新冠肺炎疫情期间骨科住院手术患者的系统防控策略和临床救治

Systematic control strategy and clinical treatment experiences of orthopedic surgery patients during the epidemic of COVID-19

目的探讨新型冠状病毒肺炎(COVID-19)疫情期间骨科住院手术患者尤其疑似症状患者,住院手术的系统防控策略和临床救治。方法回顾性分析2020年1月25日—2020年3月15日新型冠状病毒肺炎疫情流行期间陆军军医大学大坪医院骨科收治患者21例,其中6例疑似症状患者(男性2例,女性4例;年龄44~84岁,平均67.5岁),包括1例锁骨骨折、1例股骨假体周围骨折、1例股骨转子间骨折、1例股骨颈骨折、1例C 6椎体爆裂骨折并脊髓损伤和1例寰枢椎骨折脱位,其中2例有发热症状,3例有呼吸道症状,3例有肺炎影像学特征,结合“新型冠状病毒肺炎疫情下创伤骨科手术患者诊疗及感染防控策略”,采用科室的症状筛查、分层评估、分级病房、系统防控方法完成了安全防控和手术救治。结果21例患者均完成了系统防控,包括症状筛查、分层评估、分级病房隔离观察、安全手术救治。其中6例疑似症状患者完成筛查、隔离后接受手术,锁骨骨折和股骨假体周围骨折行切开复位钢板内固定,股骨转子间骨折和股骨颈骨折行股骨头置换,C 6椎体爆裂骨折和寰枢椎骨折脱位行骨折切开复位内固定。全部患者术后效果满意,无感染、内固定失败等并发症。结论COVID-19肺炎疫情期间骨科住院手术,结合“新冠期间骨科手术患者诊疗及感染防控策略”,尤其对于疑似症状患者,通过症状筛查、分层评估、分级病房、系统防控后手术等措施,强化常规病房的疫情防控效果,为患者安全、及时、有效救治创建必要条件。

Objective To investigate the experience and strategy of systematic prevention and control of hospitalized patients with suspected orthopedic symptoms during the epidemic of COVID-19.Methods Totally 21 orthopedics patients were treated in Daping Hospital during the COVID-19 pandemic from Jan.25,2020 to Mar.15,2020.Six patients with suspected symptoms were analyzed retrospectively,including 1 case of clavicle fracture,1 case of periprosthetic fracture of femur,1 case of intertrochanteric fracture,1 case of femoral neck fracture,1 case of burst fracture of C 6 vertebra with spinal cord injury and 1 case of atlantoaxial fracture and dislocation.Among them,2 cases had fever,3 cases had respiratory symptoms and 3 cases had imaging features of pneumonia.All the selected cases were implemented with“diagnosis,treatment and infection prevention and control strategy of patients undergoing orthopedic trauma surgery under COVID-19 epidemic situation”,and the effective prevention and control and surgical treatment were completed safely by using the methods of symptom screening,hierarchical evaluation,graded ward and systematic prevention and control in our department.Results All 21 cases completed systematic prevention and control,including symptom screening,hierarchical evaluation,isolation observation in graded ward and safe surgical treatment.One case of clavicle fracture and 1 case of periprosthetic fracture were treated with open reduction and plate internal fixation,1 case of femoral intertrochanteric fracture and 1 case of femoral neck fracture were treated with femoral head replacement,1 case of C 6 burst fracture and 1 case of atlantoaxial fracture and dislocation were treated with open reduction and bone block internal fixation.All patients were discharged with satisfactory results,and there were no complications such as infection,and failure of internal fixation.Conclusion During the epidemic period of COVID-19,hospitalized orthopedic patients with suspected symptoms who underwent surgery,combined with the“diagnosis,treatment and infection prevention and control strategy of patients undergoing orthopedic trauma surgery under COVID-19 epidemic situation”,through symptom screening,hierarchical evaluation,graded ward,systematic prevention and control operation,the epidemic prevention and control effect can be enhanced to create necessary conditions for safe,timely and effective treatment.