新型冠状病毒肺炎期间矫形骨科的诊疗防控策略

Prevention and control strategies of orthopedic diagnosis and treatment during corona virus disease 2019 epidemic

背景:新型冠状病毒肺炎(COVID-19)流行期间全民隔离、限制人口流动,给矫形骨科患者管理提出了前所未有的挑战。目的:总结互联网手段在COVID-19疫情持续期间医患互动的经验,探讨在特殊时期矫形骨科患者诊疗防控和功能康复策略。方法:首先组建以科主任为组长的患者管理小组,建立患者联络方案及会诊决策机制,整理应急处理办法。通过电话及微信、QQ等互联网方式采集2020年1月23日前2个月在我院矫形骨科接受手术的患者信息,根据患者的功能状态将所有患者分为稳定期、调整期和急诊期,在保障COVID-19防疫的基础上,以矫形骨科"一路两线三平衡"矫形重建原则为基础指导患者功能康复。结果:通过电话、互联网方式联络71例患者纳入本研究,其中,男32例,女39例,2~62岁,平均28.1岁。稳定期患者62例,调整期8例,1例处于急诊期。稳定期患者中,居家佩戴Ilizarov外固定架或组合式外固定器,通过电话及互联网手段采集信息,指导针道护理,辅助负重功能锻炼。通过互联网视频指导8例调整期患者继续调整外固定器,规避相关并发症。急诊期患者1例,安排其在严密防护下于当地医院接受治疗。本组病例在COVID-19流行期间未发生感染、血栓、关节脱位等严重并发症,根据秦泗河下肢畸形矫正残缺修复与功能重建术后疗效评价表统计结果,优62例(87.3%),良8例(11.2%),差1例(1.5%)。结论:在疫情期间,通过电话、互联网手段可迅速完成矫形骨科患者的信息采集和居家康复指导",一路两线三平衡"原则对疫情持续期矫形骨科患者管理有重要指导意义。

Background: It is an unprecedented challenge to the management of orthopedics as mass segregation and population mobility restriction during the epidemic of corona virus disease 2019(COVID-19). Objective: To summarize the experience of the internet approach in doctor-patient interaction, and to explore the strategy of prevention, control and functional rehabilitation for orthopedic patients during the COVID-19 epidemic. Methods: Firstly the special management panel was established with the director as the leader, and patient contact plan, consultation decision-making mechanism and emergency treatment measures were made simultaneously. The patients who underwent surgery within 2 months before January 23, 2020 in department of orthopaedics were connected with telephone and internet approaches such as WeChat and QQ. According to their functional status, the patients were divided into stable stage, adjusting stage and emergency stage. On the basis of COVID-19 prevention, the patients at tdhifefierr efuntn csttiaogneasl wreerhea bgiilviteant idoinff. erReenst utlrtes:a tDmuernitn sgt rtahtee geiepsi daecmciocr dpinergi otod tohfe CprOinVcIiDpl-e 1 o9 f, "aO tnoet awl aolfk, 7 t1 w op laitnieens tas nwd etrher eeen rboalllaendc iens " t fhoirs study including 32 males and 39 females, with average age of 28.1 years(range, 2-62 years), and none of them were confirmed or suspected of COVID-19. 62 patients were at stable stage, 8 patients at adjusting stage and 1 patient at emergency stage. For patients at stable period, limb deformity correction had been completed and they were instructed functional exercise with fixator under the assistance of internet. Through video call, 8 patients at adjusting stage were adjusted with their external fixator without any related complications. One patient who suffered from femoral shaft fracture was admitted in a local hospital under strict protection. No serious complications like infection, thrombosis and joint dislocation were found. According to the statistical results of Qinsihe evaluation method for deformity correction and limb reconstruction, there were 62 excellent cases(87.3%), 8 good cases(11.2%), and 1 poor case(1.5%). Conclusions: Telephone and internet method can help information collection and rehabilitation guidance for the orthopedic patients, who were restricted at home during the epidemic of COVID-19. The principle of "One walk,two lines and three balances" has essential guiding significance for the patient management.