Division of Orthopaedic Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, 2nd Floor Wood Building, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA.
World J Surg. 2010 May;34(5):954-62. doi: 10.1007/s00268-010-0487-3.
The goal of this retrospective review was to characterize the spectrum of surgical admissions to a tertiary hospital specializing in musculoskeletal conditions in children and adolescents in Nepal.
We reviewed hospital records from 1996 to 2006 to categorize all major surgical procedures. Additional information collected included diagnosis, patient age, gender, and home district.
Of 7,556 major surgical procedures performed from 1996 to 2006, 91% could be placed within the following categories: congenital (n = 2,984; 38%), burn contracture (n = 1,400; 19%), posttraumatic (n = 1,047; 14%), neuromuscular (n = 750; 10%), and infection (n = 731; 10%). The most common diagnosis was congenital clubfoot, which accounted for 2,348 cases (31%). Thirty-three percent of cases (n = 2,447) involved injuries (burns, fractures, dislocations). While burns most commonly involved the upper extremity, fractures in the elbow region were the most frequent posttraumatic problem. The most common neuromuscular diagnosis was poliomyelitis. The sequelae of musculoskeletal sepsis represented 731 cases (10%), most commonly chronic osteomyelitis. Other diagnoses termed miscellaneous included angular deformities of the lower extremities, scoliosis and other spinal deformities, hip dysplasia, and tumors.
The majority of surgical pathology involved injuries and congenital problems (mainly clubfoot). The presentation was delayed in most patients, and in such cases, the treatment is more complex and costly, and the desired functional outcome is difficult to achieve. In addition to preventive measures, morbidity cases could have been reduced by the timely provision of services at the primary referral level. Strengthening the delivery of basic orthopedic services at primary health care facilities may eliminate or reduce the need for complex reconstructive procedures and diminish the likelihood of permanent disability in our population.
本回顾性研究旨在描述尼泊尔一家专门治疗儿童和青少年肌肉骨骼疾病的三级医院的住院患者的手术类型谱。
我们回顾了 1996 年至 2006 年的医院病历，对所有主要手术进行分类。收集的其他信息包括诊断、患者年龄、性别和家庭所在地区。
在 1996 年至 2006 年期间进行的 7556 次主要手术中，91%可归入以下类别：先天性（n = 2984；38%）、烧伤挛缩（n = 1400；19%）、创伤后（n = 1047；14%）、神经肌肉（n = 750；10%）和感染（n = 731；10%）。最常见的诊断是先天性马蹄内翻足，占 2348 例（31%）。33%的病例（n = 2447）涉及损伤（烧伤、骨折、脱位）。虽然烧伤最常见于上肢，但肘部骨折是最常见的创伤后问题。最常见的神经肌肉诊断是脊髓灰质炎。骨骼肌肉感染的后遗症占 731 例（10%），最常见的是慢性骨髓炎。其他称为杂项的诊断包括下肢成角畸形、脊柱侧凸和其他脊柱畸形、髋关节发育不良和肿瘤。
大多数外科病理涉及损伤和先天性问题（主要是马蹄内翻足）。大多数患者的就诊时间都被延误了，在这种情况下，治疗会更加复杂和昂贵，并且难以达到理想的功能效果。除了预防措施外，通过在初级转诊一级及时提供服务，也可以减少发病率。加强基层医疗保健设施提供基本矫形服务，可能消除或减少复杂重建手术的需要，并减少我们人群中永久性残疾的可能性。
