新型冠状病毒肺炎疫情下足踝外科急症处理的策略初探

mergent foot and ankle surgery in the epidemic of COVID-19

目的:初步探讨新型冠状病毒肺炎(COVID-19)疫情下足踝外科急症处理的临床策略。方法:回顾性研究自2020年1月20日至2020年2月26日华中科技大学同济医学院附属普爱医院足踝外科收治的18例急性足踝损伤患者资料。男11例,女7例;年龄18~70岁,平均42.5岁;急诊开放性损伤5例,急诊闭合性损伤13例;门诊确诊、疑似COVID-19患者5例,非COVID-19患者13例。2例开放性损伤合并COVID-19患者及1例闭合性复杂pilon骨折合并COVID-19患者行急诊手术,其中1例合并COVID-19急诊手术患者予以二期手术治疗。1例左侧跟骨闭合性骨折合并COVID-19患者急诊入院二期手术治疗,1例右外踝闭合性骨折合并COVID-19患者急诊行石膏外固定保守治疗后转隔离病房。其余10例非COVID-19闭合性创伤患者中仅3例入院后常规二期行手术治疗,其余均门诊保守治疗。记录患者入院后确诊COVID-19的数量变化,非COVID-19足踝住院患者的新发感染情况,以及医务人员确诊COVID-19的数据变化。总结疫情暴发以来实施的一些措施和经验。结果:足踝急诊入院患者11例,门诊确诊、疑似COVID-19患者5例,非COVID-19患者6例。住院期间最终确诊COVID-19患者5例。非COVID-19患者无新发感染者。治疗期间医护人员无确诊COVID-19。未发生医护之间及医患之间交叉感染。结论:需在防疫与应对足踝外科手术的平衡中选择合理的处理策略,不建议一味的简单化处理。在疫情防控原则的指导下,完善足踝外科急症手术的处理流程,最大程度地恢复患者的后期功能康复。

Objective To report our experience in the emergent foot and ankle surgery in the epidemic of COVID-19.Methods The data of 18 patients with acute foot and ankle injury were reviewed who had been admitted to the Department of Foot and Ankle Surgery,Wuhan Fourth Hospital from 20th January,2020 to 26th February,2020.They were 11 men and 7 women,aged from 18 to 70 years(average,42.5 years).There were 5 cases of acute open injury and 13 ones of acute closed injury.COVID-19 infection was diagnosed or suspected in 5 cases but not in the other 13 cases.Emergency operation was carried out for 2 patients with open injury plus COVID-19 infection and one with complicated pilon fracture plus COVID-19 infection,one of whom received secondary operation.One patient with closed fracture of the left calcaneus plus COVID-19 infection was hospitalized from emergency department for secondary surgery,and another with closed fracture of the right lateral malleolus was referred to the isolation ward after emergency plaster fixation.Of the 10 patients with closed injury but without COVID-19 infection,3 received conventional secondary surgery after admission and the others conservative treatment at the outpatient department.Recorded were COVID-19 infections in the patients after admission and in the medical staff.The measures taken and experience in control and prevention of COVID-19 infection after outbreak of the epidemic were reviewed.Results Of the 11 patients who had been hospitalized for foot and ankle injury in emergency,5 were definitely diagnosed of or suspected of COVID-19 infection and 6 free of COVID-19 infection.During hospitalization,COVID-19 infection was confirmed in the 5 cases and no COVID-19 infection occurred in the other 6 patients.No COVID-19 infection occurred in the medical staff;no cross infection was observed between the patients and the medical staff.Conclusions Reasonable strategies are advised to balance the foot and ankle surgery and epidemic prevention.A simplified management is not advised for all the cases.The operative procedures in emergent foot and ankle surgery should be optimized in line with the epidemic control and prevention principles to facilitate functional rehabilitation for the patients.