骨外固定技术临床规范应用与医疗质量控制的初步探索(8113例临床应用经验总结)

Clinical Standard Application and Medical Quality Control of Bone External Fixation Technique(Summary of Clinical Application Experience of 8113 Cases)

目的建立规范的骨外固定技术临床应用流程与全过程医疗质量控制标准。方法整理分析1988年1月至2017年12月秦泗河矫形外科团队结合骨外固定技术治疗的8113例四肢手术患者,男4487例,女3626例;年龄1.3~82.0岁,平均(23.8±21.4)岁;上肢152例,下肢7961例,其中髋关节259例,大腿230例,单纯膝关节1985例,单纯小腿357例,单纯足踝4026例,同时合并膝、小腿畸形者580例,同时合并膝、足踝畸形者676例。外固定器种类包括夏氏组合式外固定器4725套,Ilizarov环式外固定器3388套,Orthofix单臂外固定器64套,Taylor计算机辅助六轴空间外固定器5套,其中组合式外固定器与环式外固定器Ⅰ期联合应用69套。将临床应用流程表、术前检查表、应用骨外固定技术术前规划表、术后康复指导卡应用于骨外固定技术临床实践中。实现骨外固定技术治疗流程的信息采集、综合数据分析、外固定手术方案制定、个体化康复指导、术后随访的闭环质量控制,建立适应于各类骨外固定技术操作的治疗流程规范。结果将与骨外固定技术应用相关的质量控制环节纳入临床管理后,形成了有效的临床系统化质量控制管理体系,保障了临床工作流程顺畅,规避了医疗风险。结论骨外固定技术专业特色较强,秦泗河矫形外科团队形成的规范骨外固定临床应用流程和质量控制标准,是从事骨外固定技术30年积累的成果,具有独创性和实用性,值得推广。

Objective To standardizethe medical quality control and clinical application during the whole process of bone external fixation.Methods 8113 cases of extremities combined with bone external fixation were analyzed in Qin Sihe orthopaedic surgical team.4487 cases were males,and 3626 cases were females.The average age was(23.8±21.4)years(range:1.3~82.0 years).There were 152 cases of upper limbs and 7961 cases of lower limbs.Among them,there were 259 cases of hip joint,230 cases of thigh,1985 cases of knee alone,357 cases of lower leg alone,4026 cases of ankle alone,580 cases of knee and lower leg deformity and 676 cases of knee,foot and ankle deformity.The instruments included the hybrid external fixator,the Ilizarov ring external fixator,the Orthofix unilateral external fixator,and the Taylor hexapod space external fixator.The flow chart of the clinical application,preoperative checklist,preoperative planning chart for the application of bone external fixation technique and postoperative rehabilitation guide card were applied in the clinical practice of bone external fixation technique.The process realized information collection,a comprehensive analysison data,the formulation of external fixation surgical plan,individualized rehabilitation guidance,and quality control of closed-loop postoperative follow-up.The treatment specifications suitable for various bone external fixation techniques were established.Results After the quality control related to the application of bone external fixation technology was incorporated into clinical management,an effective and systematic management system on clinical quality control was created,which guaranteed a smooth clinical workflow and avoided medical risks.Conclusion Bone external fixation technology has strong professional characteristics.The medical quality control standard and the standard clinical application of bone external fixation formed by Qin Sihe orthopaedic department is the result of 30 years of accumulation in bone external fixation technology.It is original,practical,and is worthy of promotion.