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功能有利位置的关节融合术:关于私人意外险中残疾评定的思考

[Joint arthrodesis in functionally favorable position : Considerations on measurement of disability in private accident insurance].

作者信息

Klemm H-T, Wittchen V, Willauschus W, Fuhrmann R A, Hohendorff B

机构信息

Freies Institut für medizinische Begutachtungen, Ludwigstraße 25, 95444, Bayreuth, Deutschland.

Fachgesellschaft Interdisziplinäre Medizinische Begutachtung (FGIMB e. V.), Hamburg, Deutschland.

出版信息

Unfallchirurg. 2020 Dec;123(12):988-998. doi: 10.1007/s00113-020-00913-4.

Abstract

If an accident results in a functional disorder that persists and permanently restricts physical and/or mental capacity, this is referred to as a disability. In private accident insurance it is the task of the medical expert to assess this disability by examining the medical findings and produce an assessment taking account of the literature and comparing against generally acknowledged guidance values. The priority dismemberment disability rating schedule initially provides loss values. For the "next lowest" disability levels for arthrodesis of extremity joints, the assessment recommendations are based on a functionally favorable position although this functionally favorable position is not more precisely defined.In this article the authors have defined these functionally favorable positions based on the information available in the literature. In particular, the operatively favorable settings for arthrodesis of the affected joint that are stated in the literature on trauma and orthopedic surgery were consulted. Of course, the functional perspective has been especially emphasized.A difficulty in achieving this was that the literature on arthrodesis is now almost only of historical value due to modern endoprosthetics. The knowledge gained was checked against medical experience and is expounded here.

摘要

如果事故导致功能障碍持续存在并永久性地限制身体和/或精神能力,这被称为残疾。在私人意外保险中,医学专家的任务是通过检查医学检查结果来评估这种残疾,并结合文献进行评估,与普遍认可的指导值进行比较。优先伤残评定表最初提供损失值。对于四肢关节融合术的“次低”残疾级别,评估建议基于功能上有利的位置,尽管这种功能上有利的位置没有更精确的定义。在本文中,作者根据文献中可用的信息定义了这些功能上有利的位置。特别是,参考了创伤和矫形外科文献中所述的受影响关节融合术的手术有利设置。当然,功能视角得到了特别强调。实现这一点的一个困难在于,由于现代人工关节置换术,关于关节融合术的文献现在几乎只有历史价值。所获得的知识与医学经验进行了核对,并在此进行阐述。

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