|
|
新冠疫情下髋关节骨折治疗相关分析
|
Abstract:
目的：探讨新型冠状病毒(COVID-19)在全球大流行期间对于髋部骨折尤其是老年髋部骨折治疗经验的总结。方法：检索Cochrane Library、EMBASE、pubMbed和CNKI等数据库，检索时间从建库至2022年5月，全面检索COVID-19大流行下关于老年髋部骨折治疗方法、新治疗模式的特点，进行总结与分析。结果：在COVID-19流行期间，老年人髋部骨折的发生率增加，受防疫、医疗资源影配置等影响进行早期手术干预(<48小时)的目标几乎很难达到，但相对于保守治疗而言，髋关节骨折手术干预，可以明显降低死亡率及相关并发症。结论：在COVID大流行期间，应根据患者病情特点，在医疗资源适配、做好防护确保患者、医护安全情况下，给予髋部骨折患者个性化的手术干预，对于提高生存率、改善预后等方面有较高的社会价值及意义。
Objective: To summarize the experience in the treatment of hip fractures, especially in the elderly, during the COVID-19 pandemic. Methods: Cochrane Library, EMBASE, pubMbed and CNKI were searched from inception to May 2022. The characteristics of treatment methods and new treatment modes for hip fractures in the elderly during the COVID-19 pandemic were summarized and ana-lyzed. Results: During the epidemic period of COVID-19, the incidence of hip fractures in the elderly increased. Influenced by epidemic prevention and medical resources allocation, early surgical in-tervention (<48 hours) is almost impossible to achieve, but surgical intervention of hip fracture can significantly reduce mortality and related complications compared with conservative management. Conclusions: During the COVID-19 pandemic, personalized surgical intervention should be given to patients with hip fracture according to the characteristics of the patient’s condition, under the con-dition of the adaption of medical resources, good protection to ensure the safety of patients and medical staff, which has high social value and significance in improving the survival rate and prog-nosis.
| [1] | WHO (2020) Novel Coronavirus—China. http://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/ |
| [2] | Zhu, N., Zhang, D., Wang, W., et al. (2020) A Novel Coronavirus from Patients with Pneumonia in China, 2019. The New England Journal of Medicine, 382, 727-733. https://doi.org/10.1056/NEJMoa2001017 |
| [3] | General Office of National Health Commission of the People’s Republic of China, Office of State Administration of Traditional Chinese Medicine of the People’s Republic of China (2020) Diagnosis and Treatment Scheme for Novel Coronavirus Pneumonia (Trial Implementation 5th Edition, Revision Edition).
http://www.gov.cn/zhengce/2020-02/09/content_5476415.htm |
| [4] | Cauley, J.A. (2017) Osteoporosis: Fracture Epide-miology Update 2016. Current Opinion in Rheumatology, 29, 150-156.
https://doi.org/10.1097/BOR.0000000000000365 |
| [5] | Veronese, N. and Maggi, S. (2018) Epidemiology and So-cial Costs of Hip Fracture. Injury, 49, 1458-1460.
https://doi.org/10.1016/j.injury.2018.04.015 |
| [6] | Had？eld, J.N. and Gray, A.C. (2020) The Evolving COVID-19 Effect on Hip Fracture Patients. Injury, 51, 1411-1412.
https://doi.org/10.1016/j.injury.2020.06.006 |
| [7] | Sheikh, H.Q., Hossain, F.S., Aqil, A., Akinbamijo, B., Mushtaq, V. and Kapoor, H. (2017) A Comprehensive Analysis of the Causes and Predictors of 30-Day Mortality Following Hip Fracture Surgery. Clinics in Orthopedic Surgery, 9, 10-18.
https://doi.org/10.4055/cios.2017.9.1.10 |
| [8] | Mi, B., Chen, L., Xiong, Y., et al. (2020) Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients. The Journal of Bone and Joint Surgery, 102, 750-758. https://doi.org/10.2106/JBJS.20.00390 |
| [9] | LeBrun, D.G., Konnaris, M.A., Ghahramani, G.C., et al. (2020) Hip Fracture Outcomes during the COVID-19 Pandemic: Early Results from New York. Journal of Orthopaedic Trauma, 34, 403-410.
https://doi.org/10.1097/BOT.0000000000001849 |
| [10] | Brox, W.T., Roberts, K.C, Taksali, S., et al. (2015) The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Hip Fractures in the Elderly. The Journal of Bone and Joint Surgery, 97, 1196-1199.
https://doi.org/10.2106/JBJS.O.00229 |
| [11] | 中国老年医学学会骨与关节分会创伤骨科学术工作委员会. 老年髋部骨折诊疗专家共识(2017) [J]. 中华创伤骨科杂志, 2017, 19(11): 921-927. |
| [12] | White, S.M., Altermatt, F., Barry, J., et al. (2018) International Fragility Fracture Network Consensus Statement on the Principles of Anaesthesia for Patients with Hip Fracture. Anaesthesia, 73, 863-874.
