Washington University School of Medicine, Chesterfield, MO 63017, USA.
J Orthop Res. 2012 Oct;30(10):1523-8. doi: 10.1002/jor.22125. Epub 2012 Apr 16.
An increasing emphasis has been placed across health care on evidence-based medicine with higher level studies, such as randomized trials and prospective cohort studies. Historically, clinical research in orthopaedic surgery has been dominated by studies with low patient numbers from a limited number of surgeons. The purpose of this study was to test our hypothesis that orthopaedics has fewer multi-center collaborative studies as compared to other medical disciplines. We chose three leading journals from general medicine, a leading journal from the surgical subspecialties of obstetrics and gynecology, ophthalmology and otolaryngology, and three leading journals from orthopaedic surgery based on highest impact factor. We compared the percentage of collaborative studies and the number of contributing institutions and authors in original research manuscripts published in 2009 between general medical, surgical subspecialty and orthopaedic surgery journals. A significantly higher percentage of manuscripts resulted from multicenter collaborative efforts in the general medical literature (p < 0.000001) and the other surgical subspecialty literature (p < 0.000001) compared to the orthopaedic surgery literature. Manuscripts published in the general medical journals came from more institutions (p < 0.0001) and had significantly more authors (p < 0.000001) than those published in the orthopaedic surgery journals. There is an opportunity to stimulate greater multicenter collaborative research, which correlates with increased patient numbers, a higher level of evidence and more generalizable findings, in the orthopaedic surgery community. These efforts can be supported through increased funding, surgeon participation, and appropriate expansion of authorship for multicenter studies in orthopaedic journals.
医疗保健领域越来越重视循证医学，越来越重视高级别的研究，如随机试验和前瞻性队列研究。从历史上看，骨科临床研究一直由数量有限的外科医生进行的低患者数量的研究主导。本研究的目的是检验我们的假设，即与其他医学学科相比，骨科的多中心合作研究较少。我们选择了普通医学领域的三个领先期刊、妇产科、眼科和耳鼻喉科的一个领先外科专业期刊以及三个领先的骨科期刊，根据最高影响因素进行选择。我们比较了 2009 年普通医学、外科专业和骨科手术期刊发表的原始研究手稿中合作研究的百分比和参与机构和作者的数量。普通医学文献（p < 0.000001）和其他外科专业文献（p < 0.000001）中多中心合作研究的比例明显高于骨科手术文献。普通医学杂志发表的手稿来自更多机构（p < 0.0001），作者数量也明显多于骨科手术杂志（p < 0.000001）。骨科领域有机会刺激更多的多中心合作研究，这与患者数量增加、证据水平提高和更具普遍性的发现相关。这些努力可以通过增加资金、外科医生的参与以及适当扩大骨科期刊多中心研究的作者身份来支持。
