Franzblau Lauren E, Wang Keming, Liang Xuebing, Guo Yang, Li Yingni, Lin Yu-Chieh Jay, Lee Sunghee, Pennell Beth-Ellen, Shauver Melissa J, Chung Kevin C
University of Michigan Medical School, Ann Arbor, MI, USA.
17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Int J Rheum Dis. 2018 Nov;21(11):1970-1976. doi: 10.1111/1756-185X.12971. Epub 2016 Dec 30.
In China, hand surgeons treat fewer rheumatoid arthritis (RA) patients compared to other countries. We investigated whether physician and surgeon knowledge, attitudes and practices regarding RA hand deformities reflect current evidence and may contribute to the low utilization of surgery.
We surveyed hand surgeons and rheumatologists at three tertiary hospitals in Beijing, China. Questionnaires were developed from literature and expert review to assess their knowledge, attitudes and practice patterns related to rheumatoid hand surgery.
Thirty-five hand surgeons and 59 rheumatologists completed the survey. Roughly one-third felt that the rheumatologists and hand surgeons agree on how to manage RA hand deformities. One-fifth of rheumatologists and 29% of hand surgeons believed that drug therapy can correct hand deformities, which contradicts current evidence. Likewise, 30% and 14%, respectively, recommended surgery for early-stage hand sequelae that do not meet current indications for surgery. Over 80% of surgeons and rheumatologists had no exposure to the other specialty during training and felt their training on the treatment of rheumatoid hand deformities was inadequate.
Although we found similar interspeciality disagreement in China as is seen in the United States, there appears to be less interaction through training and consultations. Our results also indicate potential deficits in training and unawareness of evidence and indications for rheumatoid hand surgery. These findings help to explain why surgery for rheumatoid hand deformities is rare in China; doctors have fewer opportunities to collaborate across specialties and may not be able to select appropriate candidates for surgery.
在中国，与其他国家相比，手外科医生治疗的类风湿性关节炎（RA）患者较少。我们调查了医生和外科医生关于RA手部畸形的知识、态度和做法是否反映了当前的证据，以及是否可能导致手术利用率较低。
我们对中国北京三家三级医院的手外科医生和风湿病学家进行了调查。通过文献和专家评审制定问卷，以评估他们与类风湿手部手术相关的知识、态度和实践模式。
35名手外科医生和59名风湿病学家完成了调查。大约三分之一的人认为，风湿病学家和手外科医生在如何处理RA手部畸形方面意见一致。五分之一的风湿病学家和29%的手外科医生认为药物治疗可以矫正手部畸形，这与当前的证据相矛盾。同样，分别有30%和14%的人建议对不符合当前手术指征的早期手部后遗症进行手术。超过80%的外科医生和风湿病学家在培训期间没有接触过其他专业，并且觉得他们在类风湿手部畸形治疗方面的培训不足。
尽管我们在中国发现了与美国类似的跨专业分歧，但通过培训和会诊的互动似乎较少。我们的结果还表明，在类风湿手部手术的培训和对证据及指征的认识方面可能存在不足。这些发现有助于解释为什么在中国类风湿手部畸形的手术很少见；医生跨专业合作的机会较少，可能无法选择合适的手术候选人。
