定旨在克服这些障碍的有针对性的计划，以促进发展中国家对骨盆和髋臼骨折的护理。
Objectives: To document the current state of pelvic and acetabular surgery in the developing world and to identify critical areas for improvement in the treatment of these complex injuries.Design: A 50-question online survey.Setting: International, multicenter.Patients/Participants: One hundred eighty-one orthopaedic surgeons at Surgical Implant Generation Network (SIGN) hospitals, which represent a cross-section of institutions in low-and middle-income countries that treat high-energy musculoskeletal trauma.Interventions: Administration and analysis of 50-question survey.Main Outcome Measures: Surgeon training and experience; hospital resources; volume and patterns of pelvic/acetabular fracture management; postoperative protocols and resources for rehabilitation; financial responsibilities for patients with pelvic/acetabular fractures.Results: Complete surveys were returned by 75 institutions, representing 61.8% of the global SIGN nail volume. Although 96% of respondents were trained in orthopaedic surgery, 53.3% have no formal training in pelvic or acetabular surgery. Emergency access to the operating room is available at all responding sites, but computed tomography scanners are available at only 60% of sites, and a mere 21% of sites have access to angiography for pelvic embolization. Cannulated screws (53.3%) and pelvic reconstruction plates (56%) are available at just over half of the sites, and 68% of sites do not have pelvic reduction clamps and retractors. 21.3% of sites do not have access to intraoperative fluoroscopy. Responding hospitals see an average of 38.8 pelvic ring injuries annually, with 24% of sites treating them all nonoperatively. Sites treated an average of 22.5 acetabular fractures annually, with 34.7% of institutions treating them all nonoperatively. Patients travel up to 1000 km or 20 hours for pelvic/acetabular treatment at some sites. Although 78.7% of sites have inpatient physical or occupational therapy services, only 17% report access to home physical therapy, and only 9% report availability of nursing or rehabilitation facilities postdischarge. At over 80% of hospitals, patients and their families are at least partially responsible for payment of surgical, implant, hospital, and outpatient fees. Government aid is available for inpatient fees at over 40% of sites, but outpatient services are subsidized at only 28% of sites.Conclusions: We report the current state of pelvic and acetabular surgery in low-and middle-income countries. Our results identify significant needs in surgeon training, hospital resources, availability of instruments and implants, and access to appropriate postoperative rehabilitation services for pelvic and acetabular surgery in the developing world. Targeted programs designed to overcome these barriers are required to advance the care of pelvic and acetabular fractures in the developing world.