https://doi.org/10.1111/anae.14225 |
| [13] | Grif？ths, R., Alper, J., Beckingsale, A., et al. (2011) Management of Proximal Femoral Fractures 2011. Anaesthesia, 67, 85-98. https://doi.org/10.1111/j.1365-2044.2011.06957.x |
| [14] | White, S.M., Griffiths, R. and Moppett, I.K. (2016) Stand-ardising Anaesthesia for Hip Fracture Surgery. Anaesthesia, 71, 1391-1395. https://doi.org/10.1111/anae.13593 |
| [15] | Neuman, M.D., Ellenberg, S.S., Sieber, F.E., Magaziner, J.S., Feng, R. and Carson, J.L. (2016) Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN): Protocol for a Pragmatic, International Multicentre Trial. BMJ Open, 6, e013473. https://doi.org/10.1136/bmjopen-2016-013473 |
| [16] | Kowark, A., Adam, C., Ahrens, J., et al. (2018) Improve Hip Fracture Outcome in the Elderly Patient (iHOPE): A Study Protocol for a Pragmatic, Multicentre Randomised Controlled Trial to Test the Efficacy of Spinal versus General Anaesthesia. BMJ Open, 8, e023609. https://doi.org/10.1136/bmjopen-2018-023609 |
| [17] | Li, T., Yeung, J., Li, J., et al. (2017) Comparison of Regional with General Anaesthesia on Postoperative Delirium (RAGA-Delirium) in the Older Patients Undergoing Hip Fracture Surgery: Study Protocol for a Multicentre Randomised Controlled Trial. BMJ Open, 7, e016937. https://doi.org/10.1136/bmjopen-2017-016937 |
| [18] | Griffiths, R., Babu, S., Dixon, P., et al. (2021) Guideline for the Management of Hip Fractures 2020. Anaesthesia, 76, No. 2. https://doi.org/10.1111/anae.15291 |
| [19] | White, S.M., Moppett, I.K., Griffiths, R., et al. (2016) Secondary Analysis of Outcomes after 11,085 Hip Fracture Operations from the Prospective UK Anaesthesia Sprint Audit of Practice (ASAP 2). Anaesthesia, 71, 506-514.
https://doi.org/10.1111/anae.13415 |
| [20] | O’Donnell, C.M., McLoughlin, L., Patterson, C.C., et al. (2018) Peri-operative Outcomes in the Context of Mode of Anaesthesia for Patients Undergoing Hip Fracture Surgery: Systematic Review and Meta-Analysis. British Journal of Anaesthesia, 120, 37-50. https://doi.org/10.1016/j.bja.2017.09.002 |
| [21] | Wesselink, E.M., Kappen, T.H., Torn, H.M., Slooter, A.J.C. and van Klei, W.A. (2018) Intraoperative Hypotension and the Risk of Postoperative Adverse Outcomes: A Systematic Review. British Journal of Anaesthesia, 121, 706-721.
https://doi.org/10.1016/j.bja.2018.04.036 |
| [22] | 张英泽. 新型冠状病毒肺炎疫情期间创伤骨折的诊治原则[J]. 中华创伤骨科杂志, 2020, 22(2): 116-118. |
| [23] | 吴巍, 关邯峰, 方忠, 等. 新型冠状病毒肺炎疫情期骨科诊疗的规范化流程建议[J]. 骨科, 2020, 11(2): 93-99. |
| [24] | The HIP Attack Investigators (2020) Accelerated Surgery versus Standard Care in Hip Fracture (HIP ATTACK): An International, Randomised, Controlled Trial. Lancet, 395, 698-708. https://doi.org/10.1016/S0140-6736(20)30058-1 |
| [25] | Fessler, J., Jacobsen, T., Lauritzen, J.B. and J？rgensen, H.L. (2021) Mortality among Hip Fracture Patients Infected with COVID-19 Perioperatively. European Journal of Trauma and Emergency Surgery, 47, 659-664.
https://doi.org/10.1007/s00068-021-01634-y |
| [26] | Mi, B., Chen, L., Tong, D., et al. (2020) Delayed Surgery versus Nonoperative Treatment for Hip Fractures in Post- COVID-19 Arena: A Retrospective Study of 145 Patients. Acta Or-thopaedica, 91, 639-643.
https://doi.org/10.1080/17453674.2020.1816617 |
| [27] | Lei, J., Li, J., Li, X. and Qi, X. (2020) CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology, 295, 18. https://doi.org/10.1148/radiol.2020200236 |
| [28] | Lim, M.A. and Pranata, R. (2020) Coronavirus Disease 2019 (COVID-19) Markedly Increased Mortality in Patients with Hip Fracture—A Systematic Review and Meta-Analysis. Journal of Clinical Orthopaedics and Trauma, 12, 44.
https://doi.org/10.1016/j.jcot.2020.11.008 |
