非洲区域性创伤性四肢骨盆骨折延误治疗的调查研究

Investigation and study of delayed treatment of traumatic limbs and pelvis fractures in parts of Africa

目的探讨非洲区域性创伤性四肢骨盆骨折延误规范治疗的原因,总结可行性干预策略。方法回顾性分析于非洲尼日尔综合示范医院自2021-02—2022-03诊治的59例创伤性四肢骨盆骨折延误治疗患者,对患者延误规范治疗的原因进行调查研究,统计分析创伤性四肢骨盆骨折延误治疗的原因及特点。结果调查结果发现造成尼日尔患者延误治疗的原因包括患者认知不足及不重视(63%),医疗资源匮乏(20%),经济条件差(17%)。59例创伤性四肢骨盆骨折中,以男性最多见(男女比例为5.6∶1);下肢骨折占多数(69.49%),其次是上肢骨折(23.76%);主要致伤因素为跌倒摔伤(45.76%)和交通事故伤(44.07%);其中26例可通过手术复位固定骨折,但因骨折端不规则骨痂形成、废用性骨萎缩、骨质疏松等增加了手术难度和骨折不愈合的风险,17例在当地医疗条件下丧失了手术机会遗留长期残疾,16例关节内及关节周围骨折只能进行关节置换或关节融合术以改善患肢功能,但预后效果欠佳。结论创伤性四肢骨盆骨折延误规范治疗既有患者不重视的原因,也有尼日尔医疗资源和经济条件差的原因,但最主要的原因是患者不重视。

Objective To explore the factors of delayed and non-standard treated traumatic limbs and pelvic fractures in parts of Africa,and to summarize the feasible intervention strategies.Methods Retrospective analysis was made on 59 patients with delayed treatment of traumatic limbs and pelvic fractures in Niger Comprehensive Demonstration Hospital in Africa from February 2021 to March 2022.The reasons for delayed standard treatment of patients were investigated and studied,and the causes and characteristics of delayed treatment of traumatic limb and pelvic fractures were statistically analyzed.Results The survey found that the reasons for delayed treatment in Niger included poor patient awareness and neglect(63%),lack of medical resources(20%),and poor economic conditions(17%).Among 59 cases of traumatic pelvic and limbs fractures,the most common were males(male to female ratio was 5.6:1).The lower extremity fractures were the majority(69.49%),followed by the upper extremity fractures(23.76%).The main injury factors were falling injury(45.76%)and traffic accident injury(44.07%).Among them,26 cases could be fixed by surgical reduction,but due to irregular callus formation at the fracture end,disuse osteopenia,and osteoporosis,etc.,which increased the difficulty of surgery and the risk of fracture nonunion,17 cases lost the opportunity of surgery under local medical conditions and left long-term disability,16 cases of intra-articular and periarticular fractures could only undergo joint replacement or joint fusion to improve the function of the affected limb.But the prognosis was not good.Con⁃clusion The delay in standard treatment of traumatic limbs and pelvic fractures is due to the lack of attention of patients,poor medical resources and economic conditions in Niger,but the most important reason is the lack of attention of patients.