Whiting Paul S, Anderson Duane R, Galat Daniel D, Zirkle Lewis G, Lundy Douglas W, Mir Hassan R
*University of Wisconsin, Madison, WI;†Soddo Christian Hospital, Soddo, Ethiopia;‡Tenwek Hospital, Bomet, Kenya;§SIGN Fracture Care International, Richland, WA;‖Resurgens Orthopaedics, Atlanta, GA; and¶Florida Orthopaedic Institute, University of South Florida, Tampa, FL.
J Orthop Trauma. 2017 Jul;31(7):e217-e223. doi: 10.1097/BOT.0000000000000826.
To document the current state of pelvic and acetabular surgery in the developing world and to identify critical areas for improvement in the treatment of these complex injuries.
A 50-question online survey.
International, multicenter.
PATIENTS/PARTICIPANTS: One hundred eighty-one orthopaedic surgeons at Surgical Implant Generation Network (SIGN) hospitals, which represent a cross-section of institutions in low- and middle-income countries that treat high-energy musculoskeletal trauma.
Administration and analysis of 50-question survey.
Surgeon training and experience; hospital resources; volume and patterns of pelvic/acetabular fracture management; postoperative protocols and resources for rehabilitation; financial responsibilities for patients with pelvic/acetabular fractures.
Complete surveys were returned by 75 institutions, representing 61.8% of the global SIGN nail volume. Although 96% of respondents were trained in orthopaedic surgery, 53.3% have no formal training in pelvic or acetabular surgery. Emergency access to the operating room is available at all responding sites, but computed tomography scanners are available at only 60% of sites, and a mere 21% of sites have access to angiography for pelvic embolization. Cannulated screws (53.3%) and pelvic reconstruction plates (56%) are available at just over half of the sites, and 68% of sites do not have pelvic reduction clamps and retractors. 21.3% of sites do not have access to intraoperative fluoroscopy. Responding hospitals see an average of 38.8 pelvic ring injuries annually, with 24% of sites treating them all nonoperatively. Sites treated an average of 22.5 acetabular fractures annually, with 34.7% of institutions treating them all nonoperatively. Patients travel up to 1000 km or 20 hours for pelvic/acetabular treatment at some sites. Although 78.7% of sites have inpatient physical or occupational therapy services, only 17% report access to home physical therapy, and only 9% report availability of nursing or rehabilitation facilities postdischarge. At over 80% of hospitals, patients and their families are at least partially responsible for payment of surgical, implant, hospital, and outpatient fees. Government aid is available for inpatient fees at over 40% of sites, but outpatient services are subsidized at only 28% of sites.
We report the current state of pelvic and acetabular surgery in low- and middle-income countries. Our results identify significant needs in surgeon training, hospital resources, availability of instruments and implants, and access to appropriate postoperative rehabilitation services for pelvic and acetabular surgery in the developing world. Targeted programs designed to overcome these barriers are required to advance the care of pelvic and acetabular fractures in the developing world.
记录发展中国家骨盆与髋臼手术的现状，并确定这些复杂损伤治疗中关键的改进领域。
一项包含50个问题的在线调查。
国际多中心。
患者/参与者：外科植入物生成网络（SIGN）医院的181名骨科医生，这些医院代表了低收入和中等收入国家中治疗高能量肌肉骨骼创伤的各类机构。
进行并分析包含50个问题的调查。
外科医生培训与经验；医院资源；骨盆/髋臼骨折治疗的数量及模式；术后康复方案及资源；骨盆/髋臼骨折患者的经济负担。
75家机构返回了完整的调查问卷，占全球SIGN髓内钉使用量的61.8%。尽管96%的受访者接受过骨外科培训，但53.3%的人没有骨盆或髋臼手术的正规培训。所有回复的机构都能紧急使用手术室，但只有60%的机构有计算机断层扫描扫描仪，仅有21%的机构可进行骨盆栓塞血管造影。略超过一半的机构有空心螺钉（53.3%）和骨盆重建钢板（56%），68%的机构没有骨盆复位钳和牵开器。21.3%的机构无法进行术中透视。回复的医院每年平均诊治38.8例骨盆环损伤，24%的机构对所有病例都采取非手术治疗。各机构每年平均治疗22.5例髋臼骨折，34.7%的机构对所有病例都采取非手术治疗。在一些机构，患者为接受骨盆/髋臼治疗需前往1000公里外或耗时20小时。尽管78.7%的机构有住院物理治疗或职业治疗服务，但只有17%的机构提供家庭物理治疗，只有9%的机构报告出院后有护理或康复设施。在超过80%的医院，患者及其家属至少要部分承担手术、植入物、住院和门诊费用。超过40%的机构住院费用有政府援助，但只有28%的机构补贴门诊服务。
我们报告了低收入和中等收入国家骨盆与髋臼手术的现状。我们的结果表明，发展中国家在外科医生培训、医院资源、器械和植入物的可及性以及骨盆和髋臼手术术后获得适当康复服务方面存在重大需求。需要制定有针对性的项目来克服这些障碍，以推进发展中国家骨盆和髋臼骨折的治疗。
